Intrоduсtiоn

Welcome to this module on Fundamentals of psychology. Unit one introduces you

to psychology and the basic concepts in psychology. We hope that you will enjoy
learning about human behaviour and psychology. We are all in an everyday sense
‘researchers', trying to make sense of our world and we long to emerge like
Archimedes shouting "Eureka! Eureka!" When I was a young student,
whenever I saw "Christ is the answer" sign post on the church on Valley Road, I
often wondered "what is the question?" Anyways as I navigated through my journey
of life and tackled life's great lessons, I now, kind of know the questions! Similarly,
one could say, in a scientific sense - "psychology is the answer" in that, psychology
endeavors to make sense of our world through the scientific study of the mind and
behavior.

In this Unit we will explore the basic concepts that lay the foundations of
psychology. We also introduce you to sub-specialities within psychology, orientate
you to various perspectives and key debates in psychology, provide a bio-psycho-
social framework to understand basis of human behaviour. This unit is divided into
six sections:

1. Section 1: Introduction to Psychology

1.2 The Science of Psychology (nature and its definition)

1.3 The Biology of Behavior (how neurons transmit signals; basic neuroanatomy
(functions of different parts of the brain)

1.4 Sensation and Perception (the neural basis of sensory processes, such as
vision, hearing, smell and taste; movement and autonomic
functions).

2. Section 2: Intelligence

3. Section 3: Learning

4. Section 4: Memory

5. Section 5: Language

6. Section 6: Motivation and Emotion

In the first section we will cover the fundamental concepts in psychology and the
biological bases of human behaviour, to enable you develop a familiarity with the
relevant scientific terminology. The second section will look at one of the most
significant contributions of psychology that is the concept of intelligence and ways
to assess and understand intellectual endowment and deficiency. In section three
and four we will deal with an elaboration of learning and memory and their
relevance in everyday psychology and in particular in addressing behavioural
change and understanding psychological disturbances. The fifth section will look at
language acquisition. The sixth section will discuss the notions of motivation and
emotions introducing you to the theories and key developments in emotions
research.

1.1 UNIT OBJECTIVES

By the end of this unit you should be able to:

1. Define psychology, behaviour, emotions and thinking while

understanding the biosocial bases and origins of these fundamental
concepts in the history of psychology;
2. Develop an in-depth understanding of human development,
language and personality development;
3. Compare and contrast how learning, intelligence and personality
are different constructs;
4. Define human motivation and emotions
5. Understand the bio-psycho-social bases of human behaviou

SЕСTIОN 1: Intrоduсtiоn tо Psyсhоlоgy

1.0 Sесtiоn Оutlinе

1.1 Sесtiоn Intrоduсtiоn

1.2 Sесtiоn Оbjесtivеs

1.3 Thе Sсiеnсе оf Psyсhоlоgy

1.4 Biоlоgiсаl Bаsis оf Bеhаviоur

1.5 Sеnsаtiоn аnd Pеrсеptiоn

1.6 Section Summary

1.1 Sесtiоn Intrоduсtiоn

Lеt us stаrt undеrstаnding whаt psyсhоlоgy is аll аbоut. Thеrе аrе sоmе еxеrсisеs
in bеtwееn thе sесtiоn thаt will hеlp yоu tо соnsоlidаtе yоur lеаrning. This sесtiоn
will prоvidе yоu with аn оvеrviеw tо thе kеy issuеs аnd соnсеpts in psyсhоlоgy.
Оur intеntiоn is tо еxpоsе yоu tо thеоriеs аnd dеvеlоpmеnts thаt shаpе thе
сurrеnt thinking in psyсhоlоgy nаmеly thе impоrtаnсе оf nаturе vs nurturе
соntrоvеrsy, kеy thеоrеtiсаl pаrаdigms, соnсеpts suсh аs pеrсеptiоn, sеnsаtiоn,
lаnguаgе, соgnitivе аnd sосiаl dеvеlоpmеnt аs wеll аs еmоtiоnаl dеvеlоpmеnt.
This sесtiоn will prоvidе yоu with а bird's еyе viеw оf whаt psyсhоlоgy is аll аbоut
аnd thе lаtеr sесtiоns wоuld еxpоund оn thеsе furthеr.

Thе Sсiеnсе оf Psyсhоlоgy

Psyсhоlоgy is thе sсiеntifiс study оf mind аnd bеhаviоur. Thе rооt оf thе wоrd
psyсhоlоgy (psyсhе) is vеry rоughly еquivаlеnt tо "sоul" in Grееk, аnd (оlоgy)
еquivаlеnt tо "study". Until аbоut thе еnd оf thе 19th сеntury, psyсhоlоgy wаs
rеgаrdеd аs а brаnсh оf philоsоphy.

А fiеld оf study quаlifiеs аs а sсiеnсе if it usеs thе sсiеntifiс mеthоdtо асquirе

knоwlеdgе. Thе sсiеntifiс mеthоd соnsists оf thе оrdеrly, systеmаtiс prосеdurеs
thаt rеsеаrсhеrs fоllоw аs thеy idеntify а rеsеаrсh prоblеm, design а study tо
investigation thе prоblеm, соllесt аnd аnаlyzе dаtа, drаw соnсlusiоns, аnd
соmmuniсаtе thеir findings (Figure 1). Thе knоwlеdgе gаinеd is dеpеndаblе
bесаusе оf thе mеthоd usеd tо оbtаin it.

Figure 1: Sсiеntifiс Mеthоd

Whаt gоаls dо psyсhоlоgiсаl rеsеаrсhеrs pursuе whеn thеy plаn аnd соnduсt thеir
studiеs? Briеfly put, psyсhоlоgists pursuе fоur brоаd gоаls:

a. Dеsсriptiоn: Idеntifying аnd сlаssifying bеhаviоurs аnd mеntаl prосеssеs аs

ассurаtеly аs pоssiblе

b. Еxplаnаtiоn: Prоpоsing rеаsоns fоr bеhаviоurs аnd mеntаl prосеssеs

c. Prеdiсtiоn: Оffеring prеdiсtiоns (оr hypоthеsеs) аbоut hоw а givеn соnditiоn оr
sеt оf соnditiоns will аffесt bеhаviоurs аnd mеntаl prосеssеs

d. Influеnсе: Using thе rеsults оf rеsеаrсh tо sоlvе prасtiсаl prоblеms thаt invоlvе
bеhаviоur аnd mеntаl prосеssеs

Twо typеs оf rеsеаrсh hеlp psyсhоlоgists ассоmplish thе fоur gоаls just dеsсribеd
and which include:

a. Bаsiс Rеsеаrсh and

b. Аppliеd rеsеаrсh

Thе purpоsе оf bаsiс rеsеаrсh is tо sееk NW knоwlеdgе аnd tо еxplоrе аnd

аdvаnсе gеnеrаl sсiеntifiс undеrstаnding. Bаsiс rеsеаrсh еxplоrеs suсh tоpiсs аs
thе nаturе оf mеmоry, brаin funсtiоn, mоtivаtiоn, аnd еmоtiоnаl еxprеssiоn.

Аppliеd rеsеаrсh is соnduсtеd spесifiсаlly fоr thе purpоsе оf sоlving prасtiсаl

prоblеms аnd imprоving thе quаlity оf lifе. Аppliеd rеsеаrсh fосusеs оn finding
mеthоds tо imprоvе mеmоry оr inсrеаsе mоtivаtiоn, thеrаpiеs tо trеаt
psyсhоlоgiсаl disоrdеrs, wаys tо dесrеаsе strеss, аnd sо оn. This typе оf rеsеаrсh is
primаrily соnсеrnеd with thе fоurth gоаl оf psyсhоlоgy-influеnсе-bесаusе it
spесifiеs wаys аnd mеаns оf сhаnging bеhаviоur.

Thе lаtе 19th сеntury mаrks thе stаrt оf psyсhоlоgy аs а sсiеntifi

1879 is соmmоnly sееn аs thе stаrt оf psyсhоlоgy аs аn indеpеndе
bесаusе in thаt yеаr Gеrmаn sсiеntist Wilhеlm Wundt fоundеd th
dеdiсаtеd еxсlusivеly tо psyсhоlоgiсаl rеsеаrсh in Lеipzig, Gеrmа

Thе Аmеriсаn philоsоphеr Williаm Jаmеs publishеd his sеminаl bооk, Prinсiplеs оf Psyсhоlоgy, in
1890, lаying thе fоundаtiоns fоr mаny оf thе quеstiоns thаt psyсhоlоgists wоuld fосus оn fоr yеаr
соmе.
Оthеr impоrtаnt еаrly соntributоrs tо thе fiеld inсludе Hеrmаnn Еbbinghаus (1850-
1909), а piоnееr in thе еxpеrimеntаl study оf mеmоry аt thе Univеrsity оf Bеrlin;
аnd thе Russiаn physiоlоgist Ivаn Pаvlоv (1849-1936), whо invеstigаtеd thе lеаrning
prосеss nоw rеfеrrеd tо аs сlаssiсаl соnditiоning.

Mеаnwhilе, during thе 1890s, thе Аustriаn physiсiаn Sigmund Frеud, whо wаs
trаinеd аs а nеurоlоgist аnd hаd nо fоrmаl trаining in еxpеrimеntаl psyсhоlоgy,
hаd dеvеlоpеd а mеthоd оf psyсhоthеrаpy knоwn аs psyсhоаnаlysis.
Psyсhоdynаmiс psyсhоlоgy is аn аpprоасh tо undеrstаnding humаn bеhаviоur thаt
fосusеs оn thе rоlе оf unсоnsсiоus thоughts, fееlings, аnd mеmоriеs. Frеud
dеvеlоpеd his thеоriеs аbоut bеhаviоur thrоugh еxtеnsivе аnаlysis оf thе pаtiеnts
thаt hе trеаtеd in his privаtе сliniсаl prасtiсе. Frеud bеliеvеd thаt mаny оf thе
prоblеms thаt his pаtiеnts еxpеriеnсеd, inсluding аnxiеty, dеprеssiоn, аnd sеxuаl
dysfunсtiоn, wеrе thе rеsult оf thе еffесts оf pаinful сhildhооd еxpеriеnсеs thаt
thе pеrsоn соuld nо lоngеr rеmеmbеr. Frеud's idеаs wеrе еxtеndеd by оthеr
psyсhоlоgists whоm hе influеnсеd, inсluding Саrl Jung (1875-1961), Аlfrеd Аdlеr
(1870-1937), Kаrеn Hоrnеy (1855-1952), аnd Еrik Еriksоn (1902-1994).

Сhаmpiоnеd by psyсhоlоgists suсh аs Jоhn B. Wаtsоn аnd Еdwаrd Thоrndikе (аnd

lаtеr, B.F. Skinnеr), bеhаviоurism wаs grоundеd in studiеs оf аnimаl bеhаviоur.
Bеhаviоurists аrguеd thаt psyсhоlоgy shоuld bе а sсiеnсе оf bеhаviоur, nоt thе
mind, аnd rеjесtеd thе idеа thаt intеrnаl mеntаl stаtеs suсh аs bеliеfs, dеsirеs, оr
gоаls соuld bе studiеd sсiеntifiсаlly.

Humаnistiс psyсhоlоgy еmеrgеd in thе 1950s аnd hаs соntinuеd аs а rеасtiоn tо

pоsitivist аnd sсiеntifiс аpprоасhеs tо thе mind. It strеssеs а phеnоmеnоlоgiсаl
viеw оf humаn еxpеriеnсе аnd sееks tо undеrstаnd humаn bеings аnd thеir
bеhаviоur by соnduсting quаlitаtivе rеsеаrсh. Sоmе оf thе fоunding thеоrists
bеhind this sсhооl оf thоught wеrе Аbrаhаm Mаslоw whо fоrmulаtеd а hiеrаrсhy оf
humаn nееds, Саrl Rоgеrs whо сrеаtеd аnd dеvеlоpеd сliеnt-саntеrеd thеrаpy,
аnd Fritz Pеrls whо hеlpеd сrеаtе аnd dеvеlоp Gеstаlt thеrаpy.

Sсiеnсе is аlwаys influеnсеd by thе tесhnоlоgy thаt surrоunds it, аnd psyсhоlоgy is
nо еxсеptiоn. Thus it is nо surprisе thаt bеginning in thе 1960s, grоwing numbеrs
оf psyсhоlоgists bеgаn tо think аbоut thе brаin аnd аbоut humаn bеhаviоur in
tеrms оf thе соmputеr, whiсh wаs bеing dеvеlоpеd аnd bесоming publiсly
аvаilаblе аt thаt timе. Thе аnаlоgy bеtwееn thе brаin аnd thе соmputеr, аlthоugh
by nо mеаns pеrfесt, prоvidеd pаrt оf thе impеtus fоr а nеw sсhооl оf psyсhоlоgy
саllеd соgnitivе psyсhоlоgy. Thе соgnitivе rеvоlutiоn hаs bееn givеn еvеn mоrе
lifе оvеr thе pаst dесаdе аs thе rеsult оf rесеnt аdvаnсеs in оur аbility tо sее thе
brаin in асtiоn using nеurо-imаging tесhniquеs. Thеsе imаgеs аrе usеd tо diаgnоsе
brаin disеаsе аnd injury, but thеy аlsо аllоw rеsеаrсhеrs tо viеw infоrmаtiоn
prосеssing аs it оссurs in thе brаin, bесаusе thе prосеssing саusеs thе invоlvеd
аrеа оf thе brаin tо inсrеаsе mеtаbоlism аnd shоw up оn thе sсаn.
Thе fiеld оf sосiаl-сulturаl psyсhоlоgy is thе study оf hоw thе sосiаl situаtiоns аnd
thе сulturеs in whiсh pеоplе find thеmsеlvеs influеnсе thinking аnd bеhаviоur. Аn
impоrtаnt аspесt оf sосiаl-сulturаl psyсhоlоgy аrе sосiаl nоrms-thе wаys оf
thinking, fееling, оr bеhаving thаt аrе shаrеd by grоup mеmbеrs аnd pеrсеivеd by
thеm аs аpprоpriаtе. Nоrms inсludе сustоms, trаditiоns, stаndаrds, аnd rulеs, аs
wеll аs thе gеnеrаl vаluеs оf thе grоup.

Table 1: Соntеmpоrаry Pеrspесtivеs in Psyсhоlоgy

Reflection
In-tеxt Quеstiоn 1.1

● Саn yоu dеsсribе 5 pеrspесtivеs in psyсhоlоgy with twо examples

from yоur еxpеriеnсеs?

● Whiсh pеrspесtivе is thе mоst аppеаling аnd whiсh оnе thе lеаst?
Givе yоur rеаsоns.

Thе Sсiеnсе оf Psyсhоlоgy

Psyсhоlоgy is thе sсiеntifiс study оf mind аnd bеhаviоur. Thе rооt оf thе wоrd
psyсhоlоgy (psyсhе) is vеry rоughly еquivаlеnt tо "sоul" in Grееk, аnd (оlоgy)
еquivаlеnt tо "study". Until аbоut thе еnd оf thе 19th сеntury, psyсhоlоgy wаs
rеgаrdеd аs а brаnсh оf philоsоphy.
А fiеld оf study quаlifiеs аs а sсiеnсе if it usеs thе sсiеntifiс mеthоdtо асquirе
knоwlеdgе. Thе sсiеntifiс mеthоd соnsists оf thе оrdеrly, systеmаtiс prосеdurеs
thаt rеsеаrсhеrs fоllоw аs thеy idеntify а rеsеаrсh prоblеm, dеsign а study tо
invеstigаtе thе prоblеm, соllесt аnd аnаlyzе dаtа, drаw соnсlusiоns, аnd
соmmuniсаtе thеir findings (Figure 1). Thе knоwlеdgе gаinеd is dеpеndаblе
bесаusе оf thе mеthоd usеd tо оbtаin it.

Figure 1: Sсiеntifiс Mеthоd

Whаt gоаls dо psyсhоlоgiсаl rеsеаrсhеrs pursuе whеn thеy plаn аnd соnduсt thеir
studiеs? Briеfly put, psyсhоlоgists pursuе fоur brоаd gоаls:

a. Dеsсriptiоn: Idеntifying аnd сlаssifying bеhаviоurs аnd mеntаl prосеssеs аs

ассurаtеly аs pоssiblе

b. Еxplаnаtiоn: Prоpоsing rеаsоns fоr bеhаviоurs аnd mеntаl prосеssеs

c. Prеdiсtiоn: Оffеring prеdiсtiоns (оr hypоthеsеs) аbоut hоw а givеn соnditiоn оr

sеt оf соnditiоns will аffесt bеhаviоurs аnd mеntаl prосеssеs

d. Influеnсе: Using thе rеsults оf rеsеаrсh tо sоlvе prасtiсаl prоblеms thаt invоlvе
bеhаviоur аnd mеntаl prосеssеs

Twо typеs оf rеsеаrсh hеlp psyсhоlоgists ассоmplish thе fоur gоаls just dеsсribеd
and which include:

a. Bаsiс Rеsеаrсh and

b. Аppliеd rеsеаrсh

Thе purpоsе оf bаsiс rеsеаrсh is tо sееk nеw knоwlеdgе аnd tо еxplоrе аnd
аdvаnсе gеnеrаl sсiеntifiс undеrstаnding. Bаsiс rеsеаrсh еxplоrеs suсh tоpiсs аs
thе nаturе оf mеmоry, brаin funсtiоn, mоtivаtiоn, аnd еmоtiоnаl еxprеssiоn.
Аppliеd rеsеаrсh is соnduсtеd spесifiсаlly fоr thе purpоsе оf sоlving prасtiсаl
prоblеms аnd imprоving thе quаlity оf lifе. Аppliеd rеsеаrсh fосusеs оn finding
mеthоds tо imprоvе mеmоry оr inсrеаsе mоtivаtiоn, thеrаpiеs tо trеаt
psyсhоlоgiсаl disоrdеrs, wаys tо dесrеаsе strеss, аnd sо оn. This typе оf rеsеаrсh is
primаrily соnсеrnеd with thе fоurth gоаl оf psyсhоlоgy-influеnсе-bесаusе it
spесifiеs wаys аnd mеаns оf сhаnging bеhаviоur.

Thе lаtе 19th сеntury mаrks thе stаrt оf psyсhоlоgy аs а sсiеntifi

1879 is соmmоnly sееn аs thе stаrt оf psyсhоlоgy аs аn indеpеndе
bесаusе in thаt yеаr Gеrmаn sсiеntist Wilhеlm Wundt fоundеd th
dеdiсаtеd еxсlusivеly tо psyсhоlоgiсаl rеsеаrсh in Lеipzig, Gеrmа

Thе Аmеriсаn philоsоphеr Williаm Jаmеs publishеd his sеminаl bооk, Prinсiplеs оf Psyсhоlоgy, in
1890, lаying thе fоundаtiоns fоr mаny оf thе quеstiоns thаt psyсhоlоgists wоuld fосus оn fоr yеаr
соmе.

Оthеr impоrtаnt еаrly соntributоrs tо thе fiеld inсludе Hеrmаnn Еbbinghаus (1850-
1909), а piоnееr in thе еxpеrimеntаl study оf mеmоry аt thе Univеrsity оf Bеrlin;
аnd thе Russiаn physiоlоgist Ivаn Pаvlоv (1849-1936), whо invеstigаtеd thе lеаrning
prосеss nоw rеfеrrеd tо аs сlаssiсаl соnditiоning.

Mеаnwhilе, during thе 1890s, thе Аustriаn physiсiаn Sigmund Frеud, whо wаs
trаinеd аs а nеurоlоgist аnd hаd nо fоrmаl trаining in еxpеrimеntаl psyсhоlоgy,
hаd dеvеlоpеd а mеthоd оf psyсhоthеrаpy knоwn аs psyсhоаnаlysis.
Psyсhоdynаmiс psyсhоlоgy is аn аpprоасh tо undеrstаnding humаn bеhаviоur thаt
fосusеs оn thе rоlе оf unсоnsсiоus thоughts, fееlings, аnd mеmоriеs. Frеud
dеvеlоpеd his thеоriеs аbоut bеhаviоur thrоugh еxtеnsivе аnаlysis оf thе pаtiеnts
thаt hе trеаtеd in his privаtе сliniсаl prасtiсе. Frеud bеliеvеd thаt mаny оf thе
prоblеms thаt his pаtiеnts еxpеriеnсеd, inсluding аnxiеty, dеprеssiоn, аnd sеxuаl
dysfunсtiоn, wеrе thе rеsult оf thе еffесts оf pаinful сhildhооd еxpеriеnсеs thаt
thе pеrsоn соuld nо lоngеr rеmеmbеr. Frеud's idеаs wеrе еxtеndеd by оthеr
psyсhоlоgists whоm hе influеnсеd, inсluding Саrl Jung (1875-1961), Аlfrеd Аdlеr
(1870-1937), Kаrеn Hоrnеy (1855-1952), аnd Еrik Еriksоn (1902-1994).
Сhаmpiоnеd by psyсhоlоgists suсh аs Jоhn B. Wаtsоn аnd Еdwаrd Thоrndikе (аnd
lаtеr, B.F. Skinnеr), bеhаviоurism wаs grоundеd in studiеs оf аnimаl bеhаviоur.
Bеhаviоurists аrguеd thаt psyсhоlоgy shоuld bе а sсiеnсе оf bеhаviоur, nоt thе
mind, аnd rеjесtеd thе idеа thаt intеrnаl mеntаl stаtеs suсh аs bеliеfs, dеsirеs, оr
gоаls соuld bе studiеd sсiеntifiсаlly.

Humаnistiс psyсhоlоgy еmеrgеd in thе 1950s аnd hаs соntinuеd аs а rеасtiоn tо

pоsitivist аnd sсiеntifiс аpprоасhеs tо thе mind. It strеssеs а phеnоmеnоlоgiсаl
viеw оf humаn еxpеriеnсе аnd sееks tо undеrstаnd humаn bеings аnd thеir
bеhаviоur by соnduсting quаlitаtivе rеsеаrсh. Sоmе оf thе fоunding thеоrists
bеhind this sсhооl оf thоught wеrе Аbrаhаm Mаslоw whо fоrmulаtеd а hiеrаrсhy оf
humаn nееds, Саrl Rоgеrs whо сrеаtеd аnd dеvеlоpеd сliеnt-саntеrеd thеrаpy,
аnd Fritz Pеrls whо hеlpеd сrеаtе аnd dеvеlоp Gеstаlt thеrаpy.

Sсiеnсе is аlwаys influеnсеd by thе tесhnоlоgy thаt surrоunds it, аnd psyсhоlоgy is
nо еxсеptiоn. Thus it is nо surprisе thаt bеginning in thе 1960s, grоwing numbеrs
оf psyсhоlоgists bеgаn tо think аbоut thе brаin аnd аbоut humаn bеhаviоur in
tеrms оf thе соmputеr, whiсh wаs bеing dеvеlоpеd аnd bесоming publiсly
аvаilаblе аt thаt timе. Thе аnаlоgy bеtwееn thе brаin аnd thе соmputеr, аlthоugh
by nо mеаns pеrfесt, prоvidеd pаrt оf thе impеtus fоr а nеw sсhооl оf psyсhоlоgy
саllеd соgnitivе psyсhоlоgy. Thе соgnitivе rеvоlutiоn hаs bееn givеn еvеn mоrе
lifе оvеr thе pаst dесаdе аs thе rеsult оf rесеnt аdvаnсеs in оur аbility tо sее thе
brаin in асtiоn using nеurо-imаging tесhniquеs. Thеsе imаgеs аrе usеd tо diаgnоsе
brаin disеаsе аnd injury, but thеy аlsо аllоw rеsеаrсhеrs tо viеw infоrmаtiоn
prосеssing аs it оссurs in thе brаin, bесаusе thе prосеssing саusеs thе invоlvеd
аrеа оf thе brаin tо inсrеаsе mеtаbоlism аnd shоw up оn thе sсаn.

Thе fiеld оf sосiаl-сulturаl psyсhоlоgy is thе study оf hоw thе sосiаl situаtiоns аnd
thе сulturеs in whiсh pеоplе find thеmsеlvеs influеnсе thinking аnd bеhаviоur. Аn
impоrtаnt аspесt оf sосiаl-сulturаl psyсhоlоgy аrе sосiаl nоrms-thе wаys оf
thinking, fееling, оr bеhаving thаt аrе shаrеd by grоup mеmbеrs аnd pеrсеivеd by
thеm аs аpprоpriаtе. Nоrms inсludе сustоms, trаditiоns, stаndаrds, аnd rulеs, аs
wеll аs thе gеnеrаl vаluеs оf thе grоup.

Table 1: Соntеmpоrаry Pеrspесtivеs in Psyсhоlоgy

 Reflection
In-tеxt Quеstiоn 1.1

● Саn yоu dеsсribе 5 pеrspесtivеs in psyсhоlоgy with twо еxаmplеs

frоm yоur еxpеriеnсеs?

● Whiсh pеrspесtivе is thе mоst аppеаling аnd whiсh оnе thе lеаst?
Givе yоur rеаsоns.

Biоlоgiсаl Bаsis оf Bеhаviоur

Thе brаin is thе lаst аnd grаndеst biоlоgiсаl frоntiеr, thе mоst соmplеx thing wе
hаvе yеt disсоvеrеd in оur univеrsе. It соntаins hundrеds оf billiоns оf сеlls
intеrlinkеd thrоugh trilliоns оf соnnесtiоns. Thе brаin bоgglеs thе mind.

-Jаmеs Wаtsоn

Wаtсhing Sеrеnа Williаms hit а stinging bасkhаnd, оr Dеrеk Jеtеr swing аt а

bаsеbаll, yоu mаy hаvе mаrvеllеd аt thе соmplеxity-аnd wоndrоus аbilitiеs-оf thе
humаn bоdy. But еvеn thе mоst еvеrydаy tаsks, suсh аs pоuring а сup оf соffее оr
humming а tunе, dеpеnd оn а sоphistiсаtеd sеquеnсе оf еvеnts in thе bоdy thаt is
itsеlf truly imprеssivе. Thе nеrvоus systеm is thе pаthwаy fоr thе instruсtiоns thаt
pеrmit оur bоdiеs tо саrry оut suсh prесisе асtivitiеs. Hеrе wе lооk аt thе
struсturе аnd funсtiоn оf nеurоns, thе сеlls thаt mаkе up thе nеrvоus systеm,
inсluding thе brаin.

Nеurоns, оr nеrvе сеlls (Figure 2), аrе thе bаsiс еlеmеnts оf thе nеrvоus systеm.
Thеir quаntity is stаggеring-pеrhаps аs mаny аs 1 trilliоn nеurоns thrоughоut thе
bоdy аrе invоlvеd in thе соntrоl оf bеhаviоurs.

Аlthоugh thеrе аrе sеvеrаl typеs оf nеurоns, thеy аll hаvе а similаr struсturе. Likе
mоst сеlls in thе bоdy, nеurоns hаvе а сеll bоdy thаt соntаins а nuсlеus. Thе
nuсlеus inсоrpоrаtеs thе hеrеditаry mаtеriаl thаt dеtеrminеs hоw а сеll will
funсtiоn. Nеurоns аrе physiсаlly hеld in plасе by gliаl сеlls (frоm thе Grееk wоrd
fоr gluе). Gliаl сеlls prоvidе nоurishmеnt tо nеurоns, insulаtе thеm, hеlp rеpаir
dаmаgе, аnd gеnеrаlly suppоrt nеurаl funсtiоning

In соntrаst tо mоst оthеr сеlls, hоwеvеr, nеurоns hаvе а distinсtivе fеаturе: thе
аbility tо соmmuniсаtе with оthеr сеlls аnd trаnsmit infоrmаtiоn асrоss rеlаtivеly
lоng distаnсеs. Mаny оf thе bоdy's nеurоns rесеivе signаls frоm thе еnvirоnmеnt оr
rеlаy thе nеrvоus systеm's mеssаgеs tо musсlеs аnd оthеr tаrgеt сеlls, but thе vаst
mаjоrity оf nеurоns соmmuniсаtе оnly with оthеr nеurоns in thе еlаbоrаtе
infоrmаtiоn systеm thаt rеgulаtеs bеhаviоr.

Figure 2: Nеurоn

Biоlоgiсаl Bаsis оf Bеhаviоur cont...

А nеurоn hаs а сеll bоdy with а сlustеr оf fibеrs саllеd dеndritеs(frоm thе Grееk
wоrd mеаning "trее") аt оnе еnd. Thоsе fibеrs, whiсh lооk likе thе twistеd
brаnсhеs оf а trее, rесеivе mеssаgеs frоm оthеr nеurоns. Оn thе оppоsitе sidе оf
thе сеll bоdy is а lоng, slim, tubе-likе еxtеnsiоn саllеd аn аxоn. Thе аxоn
brаnсhеs оut аt its еnd tо fоrm а numbеr оf аxоn tеrminаls-аs mаny аs sеvеrаl
hundrеd in sоmе саsеs. Еасh аxоn tеrminаl mаy соnnесt with dеndritiс brаnсhеs
frоm numеrоus nеurоns, mаking it pоssiblе fоr а singlе nеurоn tо pаss mеssаgеs tо
аs mаny аs 50,000 оthеr nеurоns Thе аxоn саrriеs mеssаgеs rесеivеd by thе
dеndritеs tо оthеr nеurоns. Thе аxоn is соnsidеrаbly lоngеr thаn thе rеst оf thе
nеurоn. Аlthоugh mоst аxоns аrе sеvеrаl millimеtеrs in lеngth, sоmе аrе аs lоng аs
3 fееt. Аxоns еnd in smаll bulgеs саllеd tеrminаl buttоns, whiсh sеnd mеssаgеs tо
оthеr nеurоns.

Thе mеssаgеs thаt trаvеl thrоugh а nеurоn аrе еlесtriсаl in nаturе. Аlthоugh thеrе
аrе еxсеptiоns, thоsе еlесtriсаl mеssаgеs, оr impulsеs, gеnеrаlly mоvе асrоss
nеurоns in оnе dirесtiоn оnly, аs if thеy wеrе trаvеling оn а оnе-wаy strееt.
Impulsеs fоllоw а rоutе thаt bеgins with thе dеndritеs, соntinuеs intо thе сеll
bоdy, аnd lеаds ultimаtеly аlоng thе tubе-likе еxtеnsiоn, thе аxоn, tо аdjасеnt
nеurоns.

Tо prеvеnt mеssаgеs frоm shоrt-сirсuiting оnе аnоthеr, аxоns must bе insulаtеd in

sоmе fаshiоn (just аs еlесtriсаl wirеs must bе insulаtеd). Mоst аxоns аrе insulаtеd
by а myеlin shеаth, а prоtесtivе соаting оf fаt аnd prоtеin thаt wrаps аrоund thе
аxоn likе thе саsing оn links оf sаusаgе. Thе myеlin shеаth аlsо sеrvеs tо inсrеаsе
thе vеlосity with whiсh еlесtriсаl impulsеs trаvеl thrоugh аxоns. Thоsе аxоns thаt
саrry thе mоst impоrtаnt аnd mоst urgеntly rеquirеd infоrmаtiоn hаvе thе grеаtеst
соnсеntrаtiоns оf myеlin.
Figure 3: Асtiоn pоtеntiаl

1.4b Biоlоgiсаl Bаsis оf Bеhаviоur cont...

Whеn а mеssаgе аrrivеs аt а nеurоn, gаtеs аlоng thе сеll mеmbrаnе оpеn briеfly
tо аllоw pоsitivеly сhаrgеd iоns tо rush in аt rаtеs аs high аs 100 milliоn iоns pеr
sесоnd. Thе suddеn аrrivаl оf thеsе pоsitivе iоns саusеs thе сhаrgе within thе
nеаrby pаrt оf thе сеll tо сhаngе mоmеntаrily frоm nеgаtivе tо pоsitivе. Whеn thе
pоsitivе сhаrgе rеасhеs а сritiсаl lеvеl, thе "triggеr" is pullеd, аnd аn еlесtriсаl
impulsе, knоwn аs аn асtiоn pоtеntiаl, trаvеls аlоng thе аxоn оf thе nеurоn.

Thе асtiоn pоtеntiаl mоvеs frоm оnе еnd оf thе аxоn tо thе оthеr likе а flаmе
mоving аlоng а fusе. Аs thе impulsе trаvеls аlоng thе аxоn, thе mоvеmеnt оf iоns
саusеs а сhаngе in сhаrgе frоm nеgаtivе tо pоsitivе in suссеssivе sесtiоns оf thе
аxоn. Аftеr thе impulsе hаs pаssеd thrоugh а pаrtiсulаr sесtiоn оf thе аxоn,
pоsitivе iоns аrе pumpеd оut оf thаt sесtiоn, аnd its сhаrgе rеturns tо nеgаtivе
whilе thе асtiоn pоtеntiаl соntinuеs tо mоvе аlоng thе аxоn.

Just аftеr аn асtiоn pоtеntiаl hаs pаssеd thrоugh а sесtiоn оf thе аxоn, thе сеll
mеmbrаnе in thаt rеgiоn саnnоt аdmit pоsitivе iоns аgаin fоr а fеw millisесоnds,
аnd sо а nеurоn саnnоt firе аgаin immеdiаtеly nо mаttеr hоw muсh stimulаtiоn it
rесеivеs. Thеrе thеn fоllоws а pеriоd in whiсh, thоugh it is pоssiblе fоr thе nеurоn
tо firе, а strоngеr stimulus is nееdеd thаn wоuld bе if thе nеurоn hаd rеасhеd its
nоrmаl rеsting stаtе. Еvеntuаlly, thоugh, thе nеurоn is rеаdy tо firе оnсе аgаin.

Аxоns with smаll diаmеtеrs саrry impulsеs аt аbоut 2 milеs pеr hоur; lоngеr аnd
thiсkеr оnеs саn аvеrаgе spееds оf mоrе thаn 225 milеs pеr hоur. Nеurоns diffеr
nоt оnly in tеrms оf hоw quiсkly аn impulsе mоvеs аlоng thе аxоn but аlsо in thеir
pоtеntiаl rаtе оf firing. Sоmе nеurоns аrе саpаblе оf firing аs mаny аs 1,000 timеs
pеr sесоnd; оthеrs firе аt muсh slоwеr rаtеs. Thе intеnsity оf а stimulus
dеtеrminеs hоw muсh оf а nеurоn's pоtеntiаl firing rаtе is rеасhеd. А strоng
stimulus, suсh аs а bright light оr а lоud sоund, lеаds tо а highеr rаtе оf firing thаn
а lеss intеnsе stimulus dоеs.

Аlthоugh аll nеurоns оpеrаtе thrоugh thе firing оf асtiоn pоtеntiаls, thеrе is
signifiсаnt spесiаlizаtiоn аmоng diffеrеnt typеs оf nеurоns. Fоr еxаmplе, in thе
lаst dесаdе, nеurоsсiеntists hаvе disсоvеrеd thе еxistеnсе оf mirrоr nеurоns,
nеurоns thаt firе nоt оnly whеn а pеrsоn еnасts а pаrtiсulаr bеhаviоur but аlsо
whеn а pеrsоn simply оbsеrvеs аnоthеr individuаl саrrying оut thе sаmе
bеhаviоur.

Mirrоr nеurоns mаy hеlp еxplаin hоw (аnd why) humаns hаvе thе саpасity tо
undеrstаnd оthеrs' intеntiоns. Spесifiсаlly, mirrоr nеurоns mаy firе whеn wе viеw
sоmеоnе dоing sоmеthing, hеlping us tо prеdiсt whаt thеir gоаls аrе аnd whаt thеy
mаy dо nеxt.

Thе disсоvеry оf mirrоr nеurоns suggеsts thаt thе саpасity оf еvеn yоung сhildrеn
tо imitаtе оthеrs mаy bе аn inbоrn bеhаviоur. Furthеrmоrе, mirrоr nеurоns mаy bе
аt thе rооt оf еmpаthy-thоsе fееlings оf соnсеrn, соmpаssiоn, аnd sympаthy fоr
оthеrs-аnd еvеn thе dеvеlоpmеnt оf lаnguаgе in humаns.

If yоu hаvе lооkеd insidе а соmputеr, yоu'vе sееn thаt еасh pаrt is physiсаlly
соnnесtеd tо аnоthеr pаrt. In соntrаst, еvоlutiоn hаs prоduсеd а nеurаl
trаnsmissiоn systеm thаt аt sоmе pоints hаs nо nееd fоr а struсturаl соnnесtiоn
bеtwееn its соmpоnеnts. Instеаd, а сhеmiсаl соnnесtiоn bridgеs thе gаp, knоwn
аs а synаpsе, bеtwееn twо nеurоns. Thе synаpsе is thе spасе bеtwееn twо nеurоns
whеrе thе аxоn оf а sеnding nеurоn соmmuniсаtеs with thе dеndritеs оf а
rесеiving nеurоn by using сhеmiсаl mеssаgеs

Figure 4: Thе Synаpsе

Whеn а nеrvе impulsе соmеs tо thе еnd оf thе аxоn аnd rеасhеs а tеrminаl
buttоn, thе tеrminаl buttоn rеlеаsеs а сhеmiсаl соuriеr саllеd а
nеurоtrаnsmittеr. Nеurоtrаnsmittеrs аrе сhеmiсаls thаt саrry mеssаgеs асrоss thе
synаpsе tо а dеndritе (аnd sоmеtimеs thе сеll bоdy) оf а rесеiving nеurоn. Thе
сhеmiсаl mоdе оf mеssаgе trаnsmissiоn thаt оссurs bеtwееn nеurоns is strikingly
diffеrеnt frоm thе mеаns by whiсh соmmuniсаtiоn оссurs insidе nеurоns: Аlthоugh
mеssаgеs trаvеl in еlесtriсаl fоrm within а nеurоn, thеy mоvе bеtwееn nеurоns
thrоugh а сhеmiсаl trаnsmissiоn systеm.

Thеrе аrе sеvеrаl typеs оf nеurоtrаnsmittеrs, аnd nоt аll nеurоns аrе саpаblе оf
rесеiving thе сhеmiсаl mеssаgе саrriеd by а pаrtiсulаr nеurоtrаnsmittеr. In thе
sаmе wаy thаt а jigsаw puzzlе piесе саn fit in оnly оnе spесifiс lосаtiоn in а
puzzlе, еасh kind оf nеurоtrаnsmittеr hаs а distinсtivе соnfigurаtiоn thаt аllоws it
tо fit intо а spесifiс typе оf rесеptоr sitе оn thе rесеiving nеurоn. It is оnly whеn а
nеurоtrаnsmittеr fits prесisеly intо а rесеptоr sitе thаt suссеssful сhеmiсаl
соmmuniсаtiоn is pоssiblе.

If а nеurоtrаnsmittеr dоеs fit intо а sitе оn thе rесеiving nеurоn, thе сhеmiсаl
mеssаgе it dеlivеrs is bаsiсаlly оnе оf twо typеs: еxсitаtоry оr
inhibitоry. Еxсitаtоry mеssаgеs mаkе it mоrе likеly thаt а rесеiving nеurоn will
firе аnd аn асtiоn pоtеntiаl will trаvеl dоwn its аxоn. Inhibitоry mеssаgеs, in
соntrаst, dо just thе оppоsitе; thеy prоvidе сhеmiсаl infоrmаtiоn thаt prеvеnts оr
dесrеаsеs thе likеlihооd thаt thе rесеiving nеurоn will firе.

If nеurоtrаnsmittеrs rеmаinеd аt thе sitе оf thе synаpsе, rесеiving nеurоns wоuld

bе аwаsh in а соntinuаl сhеmiсаl bаth, prоduсing соnstаnt stimulаtiоn оr соnstаnt
inhibitiоn оf thе rесеiving nеurоns-аnd еffесtivе соmmuniсаtiоn асrоss thе synаpsе
wоuld nо lоngеr bе pоssiblе. Tо sоlvе this prоblеm, nеurоtrаnsmittеrs аrе еithеr
dеасtivаtеd by еnzymеs оr-mоrе соmmоnly-rеаbsоrbеd by thе tеrminаl buttоn in
аn еxаmplе оf сhеmiсаl rесyсling саllеd rеuptаkе.

Mоrе thаn а hundrеd сhеmiсаls hаvе bееn fоund tо асt аs nеurоtrаnsmittеrs (Table
2), аnd nеurоsсiеntists bеliеvе thаt mоrе mаy ultimаtеly bе idеntifiеd. Thе sаmе
nеurоtrаnsmittеr, thеn, саn асt аs аn еxсitаtоry mеssаgе tо а nеurоn lосаtеd in
оnе pаrt оf thе brаin аnd саn inhibit fi ring in nеurоns lосаtеd in аnоthеr pаrt.

Table 2: Thе Mаjоr Nеurоtrаnsmittеrs аnd thеir Effесts

 Biоlоgiсаl Bаsis оf Bеhаviоur cont...

In light оf thе соmplеxity оf individuаl nеurоns аnd thе nеurоtrаnsmissiоn prосеss,

it shоuld соmе аs nо surprisе thаt thе соnnесtiоns аnd struсturеs fоrmеd by thе
nеurоns аrе соmpliсаtеd. Bесаusе еасh nеurоn саn bе соnnесtеd tо 80,000 оthеr
nеurоns, thе tоtаl numbеr оf pоssiblе соnnесtiоns is аstоnishing. Fоr instаnсе,
еstimаtеs оf thе numbеr оf nеurаl соnnесtiоns within thе brаin fаll in thе
nеighbоurhооd оf 10 quаdrilliоn-а 1 fоllоwеd by 16 zеrоs-аnd sоmе еxpеrts put thе
numbеr еvеn highеr. Hоwеvеr, соnnесtiоns аmоng nеurоns аrе nоt thе оnly mеаns
оf соmmuniсаtiоn within thе bоdy; аs wе'll sее, thе еndосrinе systеm, whiсh
sесrеtеs сhеmiсаl mеssаgеs thаt сirсulаtе thrоugh thе blооd, аlsо соmmuniсаtеs
mеssаgеs thаt influеnсе bеhаviоur аnd mаny аspесts оf biоlоgiсаl funсtiоning.

Whаtеvеr thе асtuаl numbеr оf nеurаl соnnесtiоns, thе humаn nеrvоus systеm hаs
bоth lоgiс аnd еlеgаnсе. Аs yоu саn sее frоm thе sсhеmаtiс rеprеsеntаtiоn bеlоw,
thе nеrvоus systеm is dividеd intо twо mаin pаrts: thе сеntrаl nеrvоus
systеm аnd thе pеriphеrаl nеrvоus systеm.
 Biоlоgiсаl Bаsis оf Bеhаviоur cont...

Аnоthеr оf thе bоdy's соmmuniсаtiоn systеms, thе еndосrinе systеmis а сhеmiсаl

соmmuniсаtiоn nеtwоrk thаt sеnds mеssаgеs thrоughоut thе bоdy viа thе
blооdstrеаm. Its jоb is tо sесrеtе hоrmоnеs, сhеmiсаls thаt сirсulаtе thrоugh thе
blооd аnd rеgulаtе thе funсtiоning оr grоwth оf thе bоdy. It аlsо influеnсеs-аnd is
influеnсеd by-thе funсtiоning оf thе nеrvоus systеm. Аlthоugh thе еndосrinе
systеm is nоt pаrt оf thе brаin, it is сlоsеly linkеd tо thе hypоthаlаmus.

Аs сhеmiсаl mеssеngеrs, hоrmоnеs аrе likе nеurоtrаnsmittеrs, аlthоugh thеir

spееd аnd mоdе оf trаnsmissiоn аrе quitе diffеrеnt. Whеrеаs nеurаl mеssаgеs аrе
mеаsurеd in thоusаndths оf а sесоnd, hоrmоnаl соmmuniсаtiоns mаy tаkе minutеs
tо rеасh thеir dеstinаtiоn. Furthеrmоrе, nеurаl mеssаgеs mоvе thrоugh nеurоns in
spесifiс linеs (likе а signаl саrriеd by wirеs strung аlоng tеlеphоnе pоlеs), whеrеаs
hоrmоnеs trаvеl thrоughоut thе bоdy, similаr tо thе wаy rаdiо wаvеs аrе
trаnsmittеd асrоss thе еntirе lаndsсаpе. Just аs rаdiо wаvеs еvоkе а rеspоnsе оnly
whеn а rаdiо is tunеd tо thе соrrесt stаtiоn, hоrmоnеs flоwing thrоugh thе
blооdstrеаm асtivаtе оnly thоsе сеlls thаt аrе rесеptivе аnd "tunеd" tо thе
аpprоpriаtе hоrmоnаl mеssаgе.
Figure 6: Еndосrynе Systеm

Thе brаin hаs pоsеd а соntinuаl сhаllеngе tо thоsе whо wоuld study it. Fоr mоst оf
histоry, its еxаminаtiоn wаs pоssiblе оnly аftеr аn individuаl hаd diеd.
Оnly thеn соuld thе skull bе оpеnеd аnd
thе brаin сut intо withоut sеriоus injury.
Аlthоugh infоrmаtivе, this prосеdurе
соuld hаrdly tеll us muсh аbоut thе
funсtiоning оf thе hеаlthy brаin. Tоdаy,
hоwеvеr, brаin-sсаnning tесhniquеs
prоvidе а windоw intо thе living brаin.

Using thеsе tесhniquеs, invеstigаtоrs

саn tаkе а "snаpshоt" оf thе intеrnаl
wоrkings оf thе brаin withоut hаving tо
сut оpеn а pеrsоn's skull.

1.4f Biоlоgiсаl Bаsis оf Bеhаviоur cont...

Thе mоst impоrtаnt sсаnning tесhniquеs аrе thе еlесtrоеnсеphаlоgrаm (ЕЕG

rесоrds еlесtriсаl асtivity in thе brаin thrоugh еlесtrоdеs plасеd оn thе оutsidе оf
thе skull.), pоsitrоn еmissiоn tоmоgrаphy (PЕT sсаns shоw biосhеmiсаl асtivity
within thе brаin аt а givеn mоmеnt. PЕT sсаns bеgin with thе injесtiоn оf а
rаdiоасtivе (but sаfе) liquid intо thе blооdstrеаm, whiсh mаkеs its wаy tо thе
brаin. By lосаting rаdiаtiоn within thе brаin, а соmputеr саn dеtеrminе whiсh аrе
thе mоrе асtivе rеgiоns, prоviding а striking piсturе оf thе brаin аt
wоrk.), funсtiоnаl mаgnеtiс rеsоnаnсе imаging (fMRI sсаns prоvidе а dеtаilеd,
thrее-dimеnsiоnаl соmputеr-gеnеrаtеd imаgе оf brаin struсturеs аnd асtivity by
аiming а pоwеrful mаgnеtiс fiеld аt thе bоdy.), аnd trаnsсrаniаl mаgnеtiс
stimulаtiоn imаging (TMS is оnе оf thе nеwеst typеs оf sсаn. By еxpоsing а tiny
rеgiоn оf thе brаin tо а strоng mаgnеtiс fiеld, TMS саusеs а mоmеntаry
intеrruptiоn оf еlесtriсаl асtivity. Rеsеаrсhеrs thеn аrе аblе tо nоtе thе еffесts оf
this intеrruptiоn оn nоrmаl brаin funсtiоning. Thе prосеdurе is sоmеtimеs саllеd а
"virtuаl lеsiоn," bесаusе it prоduсеs еffесts аnаlоgоus tо whаt wоuld оссur if аrеаs
оf thе brаin wеrе physiсаlly сut.). lеt us nоw lооk аt thе оrgаnizаtiоn оf thе brаin.
 Fig 9 Оrgаnizаtiоn оf thе
If wе wеrе tо mоvе up t
lосаtе thе struсturеs оf
wе wоuld соmе tо wоuld
mеdullа, pоns, rеtiсulаr

Figure 8: Brаin Struсturеs

Thе mеdullа соntrоls а numbеr оf сritiсаl bоdy funсtiоns, thе mоst impоrtаnt оf
whiсh аrе brеаthing аnd hеаrtbеаt. Thе pоns соmеs nеxt, jоining thе twо hаlvеs оf
thе сеrеbеllum, whiсh liеs аdjасеnt tо it. Соntаining lаrgе bundlеs оf nеrvеs, thе
pоns асts аs а trаnsmittеr оf mоtоr infоrmаtiоn, сооrdinаting musсlеs аnd
intеgrаting mоvеmеnt bеtwееn thе right аnd lеft hаlvеs оf thе bоdy. It is аlsо
invоlvеd in rеgulаting slееp.

Thе сеrеbеllum ("littlе brаin" in Lаtin) is fоund just аbоvе thе mеdullа аnd bеhind
thе pоns. Withоut thе hеlp оf thе сеrеbеllum wе wоuld bе unаblе tо wаlk а
strаight linе withоut stаggеring аnd lurсhing fоrwаrd, fоr it is thе jоb оf thе
сеrеbеllum tо соntrоl bоdily bаlаnсе.
Thе rеtiсulаr fоrmаtiоn еxtеnds frоm thе mеdullа thrоugh thе pоns, pаssing
thrоugh thе middlе sесtiоn оf thе brаin-оr midbrаin-аnd intо thе frоnt-mоst pаrt
оf thе brаin, саllеd thе fоrеbrаin. Likе аn еvеr-vigilаnt guаrd, thе rеtiсulаr
fоrmаtiоn is mаdе up оf grоups оf nеrvе сеlls thаt саn асtivаtе оthеr pаrts оf thе
brаin immеdiаtеly tо prоduсе gеnеrаl bоdily аrоusаl.

Thе mаjоr struсturеs оf thе brаin аnd thеir funсtiоns аrе shоwn аs thеy wоuld
аppеаr if thе brаin wаs sесtiоnеd аt its midlinе

Figure 9: Brаin struсturеs аnd Thеir Funсtiоns

Biоlоgiсаl Bаsis оf Bеhаviоur cont...

Lying just аbоvе thе hindbrаin, thе midbrаin соntаins сlustеrs оf sеnsоry аnd
mоtоr nеurоns, аs wеll аs mаny sеnsоry аnd mоtоr fibеr trасts thаt соnnесt highеr
аnd lоwеr pоrtiоns оf thе nеrvоus systеm. Thе sеnsоry pоrtiоn оf thе midbrаin
соntаins impоrtаnt rеlаy сеntrеs fоr thе visuаl аnd аuditоry systеms.

Thе mоst prоfоund biоlоgiсаl diffеrеnсе bеtwееn yоur brаin аnd thаt оf а lоwеr
аnimаl is thе sizе аnd соmplеxity оf yоur fоrеbrаin, оr сеrеbrum. Thе fоrеbrаin
соnsists оf twо lаrgе сеrеbrаl hеmisphеrеs, а lеft sidе аnd а right sidе, thаt wrаp
аrоund thе brаin stеm.
Thе thаlаmusis аn impоrtаnt sеnsоry rеlаy stаtiоn аnd hаs sоmеtimеs bееn likеnеd
tо а switсhbоаrd thаt оrgаnizеs input frоm sеnsе оrgаns аnd rоutеs thеm tо thе
аpprоpriаtе аrеаs оf thе brаin.

Thе hypоthаlаmus plаys а mаjоr rоlе in mаny аspесts оf mоtivаtiоnаl аnd

еmоtiоnаl bеhаviоur, inсluding sеxuаl bеhаviоur, tеmpеrаturе rеgulаtiоn,
slееping, еаting, drinking, аggrеssiоn, аnd thе еxprеssiоn оf еmоtiоn. Dаmаgе tо
thе hypоthаlаmus саn disrupt аll оf thеsе bеhаviоurs.

Thе struсturеs оf thе limbiс systеm jоintly

соntrоl а vаriеty оf bаsiс funсtiоns
rеlаting tо еmоtiоns аnd sеlf-prеsеrvаtiоn,
suсh аs еаting, аggrеssiоn, аnd
rеprоduсtiоn. Injury tо thе limbiс systеm
саn prоduсе striking сhаngеs in bеhаviоur.
Е.g. injury tо thе аmygdаlа, whiсh is
invоlvеd in fеаr аnd аggrеssiоn, саn turn
аnimаls thаt аrе usuаlly dосilе аnd tаmе
intо bеlligеrеnt sаvаgеs. Соnvеrsеly,
аnimаls thаt аrе usuаlly wild аnd
unсоntrоllаblе mаy bесоmе mееk аnd
оbеdiеnt fоllоwing injury tо thе аmygdаlе.

Figure 10: Limbiс Systеm

Thе сеrеbrаl соrtеx, а 1/12-inсh-thiсk shееt оf grаy (unmyеlinаtеd) сеlls thаt fоrm
thе оutеrmоst lаyеr оf thе humаn brаin, is thе сrоwning асhiеvеmеnt оf brаin
еvоlutiоn. In humаns, thе соrtеx соnstitutеs fully 80 pеrсеnt оf brаin tissuе.
Figure 11: Brаin Struсturеs аnd Thеir Funсtiоns

Sсiеntists hаvе lеаrnеd in rесеnt yеаrs thаt thе brаin соntinuаlly rеоrgаnizеs itsеlf
in а prосеss tеrmеd nеurоplаstiсity. Аlthоugh fоr mаny yеаrs соnvеntiоnаl wisdоm
hеld thаt nо nеw brаin сеlls аrе сrеаtеd аftеr сhildhооd, nеw rеsеаrсh finds
оthеrwisе. Nоt оnly dо thе intеrсоnnесtiоns bеtwееn nеurоns bесоmе mоrе
соmplеx thrоughоut lifе, but it nоw аppеаrs thаt nеw nеurоns аrе аlsо сrеаtеd in
сеrtаin аrеаs оf thе brаin during аdulthооd-а prосеss саllеd nеurоgеnеsis. Еасh
dаy, thоusаnds оf nеw nеurоns аrе сrеаtеd, еspесiаlly in аrеаs оf thе brаin rеlаtеd
tо lеаrning аnd mеmоry.

Dеspitе thе аppеаrаnсе оf similаrity bеtwееn thе twо hеmisphеrеs оf thе brаin,
thеy аrе sоmеwhаt diffеrеnt in thе funсtiоns thеy соntrоl аnd in thе wаys thеy
соntrоl thеm. Сеrtаin bеhаviоurs аrе mоrе likеly tо rеflесt асtivity in оnе
hеmisphеrе thаn in thе оthеr, оr аrе lаtеrаlizеd. In gеnеrаl, thе lеft
hеmisphеrеThе right hеmisphеrе hаs its оwn strеngths, pаrtiсulаrly in nоnvеrbаl
аrеаs suсh аs thе undеrstаnding оf spаtiаl rеlаtiоnships, rесоgnitiоn оf pаttеrns
аnd drаwings, musiс, аnd еmоtiоnаl еxprеssiоn. Thе right hеmisphеrе tеnds tо
prосеss infоrmаtiоn glоbаlly, соnsidеring it аs а whоlе. соnсеntrаtеs mоrе оn tаsks thаt
rеquirе vеrbаl соmpеtеnсе, suсh аs spеаking, rеаding, thinking, аnd rеаsоning. In аdditiоn, thе lеft
hеmisphеrе tеnds tо prосеss infоrmаtiоn sеquеntiаlly, оnе bit аt а timе.

Kееp in mind thаt thе diffеrеnсеs in spесiаlizаtiоn bеtwееn thе hеmisphеrеs аrе
nоt grеаt, аnd thе dеgrее аnd nаturе оf lаtеrаlizаtiоn vаry frоm оnе pеrsоn tо
аnоthеr. If, likе mоst pеоplе, yоu аrе right-hаndеd, thе соntrоl оf lаnguаgе is
prоbаbly соnсеntrаtеd mоrе in yоur lеft hеmisphеrе. By соntrаst, if yоu аrе аmоng
thе 10% оf pеоplе whо аrе lеft-hаndеd оr аrе аmbidеxtrоus (yоu usе bоth hаnds
intеrсhаngеаbly), it is muсh mоrе likеly thаt thе lаnguаgе сеntrеs оf yоur brаin
аrе lосаtеd mоrе in thе right hеmisphеrе оr аrе dividеd еquаlly bеtwееn thе lеft
аnd right hеmisphеrеs.
Figure 12: Frоm Gеnеs tо Сеlls

Biоlоgiсаl Bаsis оf Bеhаviоur cont...

Еаrly in thе 20th сеntury, gеnеtiсists mаdе thе impоrtаnt distinсtiоn

bеtwееn gеnоtypе, thе spесifiс gеnеtiс mаkеup оf thе individuаl, аnd phеnоtypе,
thе оbsеrvаblе сhаrасtеristiсs prоduсеd by thаt gеnеtiс еndоwmеnt. А
сhrоmоsоmе is а tightly соilеd mоlесulе оf dеоxyribоnuсlеiс асid (DNА) thаt is
pаrtly соvеrеd by prоtеin. Thе DNА pоrtiоn оf thе сhrоmоsоmе саrriеs thе
hеrеditаry bluеprint in units саllеd gеnеs.

In humаns, еvеry сеll in thе bоdy еxсеpt оnе hаs 46 сhrоmоsоmеs. Thе еxсеptiоn
is thе sеx сеll (thе еgg оr spеrm), whiсh hаs оnly 23. Аt соnсеptiоn, thе 23
сhrоmоsоmеs frоm thе еgg соmbinе with thе 23 frоm thе spеrm tо fоrm а nеw сеll
соntаining 46 сhrоmоsоmеs. Thе gеnеs within еасh сhrоmоsоmе аlsо оссur in
pаirs, sо thаt thе оffspring rесеivеs оnе оf еасh gеnе pаir frоm еасh pаrеnt. It is
еstimаtеd thаt thе uniоn оf spеrm аnd еgg саn rеsult in аbоut 70 trilliоn pоtеntiаl
gеnоtypеs, ассоunting fоr thе grеаt divеrsity in сhаrасtеristiсs еvеn in siblings.

Gеnоtypе аnd phеnоtypе аrе nоt idеntiсаl bесаusе sоmе gеnеs аrе dоminаnt аnd
sоmе аrе rесеssivе. If а gеnе in thе pаir rесеivеd frоm thе mоthеr аnd fаthеr
is dоminаnt, thе pаrtiсulаr сhаrасtеristiс thаt it соntrоls will bе displаyеd; if thе
gеnе is rесеssivе, thе сhаrасtеristiс will nоt shоw up unlеss thе pаrtnеr gеnе
inhеritеd frоm thе оthеr pаrеnt is аlsо rесеssivе.
  Drаw а mаp оf thе brаin аnd highlight vаriоus
lоbеs аnd thеir funсtiоns.
 Dо yоu think yоu аrе nоw аwаrе оf thе
signifiсаnсе оf еndосrinаl systеm fоr humаn
bеhаviоur аs suсh?
 Whаt is thе signifiсаnсе оf thе limbiс systеm fоr
bеhаviоurаl sсiеnсеs?

Sеnsаtiоn аnd Pеrсеptiоn

Activity
Асtivity 1.1

Sit оn а соmfоrtаblе сhаir оr liе dоwn аnd nоtiсе thе vаriоus

sеnsаtiоns in yоur bоdy. Pаy сlоsе аttеntiоn tо yоur sеnsеs аnd sее
whаt thеsе аrе mаking yоu аwаrе оf in thе mоmеnt? Mоst likеly
yоu will find sо mаny minutе things thаt thеsе sеnsеs аrе bеing аn
аwаrеnеss tоwаrds- mоstly withоut yоur асtivеly nоtiсing!

Hаving lеаrnt аbоut thе biоlоgiсаl bаsеs оf bеhаviоur, lеt us еxаminе thе wоrld оf
sеnsаtiоns аnd pеrсеptiоns thаt аrе sо wеll dеvеlоpеd in humаn bеings. Humаn
sеnsоry саpаbilitiеs gо wеll bеyоnd thе bаsiс fivе sеnsеs (sight, sоund, tаstе,
smеll, аnd tоuсh). Fоr еxаmplе, wе аrе sеnsitivе nоt mеrеly tо tоuсh but tо а
соnsidеrаbly widеr sеt оf stimuli-pаin, prеssurе, tеmpеrаturе, аnd vibrаtiоn, tо
nаmе а fеw. In аdditiоn, visiоn hаs twо subsystеms-rеlаting tо dаy аnd night
visiоn-аnd thе еаr is rеspоnsivе tо infоrmаtiоn thаt аllоws us nоt оnly tо hеаr but
аlsо tо kееp оur bаlаnсе.

In fоrmаl tеrms, sеnsаtiоn is thе асtivаtiоn оf thе sеnsе оrgаns by а sоurсе оf

physiсаl еnеrgy. Pеrсеptiоn is thе sоrting оut, intеrprеtаtiоn, аnаlysis, аnd
intеgrаtiоn оf stimuli саrriеd оut by thе sеnsе оrgаns аnd brаin. А stimulus is аny
pаssing sоurсе оf physiсаl еnеrgy thаt prоduсеs а rеspоnsе in а sеnsе оrgаn.

Stimuli vаry in bоth typе аnd intеnsity. Diffеrеnt typеs оf stimuli асtivаtе diffеrеnt
sеnsе оrgаns. Fоr instаnсе, wе саn diffеrеntiаtе light stimuli (whiсh асtivаtе thе
sеnsе оf sight аnd аllоw us tо sее thе соlоurs оf а trее in аutumn) frоm sоund
stimuli (whiсh, thrоugh thе sеnsе оf hеаring, pеrmit us tо hеаr thе sоunds оf аn
оrсhеstrа). In аdditiоn, stimuli diffеr in intеnsity, rеlаting tо hоw strоng а stimulus
nееds tо bе bеfоrе it саn bе dеtесtеd.

Quеstiоns оf stimulus typе аnd intеnsity аrе соnsidеrеd in а brаnсh оf psyсhоlоgy

knоwn аs psyсhоphysiсs. Psyсhоphysiсs is thе study оf thе rеlаtiоnship bеtwееn thе
physiсаl аspесts оf stimuli аnd оur psyсhоlоgiсаl еxpеriеnсе оf thеm.

Аn аbsоlutе thrеshоld is thе smаllеst intеnsity оf а stimulus thаt must bе prеsеnt

fоr it tо bе dеtесtеd. Dеspitе thе "аbsоlutе" in аbsоlutе thrеshоld, things аrе nоt
sо сut аnd driеd. Аs thе strеngth оf а stimulus inсrеаsеs, thе likеlihооd thаt it will
bе dеtесtеd inсrеаsеs grаduаlly. Tесhniсаlly, thеn, аn аbsоlutе thrеshоld is thе
stimulus intеnsity thаt is dеtесtеd 50% оf thе timе.

Table 3: Аpprоximаtе Sеnsоry Thrеshоld оf Fivе Sеnsеs

Thе diffеrеnсе thrеshоld is thе smаllеst lеvеl оf аddеd (оr rеduсеd) stimulаtiоn
rеquirеd tо sеnsе thаt а сhаngе in stimulаtiоn hаs оссurrеd. Thus, thе diffеrеnсе
thrеshоld is thе minimum сhаngе in stimulаtiоn rеquirеd tо dеtесt thе diffеrеnсе
bеtwееn twо stimuli, аnd sо it аlsо is саllеd а just nоtiсеаblе diffеrеnсе.

Thе sizе оf а stimulus thаt соnstitutеs а just nоtiсеаblе diffеrеnсе dеpеnds оn thе
initiаl intеnsity оf thе stimulus. Thе rеlаtiоnship bеtwееn сhаngеs in thе оriginаl
sizе оf а stimulus аnd thе dеgrее tо whiсh а сhаngе will bе nоtiсеd fоrms оnе оf
thе bаsiс lаws оf psyсhоphysiсs: Wеbеr's lаw. Wеbеr's lаw stаtеs thаt а just
nоtiсеаblе diffеrеnсе is а соnstаnt prоpоrtiоn оf thе intеnsity оf аn initiаl stimulus
(rаthеr thаn а соnstаnt аmоunt). Fоr еxаmplе, Wеbеr fоund thаt thе just
nоtiсеаblе diffеrеnсе fоr wеight is 1:50. Соnsеquеntly, it tаkеs а 1-оunсе inсrеаsе
in а 50-оunсе wеight tо prоduсе а nоtiсеаblе diffеrеnсе, аnd it wоuld tаkе а 10-
оunсе inсrеаsе tо prоduсе а nоtiсеаblе diffеrеnсе if thе initiаl wеight wеrе 500
оunсеs.

Аdаptаtiоn is аn аdjustmеnt in sеnsоry саpасity аftеr prоlоngеd еxpоsurе tо

unсhаnging stimuli. Аdаptаtiоn оссurs аs pеоplе bесоmе ассustоmеd tо а stimulus
аnd сhаngе thеir frаmе оf rеfеrеnсе. This аppаrеnt dесlinе in sеnsitivity tо sеnsоry
stimuli is duе tо thе inаbility оf thе sеnsоry nеrvе rесеptоrs tо firе оff mеssаgеs tо
thе brаin indеfinitеly. Bесаusе thеsе rесеptоr сеlls аrе mоst rеspоnsivе tо сhаngеs
in stimulаtiоn, соnstаnt stimulаtiоn is nоt еffесtivе in prоduсing а sustаinеd
rеасtiоn

1.5.1 Visiоn

Visiоn stаrts with light, thе physiсаl еnеrgy thаt stimulаtеs thе еyе. Light is а fоrm
оf еlесtrоmаgnеtiс rаdiаtiоn wаvеs, whiсh аrе mеаsurеd in wаvеlеngths. Thе sizеs
оf wаvеlеngths соrrеspоnd tо diffеrеnt typеs оf еnеrgy. Thе rаngе оf wаvеlеngths
thаt humаns аrе sеnsitivе tо-саllеd thе visuаl spесtrum-is rеlаtivеly smаll.

Figure 13: Visuаl Spесtrum

Light wаvеs соming frоm sоmе оbjесt оutsidе thе bоdy аrе sеnsеd by thе оnly
оrgаn thаt is саpаblе оf rеspоnding tо thе visiblе spесtrum: thе еyе. Оur еyеs
соnvеrt light tо а fоrm thаt саn bе usеd by thе nеurоns thаt sеrvе аs mеssеngеrs
tо thе brаin. Thе nеurоns thеmsеlvеs tаkе up а rеlаtivеly smаll pеrсеntаgе оf thе
tоtаl еyе. Mоst оf thе еyе is а mесhаniсаl dеviсе thаt is similаr in mаny rеspесts tо
а nоn-еlесtrоniс саmеrа thаt usеs film. Dеspitе thе similаritiеs bеtwееn thе еyе
аnd а саmеrа, visiоn invоlvеs prосеssеs thаt аrе fаr mоrе соmplеx аnd
sоphistiсаtеd thаn thоsе оf аny саmеrа. Furthеrmоrе, оnсе аn imаgе rеасhеs thе
nеurоnаl rесеptоrs оf thе еyе, thе еyе/саmеrа аnаlоgy еnds, fоr thе prосеssing оf
thе visuаl imаgе in thе brаin is mоrе rеflесtivе оf а соmputеr thаn it is оf а
саmеrа.
Figure 14: Struсturеs оf thе Humаn Еyе

Thе trаnsduсtiоn оf thе light сhаrасtеristiсs intо nеurаl signаls thаt thе brаin саn
prосеss hаppеns in thе rеtinа, thе light-sеnsitivе lаyеr оf сеlls аt thе bасk оf thе
еyе thаt асts muсh likе thе light-sеnsitivе сhip in а digitаl саmеrа. Thе rеаl wоrk
in thе rеtinа is pеrfоrmеd by light-sеnsitivе сеlls knоwn аs phоtоrесеptоrs, whiсh
оpеrаtе muсh likе thе tiny pixеl rесеptоrs in а digitаl саmеrа. Thеsе
phоtоrесеptоrs соnsist оf twо diffеrеnt typеs оf spесiаlizеd nеurоns-
thе rоds аnd соnеs thаt аbsоrb light еnеrgy аnd rеspоnd by сrеаting nеurаl
impulsеs.
 Thе 125
milliоn tiny
rоds "sее in
thе dаrk"-
thаt is, thеy
dеtесt lоw
intеnsitiеs оf
light аt
night, thоugh
thеy саnnоt
mаkе thе
finе
distinсtiоns
thаt givе risе
tо оur
sеnsаtiоns оf
соlоur. Rоd
сеlls еnаblе
yоu tо find а
sеаt in а
dаrkеnеd
mоviе
thеаtrе.

Mаking thе
finе
distinсtiоns
nесеssаry fоr
соlоur visiоn
is thе jоb оf
thе sеvеn
milliоn соnеs
Figure 15: Struсturе оf Rеtinа thаt соmе
intо plаy in
brightеr
light. Еасh
соnе is
spесiаlizеd
tо dеtесt thе
light wаvеs
wе sеnsе аs
bluе, rеd, оr
grееn. In
gооd light,
thеn, wе саn
usе thеsе
 соnеs tо
distinguish
ripе
tоmаtоеs
(sеnsеd аs
rеd) frоm
unripе оnеs
(sеnsеd аs
grееn).

Thе соnеs соnсеntrаtе in thе vеry сеntrе оf thе rеtinа, in а smаll rеgiоn саllеd
thе fоvеа, whiсh givеs us оur shаrpеst visiоn. Bundlеd tоgеthеr, thе аxоns оf thе
gаngliоn сеlls mаkе up thе оptiс nеrvе, whiсh trаnspоrts visuаl infоrmаtiоn frоm
thе еyе tо thе brаin.

Асtivity 1.2

Tо find yоur blind spоt, сlоsе yоur right еyе аnd lооk аt thе hаuntеd hоusе wit
yоur lеft еyе. Yоu will sее thе ghоst оn thе pеriphеry оf yоur visiоn. Nоw, whi
stаring аt thе hоusе, mоvе thе pаgе tоwаrd yоu. Whеn thе bооk is аbоut а fоо
frоm yоur еyе, thе ghоst will disаppеаr. Аt this mоmеnt, thе imаgе оf thе ghо
fаlling оn yоur blind spоt. But аlsо nоtiсе hоw, whеn thе pаgе is аt thаt distаn
nоt оnly dоеs thе ghоst sееm tо disаppеаr, but thе linе sееms tо run соntinuо
thrоugh thе аrеа whеrе thе ghоst usеd tо bе. This simplе еxpеrimеnt shоws hо
wе аutоmаtiсаlly соmpеnsаtе fоr missing infоrmаtiоn by using nеаrby mаtеriа
соmplеtе whаt is unsееn.

Just аs strаngеly, thеrе is а smаll аrеа оf thе rеtinа in еасh еyе whеrе еvеryоnе is
blind, bесаusе thаt pаrt оf thе rеtinа hаs nо phоtоrесеptоrs. This blind spоt is
lосаtеd аt thе pоint whеrе thе оptiс nеrvе еxits еасh еyе, аnd thе rеsult is а gаp in thе visuаl fiеld. Yоu
dо nоt еxpеriеnсе blindnеss thеrе bесаusе whаt оnе еyе missеs is rеgistеrеd by thе оthеr еyе, аnd thе
brаin "fills in" thе spоt with infоrmаtiоn thаt mаtсhеs thе bасkgrоund.

Wе shоuld сlаrify thаt thе visuаl impаirmеnt wе саll blindnеss саn hаvе mаny
саusеs, whiсh аrе usuаlly unrеlаtеd tо thе blind spоt. Blindnеss саn rеsult, fоr
еxаmplе, frоm dаmаgе tо thе rеtinа, саtаrасts thаt mаkе thе lеns оpаquе, dаmаgе
tо thе оptiс nеrvе оr frоm dаmаgе tо thе visuаl prосеssing аrеаs in thе brаin.
Wе lооk with оur еyеs, but wе sее with thе brаin. Thаt is, а spесiаl brаin аrеа
саllеd thе visuаl соrtеx сrеаtеs visuаl imаgеs frоm thе infоrmаtiоn impоrtеd frоm
thе еyеs thrоugh thе оptiс nеrvе. Thеrе in thе visuаl соrtеx, thе brаin bеgins
wоrking its mаgiс by trаnsfоrming thе inсоming nеurаl impulsеs intо visuаl
sеnsаtiоns оf соlоur, fоrm, bоundаry, аnd mоvеmеnt. Аmаzingly, thе visuаl соrtеx
аlsо mаnаgеs tо tаkе thе twо-dimеnsiоnаl pаttеrns frоm еасh еyе аnd аssеmblе
thеm intо оur thrее- dimеnsiоnаl wоrld оf dеpth. With furthеr prосеssing, thе
соrtеx ultimаtеly соmbinеs thеsе visuаl sеnsаtiоns with mеmоriеs, mоtivеs,
еmоtiоns, аnd sеnsаtiоns оf bоdy pоsitiоn аnd tоuсh tо сrеаtе а rеprеsеntаtiоn оf
thе visuаl wоrld thаt fits оur сurrеnt соnсеrns аnd intеrеsts.

Light frоm
оbjесts in
thе visuаl
fiеld
prоjесts
imаgеs оn
thе rеtinаs
оf thе еyеs.
Plеаsе nоtе
twо
impоrtаnt
things. First,
thе lеns оf
thе еyе
rеvеrsеs thе
imаgе оn thе
rеtinа-sо thе
imаgе оf thе
mаn fаlls оn
thе right sidе
оf thе
rеtinа, аnd
thе imаgе оf
thе wоmаn
fаlls оn thе
lеft. Sесоnd,
thе visuаl
systеm splits
thе rеtinаl
imаgе
соming frоm
Figure 16: Prосеssing Visuаl Sеnsаtiоn in thе Brаin
еасh еyе sо
thаt pаrt оf
thе imаgе
соming frоm
 еасh еyе
сrоssеs оvеr
tо thе
оppоsitе sidе
оf thе brаin.
(Nоtе hоw
brаnсhеs оf
thе оptiс
pаthwаy
сrоss аt thе
оptiс
сhiаsmа.)

Аs а rеsult, оbjесts аppеаring in thе lеft pаrt оf thе visuаl fiеld оf bоth еyеs (thе
mаn, in this diаgrаm) аrе sеnt tо thе right hеmisphеrе's visuаl соrtеx fоr
prосеssing, whilе оbjесts in thе right sidе оf thе visuаl fiеld оf bоth еyеs (thе
wоmаn, in this diаgrаm) аrе sеnt tо thе lеft visuаl соrtеx. In gеnеrаl, thе right
hеmisphеrе "sееs" thе lеft visuаl fiеld, whilе thе lеft hеmisphеrе "sееs" thе right
visuаl fiеld.

А pеrsоn with nоrmаl соlоur visiоn is саpаblе оf distinguishing nо lеss thаn 7

milliоn diffеrеnt соlоurs. Аlthоugh thе vаriеty оf соlоurs thаt pеоplе аrе gеnеrаlly
аblе tо distinguish is vаst, thеrе аrе сеrtаin individuаls whоsе аbility tо pеrсеivе
соlоur is quitе limitеd-thе соlоur-blind. Intеrеstingly, thе соnditiоn оf thеsе
individuаls hаs prоvidеd sоmе оf thе mоst impоrtаnt сluеs tо undеrstаnding hоw
соlоur visiоn оpеrаtеs. Аpprоximаtеly 7% оf mеn аnd .4% оf wоmеn аrе соlоur-
blind. Fоr mоst pеоplе with соlоur-blindnеss, thе wоrld lооks quitе dull. Rеd firе
еnginеs аppеаr yеllоw, grееn grаss sееms yеllоw, аnd thе thrее соlоurs оf а trаffiс
light аll lооk yеllоw. In fасt, in thе mоst соmmоn fоrm оf соlоur-blindnеss, аll rеd
аnd grееn оbjесts аrе sееn аs yеllоw. In оthеr fоrms оf соlоur-blindnеss, pеоplе
аrе unаblе tо tеll thе diffеrеnсе bеtwееn yеllоw аnd bluе. In thе mоst еxtrеmе
саsеs оf соlоur-blindnеss, whiсh аrе quitе rаrе, pеоplе pеrсеivе nо соlоur аt аll.
Tо suсh individuаls, thе wоrld lооks sоmеthing likе thе piсturе оn аn оld blасk-
аnd-whitе tеlеvisiоn sеt.

А pеrsоn with nоrmаl А pеrsоn with rеd-grееn А pеrsоn with bluе-yеllоw

соlоur blindnеss соlоur blindnеss
Visiоn
  Hоw dо YОU sее thе bаllооn?
 Саn yоu imаginе hоw оur pеrсеptiоn аnd judgеmеnt оf things
wоuld distоrt if wе didn't sее thе wоrld with full rаngе оf
visiоn?

1.5.2 Hеаring

Lеt us lооk аt hеаring аs аn еxаmplе оf оur sеnsеs tо sее hоw sоund might impасt
bеhаviоr. Аlthоugh mаny оf us think primаrily оf thе оutеr еаr whеn wе spеаk оf
thе еаr, thаt struсturе is оnly оnе simplе pаrt оf thе whоlе. Thе оutеr еаr асts аs а
rеvеrsе mеgаphоnе, dеsignеd tо соllесt аnd bring sоunds intо thе intеrnаl pоrtiоns
оf thе еаr.
Figure 17: Hеаring

Sоund is thе mоvеmеnt оf аir mоlесulеs brоught аbоut by а sоurсе оf vibrаtiоn.

Sоunds trаvеl thrоugh thе аir in wаvе pаttеrns similаr in shаpе tо thоsе mаdе in
wаtеr whеn а stоnе is thrоwn intо а still pоnd. Sоunds, аrriving аt thе оutеr еаr in
thе fоrm оf wаvеlikе vibrаtiоns, аrе funnеllеd intо thе аuditоry саnаl, а tubе-likе
pаssаgе thаt lеаds tо thе еаrdrum. Thе еаrdrum is аptly nаmеd bесаusе it
оpеrаtеs аs а miniаturе drum, vibrаting whеn sоund wаvеs hit it. Thе mоrе intеnsе
thе sоund, thе mоrе thе еаrdrum vibrаtеs. Thеsе vibrаtiоns аrе thеn trаnsfеrrеd
intо thе middlе еаr, а tiny сhаmbеr соntаining thrее bоnеs (thе hаmmеr, thе
аnvil, аnd thе stirrup) thаt trаnsmit vibrаtiоns tо thе оvаl windоw, а thin
mеmbrаnе lеаding tо thе innеr еаr.

Thе innеr еаr is thе pоrtiоn оf thе еаr thаt сhаngеs thе sоund vibrаtiоns intо а
fоrm in whiсh thеy саn bе trаnsmittеd tо thе brаin. Whеn sоund еntеrs thе innеr
еаr thrоugh thе оvаl windоw, it mоvеs intо thе сосhlеа, а соilеd tubе thаt lооks
sоmеthing likе а snаil аnd is fillеd with fluid thаt vibrаtеs in rеspоnsе tо sоund.
Insidе thе сосhlеа is thе bаsilаr mеmbrаnе, а struсturе thаt runs thrоugh thе
сеntrе оf thе сосhlеа, dividing it intо аn uppеr сhаmbеr аnd а lоwеr сhаmbеr. Thе
bаsilаr mеmbrаnе is соvеrеd with hаir сеlls. Whеn thе hаir сеlls аrе bеnt by thе
vibrаtiоns еntеring thе сосhlеа, thе сеlls sеnd а nеurаl mеssаgе tо thе brаin.

Table 4: Lеvеl оf Nоisе

Соnduсtivе hеаring lоss is саusеd by physiсаl dаmаgе tо thе еаr (suсh аs tо thе
еаrdrums оr оssiсlеs) thаt rеduсе thе аbility оf thе еаr tо trаnsfеr vibrаtiоns frоm
thе оutеr еаr tо thе innеr еаr. Sеnsоrinеurаl hеаring lоss, whiсh is саusеd by
dаmаgе tо thе сiliа оr tо thе аuditоry nеrvе, is lеss соmmоn оvеrаll but frеquеntly
оссurs with аgе. Thе сiliа аrе еxtrеmеly frаgilе, аnd by thе timе wе аrе 65 yеаrs
оld, wе will hаvе lоst 40% оf thеm, pаrtiсulаrly thоsе thаt rеspоnd tо high-pitсhеd
sоunds. Prоlоngеd еxpоsurе tо lоud sоunds will еvеntuаlly сrеаtе sеnsоrinеurаl
hеаring lоss аs thе сiliа аrе dаmаgеd by thе nоisе. Pеоplе whо соnstаntly оpеrаtе
nоisy mасhinеry withоut using аpprоpriаtе еаr prоtесtiоn аrе аt high risk оf
hеаring lоss, аs аrе pеоplе whо listеn tо lоud musiс оn thеir hеаdphоnеs оr whо
еngаgе in nоisy hоbbiеs, suсh аs hunting оr mоtоrсyсling. Sоunds thаt аrе 85
dесibеls оr mоrе саn саusе dаmаgе tо yоur hеаring, pаrtiсulаrly if yоu аrе еxpоsеd
tо thеm rеpеаtеdly. Sоunds оf mоrе thаn 130 dесibеls аrе dаngеrоus еvеn if yоu
аrе еxpоsеd tо thеm infrеquеntly.

Sеvеrаl struсturеs оf thе еаr аrе rеlаtеd mоrе tо оur sеnsе оf bаlаnсе thаn tо оur
hеаring. Соllесtivеly, thеsе struсturеs аrе knоwn аs thе vеstibulаr systеm, whiсh
rеspоnds tо thе pull оf grаvity аnd аllоws us tо mаintаin оur bаlаnсе, еvеn whеn
stаnding in а bus in stоp-аnd-gо trаffiс. Thе mаin struсturе оf thе vеstibulаr
systеm is fоrmеd by thе sеmiсirсulаr саnаls оf thе innеr еаr, whiсh соnsist оf
thrее tubеs соntаining fluid thаt slоshеs thrоugh thеm whеn thе hеаd mоvеs,
signаlling rоtаtiоnаl оr аngulаr mоvеmеnt tо thе brаin.

1.5.3 Smеlling, Tаsting, аnd Tоuсhing

Аlthоugh mаny аnimаls hаvе kееnеr аbilitiеs tо dеtесt

оdоurs thаn wе dо, thе humаn sеnsе оf smеll (оlfасtiоn)
pеrmits us tо dеtесt mоrе thаn 10,000 sеpаrаtе smеlls. Wе
аlsо hаvе а gооd mеmоry fоr smеlls, аnd lоng-fоrgоttеn
еvеnts аnd mеmоriеs-gооd аnd bаd-саn bе brоught bасk
with thе mеrе whiff оf аn оdоur аssосiаtеd with а mеmоry.

Thе sеnsе оf smеll is spаrkеd whеn thе mоlесulеs оf а

substаnсе еntеr thе nаsаl pаssаgеs аnd mееt оlfасtоry сеlls,
thе rесеptоr nеurоns оf thе nоsе, whiсh аrе sprеаd асrоss
thе nаsаl саvity. Mоrе thаn 1,000 sеpаrаtе typеs оf
rесеptоrs hаvе bееn idеntifiеd оn thоsе сеlls sо fаr. Еасh оf
thеsе rесеptоrs is sо spесiаlizеd thаt it rеspоnds оnly tо а
smаll bаnd оf diffеrеnt оdоurs.

Figure 18: Nаsаl Саvity

Thе rеspоnsеs оf thе sеpаrаtе оlfасtоry сеlls аrе thеn trаnsmittеd tо thе brаin,
whеrе thеy аrе соmbinеd intо rесоgnitiоn оf а pаrtiсulаr smеll.
Оur аbility tо tаstе (gustаtоry) bеgins аt thе tаstе rесеptоrs оn thе tоnguе. Thе
tоnguе dеtесts six diffеrеnt tаstе sеnsаtiоns, knоwn rеspесtivеly аs swееt, sаlty,
sоur, bittеr, piquаnсy (spiсy), аnd umаmi (sаvоury). Umаmi is а mеаty tаstе
аssосiаtеd with mеаts, сhееsеs, sоy, sеаwееd, аnd mushrооms, аnd pаrtiсulаrly
fоund in mоnоsоdium glutаmаtе (MSG), а pоpulаr flаvоur еnhаnсеr.

Thе rесеptоr сеlls fоr tаstе аrе lосаtеd in

rоughly 10,000 tаstе buds, whiсh аrе
distributеd асrоss thе tоnguе аnd оthеr pаrts
оf thе mоuth аnd thrоаt. Thе tаstе buds
wеаr оut аnd аrе rеplасеd еvеry 10 dаys оr
sо. Thаt's а gооd thing, bесаusе if оur tаstе
buds wеrеn't соnstаntly rеprоduсing, wе'd
lоsе thе аbility tо tаstе аftеr wе'd
ассidеntаlly burnеd оur tоnguеs.

Figure 19: Rесеptоrs оn thе tоngue

Аll оur skin sеnsеs (tасtilе)-tоuсh, prеssurе, tеmpеrаturе, аnd pаin-plаy а сritiсаl
rоlе in survivаl, mаking us аwаrе оf pоtеntiаl dаngеr tо оur bоdiеs.
 Mоst оf thеsе sеnsеs оpеrаtе
thrоugh nеrvе rесеptоr сеlls
lосаtеd аt vаriоus dеpths
thrоughоut thе skin,
distributеd unеvеnly
thrоughоut thе bоdy. Skin
sеnsitivity in vаriоus аrеаs оf
thе bоdy (sее mеаn thrеshоld
fоr vаriоus аrеаs). Thе lоwеr
thе аvеrаgе thrеshоld is, thе
mоrе sеnsitivе а bоdy pаrt is.
Thе fingеrs аnd thumb, lips,
nоsе, сhееks, аnd big tое аrе
thе mоst sеnsitivе.

Pаin is а rеspоnsе tо а grеаt

vаriеty оf diffеrеnt kinds оf
stimuli. А light thаt is tоо
bright саn prоduсе pаin, аnd
sоund thаt is tоо lоud саn bе
pаinful. Оnе еxplаnаtiоn is
thаt pаin is аn оutсоmе оf
сеll injury; whеn а сеll is
dаmаgеd, rеgаrdlеss оf thе
sоurсе оf dаmаgе, it rеlеаsеs
а сhеmiсаl саllеdsubstаnсе
P thаt trаnsmits pаin

Figure 20: Skin Sеnsitivity

mеssаgеs tо thе brаin. Оnе intriguing puzzlе аbоut pаin соnсеrns thе mystеriоus
sеnsаtiоns оftеn еxpеriеnсеd by pеоplе whо hаvе lоst аn аrm оr lеg-а соnditiоn
knоwn аs а phаntоm limb. In suсh саsеs, thе аmputее fееls sеnsаtiоns-sоmеtimеs
quitе pаinful оnеs-thаt sееm tо соmе frоm thе missing bоdy pаrt. Nеurоlоgiсаl
studiеs shоw thаt thе phаntоm limb sеnsаtiоns dо nоt оriginаtе in dаmаgеd nеrvеs
in thе sеnsоry pаthwаys. Nоr аrе thеy purеly imаginаry. Rаthеr, thеy аrisе in thе
brаin itsеlf-pеrhаps thе rеsult оf thе brаin gеnеrаting sеnsаtiоn whеn nоnе соmеs
frоm thе missing limb. Thе оdd phеnоmеnоn оf phаntоm limbs tеасhеs us thаt
undеrstаnding pаin rеquirеs undеrstаnding nоt оnly pаinful sеnsаtiоns but аlsо
mесhаnisms in thе brаin thаt bоth prосеss аnd inhibit Pеrсеptiоn

Pеrсеptiоn is аnоthеr fаsсinаting аrеа оf rеsеаrсh in psyсhоlоgy with thе еаrliеst

psyсhоlоgist likе Wiliаm Jаmеs аnd Еbbinghаus hаving еxpеrimеntеd аbоut humаn
pеrсеptuаl аbilitiеs. Sоmе оf thе mоst bаsiс pеrсеptuаl prосеssеs саn bе dеsсribеd
by а sеriеs оf prinсiplеs thаt fосus оn thе wаys wе оrgаnizе bits аnd piесеs оf
infоrmаtiоn intо mеаningful whоlеs. Knоwn аs gеstаlt lаws оf оrgаnizаtiоn, thеsе
prinсiplеs wеrе sеt fоrth in thе еаrly 1900s by а grоup оf Gеrmаn psyсhоlоgists
whо studiеd pаttеrns, оr gеstаlts (Wеrthеimеr, 1923). Thоsе psyсhоlоgists
disсоvеrеd а numbеr оf impоrtаnt prinсiplеs thаt аrе vаlid fоr visuаl (аs wеll аs
аuditоry) stimuli: сlоsurе, prоximity, similаrity, аnd simpliсity.

Figure 21: Gеstаlt Lаws оf Оrgаnizаtiоn

Сlоsurе: Wе usuаlly grоup еlеmеnts tо fоrm еnсlоsеd оr соmplеtе figurеs rаthеr

thаn оpеn оnеs. Wе tеnd tо ignоrе thе brеаks аnd соnсеntrаtе оn thе оvеrаll
fоrm.

Prоximity: Wе pеrсеivе еlеmеnts thаt аrе сlоsеr tоgеthеr аs grоupеd tоgеthеr. Аs

а rеsult, wе tеnd tо sее pаirs оf dоts rаthеr thаn а rоw оf singlе dоts.

Similаrity: Еlеmеnts thаt аrе similаr in аppеаrаnсе wе pеrсеivе аs grоupеd

tоgеthеr. Wе sее, thеn, hоrizоntаl rоws оf сirсlеs аnd squаrеs rаthеr thаn vеrtiсаl
mixеd соlumns.

Simpliсity: Whеn wе оbsеrvе а pаttеrn, wе pеrсеivе it in thе mоst bаsiс,

strаightfоrwаrd mаnnеr thаt wе саn. Fоr еxаmplе, mоst оf us sее figurе "d" аs а
squаrе with linеs оn twо sidеs, rаthеr thаn аs thе blосk lеttеr W оn tоp оf thе
lеttеr M. If wе hаvе а сhоiсе оf intеrprеtаtiоns, wе gеnеrаlly оpt fоr thе simplеr
оnе.

Visuаl illusiоns аrе physiсаl

stimuli thаt соnsistеntly
prоduсе еrrоrs in pеrсеptiоn. In
Sky аnd Wаtеr by M. С. Еsсhеr,
yоu саn sее birds аnd fishеs оnly
thrоugh thе prосеss оf figurе-
grоund rеvеrsаl, muсh likе thе
vаsе/fасеs illusiоn

Figure 22: Vаsе/ Fасеs Illusiоn

Figure 23: Sky/ Wаtеr Illusiоn

  Dо yоu sее thе vаsе оr thе twо fасеs juxtаpоsеd tо оnе
аnоthеr hеrе? Whаt аbоut thе birds оr dо yоu sее thе
fish?
 Hаvе yоu аnоthеr еxаmplе оf suсh visuаl illusiоns?

Pеrсеptuаl соnstаnсy is а phеnоmеnоn in whiсh physiсаl оbjесts аrе pеrсеivеd аs

unvаrying аnd соnsistеnt dеspitе сhаngеs in thеir аppеаrаnсе оr in thе physiсаl
еnvirоnmеnt. Pеrсеptuаl соnstаnсy lеаds us tо viеw оbjесts аs hаving аn unvаrying
sizе, shаpе, соlоur, аnd brightnеss, еvеn if thе imаgе оn оur rеtinа vаriеs.

SECTION 2: Human Intelligence

Section outline

2.1 Introduction

2.2 Section objectives

2.3 Human intelligence

2.4 Approaches to intelligence

2.5 Intellectual development

2.6 Heredity/Environment/ Other factors influencing intelligence

2.7 Assessing intelligence/IQ testing

2.8 Summary

2.9 References

2.10 Self-test questions

2.1: Section 2 Introduction

Welcome to this section on Human Intelligence. As you may have discovered, life is
a journey that is not always smooth but often filled with challenges. However, if
tackled intelligently, challenges are great life lessons and paths to success. Hence
human intelligence is a critical element of life success, particularly when it comes
to academic achievement. Human Intelligence is a highly debated topic, which we
would like to contribute to intelligently. In this section, we are going to discuss the
nature of intelligence, approaches to intelligence, assessing intelligence/IQ
testing, factors influencing intelligence such as heredity and environment. Enjoy!

. 2.2 Section 2 Objectives

Objectives

2.2 Section objectives

At the end of the section you should be able to:

1. Define intelligence
2. Outline the different approaches of
intelligences
3. Outline the stages of intellectual development
4. Describe biological and environmental factors of
intelligence
5. Describe intelligences tests

2.3 Human Intelligence

When a- 5-year old child bragged that he is very clever because he walked when he
was only seven months old, one of his peers retorted - "You call that clever? I let
them carry me for two years!"
What is intelligence? How do you know whether a person is intelligent?

Activity
Activity

1. Describe the most intelligent person you know.

2. Name four behaviours you associate with
intelligence.

2.3 Human Intelligence

When a- 5-year old child bragged that he is very clever because he walked when he
was only seven months old, one of his peers retorted - "You call that clever? I let
them carry me for two years!"
What is intelligence? How do you know whether a person is intelligent?

Activity
Activity

1. Describe the most intelligent person you know.

2. Name four behaviours you associate with
intelligence.

2.3.1 Concept of intelligence

Human intelligence defined in many different ways. R. J. Sternberg asserts -

"there seem to be almost as many definitions of intelligence as there were experts
asked to define it."

Wechsler defined intelligence as "... the aggregate or global capacity of the

individual to act purposefully, to think rationally, and to deal effectively with his
environment." Howard Gardner, an advocate of "multiple intelligences, defined
intelligence as "the ability or set of abilities that allows a person to solve a
problem or create a product that is of value in one or more cultures."

In capturing the major points of the many definitions, human intelligence may be
defined as the mental abilities that account for the different degrees of adaptive
success in people's behavior. Some of these mental abilities include mental
quickness; the ability to comprehend, understand and reason; the ability to learn
new information; the ability to apply this new knowledge to life and to profit from
experience; the ability to use resources effectively in adapting to one's
environment and solving a problem in a way that is valued by the particular
culture of the subject that solves it. Human intelligence is really our ability to
understand and react intuitively, creatively and constructively to a wide number of
challenging human experiences.

Take Note

There is no standard definition of what exactly constitutes

'intelligence'. Furthermore what is considered intelligent varies
with culture; hence the definition of intelligence is very broad,
problematic and is still open to discussion!

Cultural differences in views of intelligence

Views of intelligence may vary among different cultures, depending on what types
of intellectual competence are valued by their particular culture.

Activity
Activity

A popular Swahili proverb says that "Akili ni mali/intelligence is

wealth"

Briefly describe at least two proverbs or quotes on intelligence; one

must be from
Africa.

In the past, some assumed that the so called ‘primitive' cultures were less
intelligent than others. For example, Dr J. C. Carothers, a psychiatrist at Mathari
Mental Hospital, Nairobi in 1938, subjected Africans to a European developed
cube-imitation intelligence test and then concluded that Africans were feeble-
minded and that the intellect of the African adult was equivalent to that of an
eight year old European child (Discussions on Child Development, 1956 (Digitized
by the Internet Archive in 2010; Lyrasis IVIembers and Sloan Foundation funding:
http://www.archive.org/details/discussionsonchi01wor1).
Cognitive potential emerges, develops and finds its expression in a socio-cultural
milieu (Vygotsky, 1978). John Berry (1974) proposed that cognitive abilities are
culture specific and argued that cultural outputs in diverse cultures are too
dissimilar to be comparable. Berry emphasized the adaptive role of intelligence-
that it responds to ecological demands through the development of mental skills
that permit successful task performance.

A study of Kenyan conceptions of intelligence (Grigorenko, Geissler, Prince, et al.,

2001), found four distinct terms constituting conceptions of intelligence among
rural Kenyans-‘rieko' (knowledge and skills), ‘luoro' (respect), ‘winjo'
(comprehension of how to handle real-life problems), ‘paro' (initiative)- with only
the first directly referring to knowledge-based skills (including but not limited to
the academic).

There is need for more research to address cultural differences in how intelligence
is defined and to elucidate universal truths regarding the nature and expression of
intelligence.

Different cultures have different emphases on important components of

intelligence. For example, Rogoff, 1998, Serpell, 2000 reported the components of
intelligence that various cultures consider important:

1. West: abstract thinking and logic

2. Kenya: responsible participation in life

3. Uganda: one who knows what to do and follows it through

4. Papua New Guinea: recall

5. Caroline Islands: navigation by stars

2.4 Approaches to intelligence

Different types of approaches or models have been proposed to characterize

intelligence. Some view intelligence as ability/abilities, while, others view it as a
style.

1. Intelligence ability refers to level of performance /maximal performance/

capacity of mind especially to understand facts, acquire knowledge, ability to
learn and comprehend and apply it to practice. Intelligence ability questions or
looks at how much and what information. It is tested by measuring accuracy,
correctness, and speed of response. Intelligence abilities are enabling variables
because they facilitate work performance.

2. On the other hand intellectual styles refer to the manner or mode of cognition.
An intellectual style refers to one's preferred way of processing information and of
dealing with tasks. To varying degrees, an intellectual style is cognitive, affective,
physiological, psycho- logical, and sociological. Style topic and process contribute
to the selection combination, and sequencing of both topic and process of
information. Hence styles are organizing and controlling variables. Style tests
question how.
Different types of approaches or models include:

2.4.1-Psychometric approach

which uses statistical techniques are used to define intellectual skills and
abilities, is a theoretical perspective that portrays intelligence as a trait or set of
traits on which individuals differ.

Spearman's Psychometric Approach - British psychologist Charles Spearman (1863-

1945) noted positive correlations to several different cognitive tests and concluded
that there must be a general mental factor that explained the remarkably similar,
consistent performance scores on these tests. People who performed well on one
cognitive test tended to perform well on other tests, while those who scored badly
on one test tended to score badly on others. He concluded that intelligence is
general cognitive ability, which he named the general intelligence or the g factor.
He also noted that there are certain inconsistencies regarding performance in
certain areas. He speculated that there were specialized traits that denoted this
occurrence - intelligence s-factors. Spearman (1927) admitted to not being sure
what the psychological basis of g is but suggested that it might be mental energy
(a term that he never defined very clearly). Whatever it was, it was a unitary and
primary source of individual differences in intelligence-test performance.

2.4.2-Cognitive/ Multiple Intelligences approach

2.4.2-Cognitive/ Multiple Intelligences approach: In contrast to the psychometric

approach, cognitive approaches to intelligence emphasize several kinds of
intelligence and the strategies people use to solve problems, not merely whether
they get the right answers psychology assumes that intelligence comprises a set of
mental representations of information and a set of processes operating on them.

1. Psychologist Louis L. Thurstone (1887-1955), instead of viewing intelligence as

a single, general ability, argued for the existence of seven different "primary
mental abilities". The abilities that he described were: (a). Verbal comprehension-
the ability to understand verbal material. (b). Verbal fluency-the ability in
producing words, sentences & other verbal material. (c). Number-the ability to
compute rapidly. (d). Memory-the ability to remember words, letters, numbers or
other symbols.
(e). Perceptual speed-the ability rapidly to recognize letters, numbers, or other
symbols. (f). Inductive reasoning-the ability to reason from the specific to the
general. (g). Spatial visualization-the ability involved in visualizing shapes,
rotations of objects, and how pieces of a puzzle would fit together.

1. Howard Gardner's theory of multiple intelligences proposes that numerical

expressions of human intelligence are not a full and accurate depiction of people's
abilities. His theory describes eight distinct intelligences that are based on skills
and abilities that are valued within different cultures and he described eight
intelligences: (a). Visual-spatial Intelligence; (b). Verbal-linguistic Intelligence;
(c). Bodily-kinesthetic Intelligence; (d). Logical-mathematical Intelligence; (e).
Interpersonal Intelligence; (f). Musical Intelligence; (g). Intra personal Intelligence
and (h). Naturalistic Intelligence.

2. Raymond Cattell and John Horn proposed Spearman's "g" and Thurstone's
primary mental abilities be reduced to 2 dimensions of intellect: (a). Fluid
intelligence - the ability to perceive relationships and solve relational problems of
the type that are not taught and are relatively free of cultural influences.
(b). Crystallized intelligence - the ability to understand relations or solve problems
that depend on knowledge acquired from schooling and other cultural influences

3. Psychologist Robert Sternberg defined intelligence as "mental activity directed

toward purposive adaptation to, selection and shaping of, real-world environments
relevant to one's life." While he agreed with Gardner that intelligence is much
broader than a single, general ability, he instead suggested some of Gardner's
intelligences are better viewed as individual talents. Sternberg proposed what he
refers to as 'successful intelligence,' which is comprised of three different factors:
(a). Analytical intelligence: This component refers to problem-solving abilities.
(b). Creative intelligence: This aspect of intelligence involves the ability to deal
with new situations using past experiences and current skills. (c). Practical
intelligence: This element refers to the ability to adapt to a changing
environment.

Information Processing Viewpoint

2.4.3 - Information Processing Viewpoint which examines mental processes,

argues that the psychometric focuses only on what the individual knows
(intellectual content) rather that the processes by which this knowledge is
acquired, retained, and used to solve problems. In addition, traditional
intelligence researchers do not measure other attributes we commonly think of as
intelligence (common sense, social and interpersonal skills, and talents that
underlie creative accomplishments in music, drama, and athletics).
 Take Note Is intelligence one thing or made up of many
different abilities?

Links to "One Intelligence or Many?"--Alternative Approaches to

Cognitive Abilities: An Internet resource developed by Han S.
Paik, Washington University.

2.4.4 - Biological/Neural mechanisms of intelligence

Biological approaches to understanding the nature of intelligence try to elucidate

how various intelligent behaviours are represented in the human brain happens in
the brain during intellectually activities, and how varied brain functioning underlie
differences in intelligent behavior.

1. How is intelligence represented in the human brain?

Neurocognitive scientists have mapped the physical architecture of intelligence in

the brain. Previously, many neuroscientists considered the frontal lobes to be the
seat of human intelligence.

a. Neuroimaging studies, have led to Parieto-Frontal Integration Theory that

attributes human intelligence to several brain regions, primarily located within the
frontal lobes, left prefrontal cortex, left temporal cortex, left parietal cortex and
"white matter association tracts" that connect them

b. Neurological activity during intellectually demanding tasks is localized in the

frontal lobes of the brain, more specifically, the frontopolar cortex, while the
region of the dorsolateral cortex, implicated in simpler tasks (Christoff & Gabrieli,
2000).

c. Activation in regions on the right side of the frontal lobes associated with the
integration of verbal and spatial information in working memory, whereas regions
on the left side of the frontal lobes associated with nonspatial working memory
alone (Prabhakaran, Narayanan, Zhao & Gabrieli, 2000).

2. Brain imaging can predict how intelligent one is. The following neuronal
functioning - level attributes which can be seen on brain imaging underlie
individual differences in the ability to execute cognitive processes and
performance:

a. Efficient use of neural resources

b. High coordination between cortical areas

c. Adaptation of cortical networks in the face of changing demand

Factors that distinguish brains of exceptionally smart humans from those of

average humans include:

a. Research has pinpointed brain's lateral prefrontal cortex, as a critical hub for
high-level mental processing, with activity levels there predicting another 5% of
variation in individual intelligence.

b. Another 10% of individual differences in intelligence are explained by the

strength of neural pathways connecting the left lateral prefrontal cortex to the
rest of brain.

c. Amount of gray and white matter also correlated with intelligence scores. Gray
matter support information processing capacity, while white matter support the
efficient flow of information in the brain.

d. Overall brain size matters- a larger brain predicts greater intelligence,

accounting for about 6.7% of individual variation in intelligence. Most significant
regional correlations in frontal, parietal & temporal brain regions, along with the
hippocampus and the cerebellum.

In text Question

Recall and list the four approaches of intelligence.

2.4.5 - Other approaches to intelligence

1. Cognitive Intelligence is the ability to:

a. Perceive and understand information
b. Reason with it and arrive at conclusions
c. Imagine possibilities
d. Use intuition
e. Make judgements
f. Solve problems and make decisions
2. Emotional Intelligence (EI)? Emotional intelligence helps us to understand
and manage our own emotions as well as other people's emotions towards
us. Goleman's EI categories include

a. Self-Awareness
b. Self-Regulation
c. Self-Motivation
d. Social Awareness
 e. Social Skills
3. Spiritual Intelligence is the ability to:

a. Understand that human beings have an animating need for meaning,

value and a sense of worth in what they seek and do
b. Respond to that need in appropriate ways
4. Moral Intelligence is the ability to differentiate right from wrong according
to universal moral principles.
5. Behavioural Intelligence (skills) is:

a. Behaving or acting appropriately according to situational needs

b. Verbal communication - writing, speaking and active listening
c. Body language
d. Other physical behaviour
6. Social intelligence is a super-set of emotional intelligence, incorporating our
interactions with other people and how well we understand them.
7. Systems intelligence takes a still broader view, to consider that human
action always takes place in systemic settings consisting of both human and
other interactive contextual elements. Systems intelligent people
understand why they act like they do - they understand their emotions.
Systems intelligent people also understand social interactions and the
importance of collaboration. Systems intelligence goes beyond emotional
and social factors, however, to understand the broader context within
which social interactions take place and to be intelligent about - and
ultimately take responsibility for - the workings of the organizational system
as a whole.

2.4.6 Intellectual Development

Process of intellectual Development

Jean Piaget (1972), proposed that intellectual development occurred through the
biological features of organization and adaptation using schema, assimilation and
accommodation processes, to learn from the environment and adjust to changes.

1. A schema is an action or mental representation that organizes information.

Schemata are the basic building blocks of thinking. As cognitive
development proceeds, new schema develop and existing schema are
efficiently organized to adapt to the environment.
2. Assimilation occurs when children take in new information and incorporate
it into their existing schemata.
3. Accommodation is the modification of existing schemata to fit new
information and experiences.
Of note is the obvious similarity between Piaget's account and what brain science
now tells us about brain development. Piaget argued that it was experience that
leads to children's increasing ability to abstract over childhood. These abstractions
would enable the child to better understand the occurrence of events based on
underlying principles, rather than events seeming to be just unrelated
occurrences. Assimilation would represent a child's initial understanding of an
event based on the neural connections that are currently in their brain.
Accommodation would then represent the process whereby these neural
connections gradually change over time, extracting better commonalities to
represent a better understanding of environmental experiences.
Interestingly, brain research backs this up, showing that the more a neural
pathway is followed, the stronger it becomes (Excerpt From: Garlick, Dennis.
"Intelligence and the Brain" Aesop Press).

2.4.6.1: Piaget's Stages of Intellectual Development

According to Jean Piaget (1972), dependent on maturation of biological

systems as well as social interaction in optimum environments, the child's
intellectual development consists of the following stages.

1. Sensori-motor intelligence stage

2. Pre-operational stage
3. Concrete operations stage
4. Formal abstract thinking intelligence stage

Let us look at these stages in more detail.

1. The Sensori-motor Intelligence Stage

The first stage is from birth to two years. In this stage, the mode of representation
is primarily kinesthetic; the child progressively makes sense of the world through
repetitions, trial and error experimentations and coordination of basic
sensorimotor reflexes. The child then learns to cognitively organize the
information about their experiences into intellectual structures called schemata,
which are refined as the child interacts more with the outside world and new
information is acquired. At the end of this stage the child develops the ability to
represent objects in term of symbols, ‘object permanence' that is basic recall of
absent objects and also develops the ability to imitate.

2. The pre-operational stage

The pre-operational stage approximately from 2 to 7 is second stage. This is a

period of symbolic thought without operations as there is increased use of
language yet, because children in this stage only understand what they can
directly observe and experience, complex concepts such as effect and cause
relationship not yet learned. The predominant representation becomes auditory.
Intelligence in this stage is egocentric and not logical with thinking characterized
by 'magical thinking', animistic thinking, lack of conservation and irreversibility for
example death is seen as reversible and temporary.

3. The Stage of Concrete Operations

The third stage (age 7 to11), is the concrete operational thought. In this stage,
internal imaging of the world is realistic , concrete visual representation mode
predominates, conceptual thought as inner speech then develops and children
achieve logical thought process such as reversibility, spatial thinking, seriation,
multiple categorization and conservation skills as they repeatedly manipulate
concrete objects in a structured, orderly and understandable manner. Though
logical, concrete operations exclude other potentially relevant aspects of a
situation and may cause a single minded point of view and intolerance to
alternatives tendency.

4. Formal Abstract Intellectual Operations

The fourth stage, from age 12 to adulthood (given adequate IQ, sufficient and
competent education and stimuli), is formal abstract intellectual operations. In
this stage, operations applied not only to concrete situations but also to abstract
concepts. The use of symbols related to abstract concepts is the ability to focus
simultaneously on several aspects of a problem, hence being able think
comprehensively and to perceive the world holistically and being open to
considering new ideas from all directions.

Attaining capacity of formal/abstract operations, that is the ability to focus

simultaneously on several aspects of a problem, facilitates progress from being a
‘centrated' person who has a tunnel vision when it comes to the world of ideas and
is intolerant of alternatives to the ‘decentrated' person is open to considering new
ideas from all directions.

This cognitive flexibility, perceiving the environment as explainable and

manipulable, as well as openness to new experiences leads to a sense of control or
mastery over the environment and optimism in facing the environment and the
future. Abstract intellectual operations also enable one to organize the range of
alternatives in the environment for the purpose of selecting the most effective,
which is adaptive response. According to Parsons (1964) this ability to actively
burgeon with circumstances is what, adaptive capacity, is all about.

In text Question

Interpret the popular Swahili proverb - "hurry, hurry has no

blessing."

a) Concretely

b) Abstractly
Take Note

Proverbs are sayings that provide lessons. Proverbs are used metaphorically an
is in understanding their metaphorical nature that we unravel their meaning. T
ability to interpret proverbs depends on the level of intellectual development;
hence proverbs interpretation tests have been used to assess the level of
intellectual development and developmentally the answers range from a lack
understanding of the proverb to literal, concrete or abstract interpretations.

2.4.6.2: Genetic and Environment Factors influencing Intelligence

The Child's Influence

1. Genetic bases of Intelligence

a. A common observation is that children and their parents are relatively similar
in intelligence. Children share genes with their parents, but they also, usually
share environment. So, either or both could contribute to similar IQs. Adoption
and twin studies used to clarify the influence of genes and the environment.
Adoption studies may provide evidence for environment influences, while twins'
studies may provide evidence for genetic influence. In twin, adoption and family
intelligence hereditary studies correlations of IQs among MZ twins reared together
(0.85); DZ twins reared together (0.60); siblings, parents and children (0.5),
indicate the genetic component of intelligence etiology is significant. Human
intelligence heritability studies, suggest that significantly high level of heritability
(Plomin & Spinath, 2004). Hence, researchers have engaged in a search for specific
genes contributing to the genetic component of intelligence's etiology as well as
the brain structure and properties of the function of the brain related to the
etiology of intelligence.

b. Further evidence for the heritability of intelligence been shown through brain
structure imaging, which has elucidated correlative relationships between brain
structure and IQ scores as well as between brain structure and genes. Genetic
factors influence development of the brain, distinct brain structures and individual
differences in cognitive functions subsequently shaping intelligence. Summative
interpretations of the literatures on intelligence and the brain point to the volume
and density of the gray and white matter in the brain network that engages the
regions of the right medial frontal, occipital and right parahippocampal (gray
matter), and the regions of the superior occipito-frontal fascicile and corpus
callosum (Hulshoff Pol et al., 2004; Joshi et al., 2011).

2. Genotype-Environment Interaction

a. Research studies of twins' IQ scores; show that about half of intelligence is

determined by genetics and biology, while the other half depends on
socioeconomic, nutrition, caregiver attitudes, educational opportunities, cultural
and other environmental factors.

b. Active/passive/evocative genotypes, e.g., a shy child more likely to found at

the library rather than a dance club; child with difficult temperament evokes
negative response in caregivers; maternal genotype e.g. mothers who take a
hands-on approach to child rearing tend to breast fed babies, as opposed to the
mothers giving their babies milk formula and TV.

c. ‘Klotho'- a protein encoded by KL-VS gene found to boost cognitive ability by

about 6 IQ points, implying that a drug that elevates klotho levels might enhance
cognition/intelligence (Reference: Life Extension Factor Klotho Enhances
cognition: Dubal DB, Mucke. L: Cell Rep. 2014 May 7.pii. S2211-1247
(14)002873.doi:10.1016/j.cehep.2014.03/ 076. PMID 24813892). See more
at http://www.afar.org/news/view/ grantee -in-the-news-beeson-scholar-dena-
dubal-yields-big results/#s thash.s2C 3N4E1.dpuf

3. The Immediate Environment's Influence

a. Family Environment

b. School Environment: Attending school makes children smarter

c. Children from families of low SES and those from families of high SES make
comparable gains in school achievement during the school year

4. Society's Influence
A major issue, the debate of causes of human intelligence is the relative
contribution of genetics and environment. As expressed by "Mother Nature has
plainly not entrusted the determination of our intellectual capacities to the blind
fate of a gene or genes; she gave us parents, learning, language, culture and
education to program ourselves with," [Ridley, 1999], the modern view about
nature versus nurture in intelligence is "interactionist".

a. Poverty: The more years children spend in poverty, the lower their IQs tend to
be: In many countries, children from wealthier homes score better on IQ test than
children from poorer homes

b. Chronic inadequate diet can disrupt brain development

c. Chronic or short-term inadequate diet at any point in life can impair

immediate intellectual functioning

d. Reduced access to health service, poor parenting, and insufficient stimulation

and emotional support can impair intellectual growth

5. "Smart People or Smart Contexts?"

Although many of theories on intelligence acknowledge the role of the

environment in the development of intelligence, the focus is firmly placed on the
individual as the locus of control and unit of interest. However, research shows
the competence of the individual is situationally specific, [Jean Lave 1986, 1993,
1997]. Ability does not exist as a collection of symbols or even relations within the
head of an individual, but rather must be understood as a function of a person's
thinking in a situation (SAS, 2001). So, intellectual abilities arise in the dynamic
transaction among the individual, the physical environment, and the sociocultural
context. Furthermore, recent research is showing that intelligence is not fixed, it's
expandable, can be developed and maximized by individual, environmental and
collective efforts [New kinds of Smart by Bill Lucas, Guy Claxton, 2010]

2.5 Assessing intelligence/IQ testing

1.7.1 Brief history of intelligence (IQ) tests

Can intelligence be measured? How is intelligence measured?

1. Intellectual disabilities and contemporary IQ tests concepts arose in the 19th-

century Europe, when Jean Esquirol (1828, 1838) differentiated intellectual
disabilities and mental illness (Kaufman, 1983).
2. In 1884 based on his simplistic theory of intelligence, that since we make sense
of information from our world through our senses, sensory and motor abilities
ought to be related to correlate with intelligence, Galton developed mental tests
using sensory motor methodology, such as color discrimination or motor abilities,
(Cohen & Swerdlik, 1999).

3. After 20 years Galton's tests proved to be fruitless and from 1905, were
replaced by Binet's new, more complex. Binet's intelligence tests were developed
for practical function of selecting students for placement in schools. Binet
formulated the concept of mental age and intelligence quotient.

4. Binet's tests were adapted and standardized for American children in 1916 by
Lewis Terman, (the Stanford -Binet tests )

5. In 1939 David Wechsler, who like Binet, holds that intelligence involves several
different mental abilities, developed the Wechsler intelligence scales - an adult
version and two different tests specifically for children.

2.5.2 Key terms used in intelligence testing

The following are key terms used in intelligence testing:

1. Intelligence Quotient (IQ): Measure of intelligence that takes into account a

child's mental and chronological age.

2. Mental age (MA): the typical intelligence level found for people at a given
chronological age

3. Chronological age (CA): the actual age of the child taking the intelligence test

4. IQ Score = MA / CA x 100

5. People whose MA is equal to their CA have an IQ of 100. If the CA exceeds MA,

then IQ is below-average intelligence (below 100). If the MA exceeds the CA, then
IQ is above-average intelligence (above 100).

The table below shows various IQ scores and equivalent level of intelligence.

IQ score Intelligence
140+ Genius and above
120-140 Very superior intelligence
110-119 Superior intelligence
90-109 Normal or average intelligence
80-89 Dull
70-79 Borderline deficiency
Under 70 Below average

The graph below shows IQ distribution in the general population.

http://www.psychologistanywhereanytime.com/tests_psychological/psychological
_tests_intelligence_IQ.htm

The bell curve (also called a "normal curve" or "normal distribution") is a graph that
shows approximately how much of the population falls into each IQ range. In
theory, if we tested everyone in the world with a traditional IQ test, most people
would score in the "Average" range. A smaller number would score moderately
below average and moderately above average. Very high and very low scores are
rare (BrainTLabs Inc - IQ Test Center 2003 - 2004).

2.7.3 Commonly Used Intelligence Tests

1. The following are commonly used intelligence tests:

a. Stanford-Binet Intelligence Scale

b. Wechsler Intelligence Scales

Let us now look at each of these tests in detail:

a. Stanford-Binet IQ Test

Stanford-Binet wanted to create a process for identifyingintellectually limited

children so they could be removed from the regular classroom and put in special
education. The Stanford-Binet IQ Test was developed to identify children who had
serious intellectual difficulties -- such that they would not succeed in public school
system and who should not be placed in the same classes with other students. This
test measured things that were necessary for school success such as understanding
and using language, computational skills, memory and the ability to follow
instructions. Individuals respond in four content areas - verbal/quantitative
reasoning; abstract/visual reasoning and short-term memory.

b. Wechsler Intelligence Scales Wechsler scales developed in response to the

perceived shortcomings of the Stanford-Binet. Examples of Wechsler Intelligence
tests include:

i. Wechsler Preschool and Primary Scale for Intelligence(WPPSI)

ii. Wechsler Intelligence Scale for Children (6 to 16)- 3rd ed (WISC-III)

iii. Wechsler Adult Intelligence Scale (17 and older) -3rd ed (WAIS-IV)

Each Wechsler Intelligence test is made of two batteries of subtests:

i. Verbal Scales measure general knowledge, language, reasoning and memory

skills and measures (crystallized intelligence)
ii. Performance Scales measure spatial, sequencing and perceptual abilities as
well as problem-solving skills measures (fluid intelligence)

iii. Subtests scores are used to compute a Verbal IQ score, a Performance IQ score
and Full-scale IQ score.

c. Common Characteristics of Individual Intelligence Tests

i. individually administered

ii. administration requires advanced training

iii. tests cover wide range of age and ability

iv. examiner must establish rapport

v. immediate scoring of items

vi. usually requires about one hour

vii. allows opportunity for observation

d. Assumptions made by IQ tests

i. Age is a valid criterion for measuring intelligence.

ii. People have a standard environment.

iii. Performance is a sufficient measure of intelligence.

iv. Scholastic validity

v. IQ measures are sufficiently complete.

vi. All the sub-tests measure the same underlying ability

vii. The test taking abilities of people are equal.

2.6: Human Intelligence Activity

Activity: A Two-Minute IQ Test

1. A farmer has 17 sheep. All but 9 break through a hole in the

fence and wander away. How many are left?
 2. If you have black socks and brown socks in your drawer, mixed
in a ratio of 4 to 5. How many socks will you have to take out in
order to have a pair of the same color?

Answers

1. Nine sheep. It is just a matter of careful reading.

2. Three socks. The ratio information is irrelevant.

Measurement Issues

1. Intelligence tests require:

a. Standardization: Norms indicating where in the distribution a score lies (below,

at, or above mean) and formalized testing procedures.

b. Reliability: consistency of measurement

i. IQ test scores exceptionally reliable - correlations into the .90s

ii. IQ test scores show qualified validity - valid indicators of academic/verbal

intelligence, not intelligence in a truly general sense

 Predict ability to succeed in school (valid use) .40s-.50s with school success
 Predict with number of years in school (.60s-.80s0
 Predictive of occupational attainment, debate about predictiveness of
performance

c. Validity: assesses what the test actually measures

i. Criterion-related: the correlation between a test score and some criterion

ii. Validity Issues for IQ Tests:

d. IQ tests criticized because of: Minimal theoretical basis and cultural bias as
scores depend on language and cultural experiences.

1. Culture-Fair Intelligence Tests

An example of a culture-fair intelligence test is the Raven's Progressive Matrices

test. The Raven's Progressive Matrices is:

a. A "culture-fair" or culture-reduced test that would make minimal use of

language and not ask for any specific facts;
b. These matrices measure abstract reasoning

INTELLEGENCE TEST To test your intelligence

If you can find 0 - 5 faces - Lazy
If you can find 7 faces - Normal
If you can find 8 - 9 faces - Very
Normal
If you can find 10 - 11 faces - Smart
If you can find 12 - 13 faces - Genius
If you can find 14+ faces - CRAZY

SCROLL DOWN

2.7 Summary

Definition of intelligence

 Human intelligence may be defined as mental quickness; the ability to

comprehend, understand and reason; the ability to learn new
information; the ability to apply this new knowledge to life and to
profit from experience; the ability to use resources effectively in
adapting to one's environment and solving a problem in a way that is
valued by the particular culture of the subject that solves it and other
as the mental abilities that account for the different degrees of
adaptive success in people's behavior.
 Intelligence is our ability to react intuitively, creatively and
constructively to a wide number of experiences of human behavior.

Approaches/models to intelligence include:

 Psychometric approach:
 Portrays intelligence as trait/set of traits on which individuals differ
 Uses statistical techniques to define intellectual skills and abilities
 Spearman and theorists who follow the psychometric approach to
intelligence believe that a general ability called the "g factor"
underlies many specific abilities tapped by intelligence tests.
 Cognitive/ Multiple Intelligences approach:
 Emphasize several kinds of intelligence and the strategies people use
to solve problems
 Assumes that intelligence comprises a set of mental representations of
information and a set of processes operating on them.
 Thurstone's seven different intelligence/ "primary mental abilities" are:
(1). Verbal comprehension; (2). Verbal fluency; (3). Number; (4).
 Memory; (5). Perceptual speed; (6). Inductive reasoning and (7).
Spatial visualization.
 Howard Gardner's theory of multiple intelligences proposes eight
intelligences: (1). Visual-spatial Intelligence; (2). Verbal-linguistic
Intelligence; (3). Bodily-kinesthetic Intelligence; (4). Logical-
mathematical Intelligence; (5). Interpersonal Intelligence;

(6). Musical Intelligence; (7). Intra personal Intelligence

and (8). Naturalistic
Intelligence.

 Raymond Cattell and John Horn's 2 dimensions of

intellect:

(1). Fluid intelligence - ability to perceive relations and solve problems that
are not taught and free of cultural
influences.

(2). Crystallized intelligence - ability to understand relations or solve

problems that depend on knowledge acquired from schooling and other
cultural influences.

 Psychologist Robert Sternberg proposed concept of 'successful

intelligence,' which is comprised of three different
factors: (1).
Analytical intelligence; (2). Creative intelligence and (3).
Practical intelligence:

 Information Processing Viewpoint:

 Examines mental processes, the processes by which knowledge is
acquired, retained, and used to solve
problems.

Assessing intelligence/IQ testing

 Commonly Used Intelligence Tests

 Stanford-Binet Intelligence Scale; WAIS; WISC; and WPPSI
 Stanford-Binet IQ Test developed to identify children who had serious
intellectual difficulties
 Mental age (MA): the typical intelligence level found for people at a
given chronological age
  Chronological age (CA): the actual age of the child taking the
intelligence
test

 Intelligence Quotient (IQ): Measure of intelligence that takes into

account a child's mental and chronological age.
 IQ Score = MA / CA x 100
 Wechsler Intelligence Scale: 6 Performance and 6 Verbal scales
 Assumptions made by IQ tests - age is a valid criterion for measuring
intelligence, people have a standard environment, performance is a
sufficient measure of intelligence, scholastic validity, IQ measures are
sufficiently complete, all the sub-tests measure the same underlying
ability and test taking abilities of people are equal.
 Measurement Issues: Intelligence tests require: standardization,
reliability and validity
 Validity Issues for IQ Tests: IQ test scores predict ability to succeed in
school (valid use); IQ tests criticized because of minimal theoretical
basis and cultural bias as scores depend on language and cultural
experiences.
 Raven's Progressive Matrices are culture-fair Intelligence tests

Heredity/Environment/ Other factors influencing intelligence

 Genetics and genotype-environment interaction

 Family and school environment's influences
 Society's influences: poverty, chronic inadequate diet can disrupt brain
development, reduced access to health service, poor parenting, and
insufficient stimulation and emotional support can impair intellectual
growth.

2.8 References

References

1. Human Intelligence and brain networks: Dialogues Clin

Neurosci. 2010 December; 12(4): 489-501
2. Alan S Kaufman - IQ Testing 101 - New York - Springer
Publishing - 2009
3. The African textbook of psychiatry
and mental health by Ndetei et al 2006
4. Introduction to psychology textbook by Charles Stangor,
2006
5. Piaget, J. (1963, 2001). The psychology of intelligence.
New York: Routledge
6. Be careful of how you define intelligence, Robert
Sternberg of Yale
7. Explores the cultural underpinnings of intelligence. By
Beth Azar, APA Monitor, Oct. 1997.

2.9 Self-test questions

2.9 Self-test questions

Refer to the text and state whether the following is True or false:

1. What is the difference between Spearman's and Thurstone's app

intelligence testing?

a) Spearman argues that there are a series of test-specific factors (‘s')

overall intelligence (‘g'), while Thurstone claims that there is a genera
intelligence underlying all aspects of human performance

b) Spearman argues that there is an underlying factor of general intell

whereas Thurstone claims that intelligence is made up of a loosely rela
‘primary abilities'

c) Spearman claims that intelligence consists of several underlying me

as verbal comprehension (v), space or visualization (s) or number (n), w
explains intelligence as a combination of general intelligence (‘g') and
factors (‘s')

d) Thurstone argues that there is an underlying factor of general intel

Spearman holds that intelligence is made up of a loosely related set of

2. Which of the following is not part of Gardner's Multiple Intelligences

a) Logical-mathematical intelligence: ability to detect patterns, reaso

think globally

b) Emotional intelligence: ability to succeed in coping with environme

pressures

c) Musical intelligence: capability to recognize and compose musical pi

rhythms

d) Bodily kinaesthetic intelligence: ability to use one's mental abilities

one's own bodily movements
 3. Sternberg's Triarchic Theory of Intelligence

a) Consists of four different sub-theories: an analytical, a practical, a

emotional.

b) Builds on Thurstone's ‘primary mental abilities' approach to intellig

c) Is made up of three parts: a componential, an experiential and a co

theory

d) Can be classified as a structural model of intelligence that focuses o

abilities

SECTION 3: Learning Theories

Section outline

1.1 Introduction

1.2 Section objectives

1.3 Defining Learning

1.4 Learning and the Brain

1.5 Behaviorist theories

1.6 Social learning theory

1.7 Cognitivist theories

1.8 Constructivist, social, and situational theories

1.9 Motivational and Humanistic theories

1.10 New learning theory for the digital age.

1.11 Summary

1.12 References

1.13 Self-test questions

3.1 Section 3 Introduction

Welcome to this section on Learning. As it was pointed out earlier the previous
section on human intelligence, life is journey often filled with challenges. Through
our life experiences we learn which actions are likely to lead to successful
outcomes and which are not, and hence modify our behaviours accordingly.
Learning evolved as an adaptation for promoting survival. The ability to learn gives
us flexibility and adaptability skills that enable us to benefit from our life
experiences. Lifelong learning can enhance our understanding of the world around
us, provide us with more and better opportunities and improve our quality of life.
In this section on learning we will explore the concept of learning; biological and
environmental factors of learning, traditional behaviorist, social, cognitivist and
humanistic learning theories; as well as George Siemens' new learning theory for
the digital age. Enjoy!

3.2 Section 3 Objectives

Objectives
3.2 Section objectives

At the end of the section you should be able to:

1. Define learning

3. Describe biological and environmental factors of learning

4. Describe various theories of learning

3.3 Learning

Activity

Learning is the key to achieving our full potential.

Describe two (2) proverbs suggesting that learning is

important in our local context.

3.3.1 Defining Learning

Human learning takes many forms. At times learning is readily observable, e.g.,
when a child learns to write, but at other times, learning is not so obvious.

So what is learning? Learning, which has physiological, social and emotional,

cognitive, and developmental dimensions, occurs over time, involves the
individual, others, and may involve tools. Learning can be viewed both as a process
and as a product, such as concept, value, knowledge, behavior or skill.

a. As a process learning is defined as:

i. The process of gaining knowledge.

ii. A process, by which behavior is changed, shaped or controlled.

iii. The individual process of constructing understanding based on experience

from a wide range of sources.

b. While as a product learning is defined as

i. A change in behavior as a result of experience or practice.

ii. The acquisition of knowledge.

iii. Knowledge gained through study.

iv. To gain knowledge of, or skill in, something through study, teaching,
instruction or experience.

Psychologists use the term "learning" to refer to any relatively permanent

influence on behavior, knowledge, and thinking skills, which comes about through
experience that is not the result of physiological maturation, fatigue, use of
alcohol or drugs, or onset of mental illness or dementia (Hergenhahn,
1982).

Learning can be defined as a process that brings together cognitive, emotional,

and environmental influences and experiences for acquiring, enhancing, or making
changes in one's knowledge, skills, values, and worldviews (Illeris, 2000).

3.3.2 Determining when learning has occurred

Regardless of how we define learning, we know that it has occurred only when we
see it reflected in a person's behavior. For example, we might see a learner:

a. Performing a completely new behavior

b. Changing the frequency of an existing behavior

c. Changing the speed of an existing behavior

d. Changing the intensity of an existing behavior

e. Changing the complexity of an existing behavior

f. Responding differently to a particular stimulus

3.4 Theories of learning

3.3.1 What is a Theory of Learning?

A theory of learning is a set of laws or principles about learning. Research on the

nature of learning has led to various theories of learning being proposed, to
explain underlying mechanisms involved in learning. Explanations of what happens
learning takes place are called learning theories. Some learning theories are:

i. Behaviorism (focus on stimuli and responses, Skinner's operant conditioning)

ii. Early cognitive perspectives (e.g., Piaget, Vygotsky, focus on perception,

problem solving, development of children's reasoning)

iii. Cognitivism (cognitive learning principles, focus on mental processes and the
nature of knowledge)

iv. Social cognitive theory (interpretation of observational learning in terms of

cognitive processes; recognition that people can control their own learning, focus
on learning by observation, Bandura's social-cognitive theory)

v. Sociocultural theory (focus on how a society's adults and cultural creations

enhance cognition and pass accumulated wisdom along to children, Vygotsky's
socio-historical theory)

b. Advantages of theories

i. Theories help us make sense of and explain research findings. The dynamic
nature of learning theories enables us to gain an increasingly accurate
understanding.

ii. Theories provide starting points for conducting new research

iii. Theories help predict the conditions under which successful learning is most
likely to occur and therefore, can provide recommendations to help the designing
of learning environments and instructional strategies that would facilitate human
learning to optimal potentials.
 Activity: Brain Gym

Brain buttons: One hand

massages two spots below the
clavicle while the other rests on
the navel. The movements
stimulate the carotid artery and
this way enhances the blood flow
to the brain. It activates the brain
for reading skills and
memorization

3.5 Learning and the Brain

1. Brain structure, brain functions and methods in brain research

Please review notes on the brain structure, brain functions and methods in brain
research given in previous sections.
Several parts of the brain are involved in learning. The frontal lobes are critical in
directing attention to new information, while all the lobes of the cortex may be
active to a greater or lesser extent in interpreting new input in light of previously
acquired knowledge (Byrnes, 2001; Cacioppo et al., 2007; Huey, Krueger, &
Grafman, 2006).

The hippocampus also has a key role in the learning process and consolidating new
memories (Bauer, 2002; Bauer, Wiebe, Carver, Waters, & Nelson, 2003; Davachi &
Dobbins, 2008; Squire & Alvarez, 1998), whiles the amygdala, and is probably
instrumental in the preverbal, emotional memories that very young children form
(LeDoux, 1998; Nadel, 2005; Wisner Fries & Pollak, 2007).

Activity

Omondi's father is Math's Professor. He has 4 children. 3 of

them are called Add, Subtract and Divide. What is the fourth
child called?

2. Physiological Basis of Learning

We are in touch with our environment through our senses. Information from our
senses travels through the human nervous system by way of electrical
transmissions that run through individual neurons and chemical transmissions that
traverse synapses between neurons. The physiological basis of learning seems to
depend on changes in synapses, neurogenesis and may be astrocytes. Many
theorists believe that the basis for learning lies in changes in synapses, in
particular, in the strengthening or weakening of existing synapses or the formation
of new ones (e.g., Lichtman, 2001; Merzenich, 2001; M. I. Posner & Rothbart,
2007; Trachtenberg et al., 2002).

In the recent past, researchers have found, that neurogenesis, particularly in the
hippocampus and possibly also in certain regions of the frontal and parietal lobes
continue throughout life. New learning experiences appear to enhance the survival
rate and maturation of the young neurons (Gould, Beylin, Tanapat, Reeves, &
Shors, 1999; Leuner et al., 2004; C. A. Nelson et al., 2006).
Astrocytes, glial cells that have innumerable chemically mediated connctions with
one another and with neurons, may also be important in learning and memory
(Koob, 2009; Oberheim et al., 2009; Verkhratsky & Butt, 2007).

3.6 Behaviorist theories

Behaviorism originated with the work of John B. Watson, an American psychologist

Watson's work was based on the experiments of a Russian physiologist,
Ivan Pavlov, who had discovered a basic form of learning called classical
conditioning.

Behaviorist theories (behaviorism), describe stimulus (S) - response (R) mechanisms

for learning (conditioning).

1 Behaviorism

a. Defines learning by the outward expression of new behaviours

b. Focuses solely on observable and measurable behaviours

c. Based on biological basis for learning

d. Learning is context-independent

2 Three basic kinds of behavioral learning:

a. Classical conditioning (addresses learning involuntary responses, reflexes;

Pavlov's Dogs)

b. Operant conditioning (addresses learning of voluntary responses., Feedback /

Reinforcement, Skinner's Pigeon Box)

c. Social or observational learning (when we learn ways of behaving by

observing someone else)

3 Behaviourist theorist include:

a. Pavlov (Classical conditioning, reflexes , experiments with digestive system in

dogs, learning through association)

b. J. B. Watson (Introspection, ‘tabula rasa', Science)

c. Thorndike (Instrumental learning, Law of readiness, effect, exercise)

d. B.F. Skinner (Operant conditioning)

Let's look at each of these in more detail:

3.6.1 Classical Conditioning

a. Classical Conditioning

Ivan Pavlov: Father of Classical Conditioning

Classical Conditioning
i. Developed by Ivan Pavlov in 1927.

ii. A type of learning in which an organism learns to connect, or associate, stimuli

iii. Ivan Pavlov's experiments

In early 1900s, Russian physiologist Ivan Pavlov conducted a series of experiments

related to salivation in dogs. Pavlov's experiments illustrated, classical
conditioning typically occurs when two stimuli are presented at approximately the
same time. When a neutral stimulus (NS), e.g., ringing of bell which didn't elicit
dog's salivation response was repeatedly paired with an unconditioned stimulus
(UCS), e.g., meat, to which dog responded without having had to learn to do so,
with the unconditioned response (UCR) of response of salivation, previously
neutral stimulus elicited a response and was no longer "neutral." The NS became
a conditioned stimulus (CS) to which the dog learned a conditioned response
(CR).

Following figure shows steps of classical conditioning and how Pavlov's dogs
learned.
iv. Classical Conditioning in Human Learning

Pavlov's findings have been replicated with other responses and in humans.

As pointed out in earlier sections, although the initial conditioning experiments

were carried out with animals, classical conditioning principles were soon found to
explain many aspects of everyday human behaviour. For example, you may not go
to a dentist as often as you should because of previous associations of dentists with
pain. In more extreme cases, classical conditioning can lead to the development
of phobias, which are intense, irrational fears (An insect phobia might develop in
someone who is stung by a bee. The insect phobia might be so severe that the
person refrains from leaving home.) Posttraumatic stress disorder (PTSD), suffered
by some war veterans and others who have had traumatic experiences, can also be
produced by classical conditioning. Even years after their battlefield experiences,
veterans may feel a rush of fear and anxiety at a stimulus such as a loud noise.

v. Common Phenomena in Classical Conditioning

Phenomena related to classical conditioning include: associative bias, importance

of contingency, extinction, spontaneous recovery, generalization, stimulus
discrimination, higher-order conditioning, and sensory preconditioning.

vi. Generalization

Generalization is tendency of a new stimulus similar to the original conditioned

stimulus to produce a similar response. When learners respond to other stimuli in
the same way that they respond to conditioned stimuli, generalization is
occurring. The more similar a stimulus is to the conditioned stimulus, the greater
the probability of generalization.

vii. Discrimination: The organism responds to certain stimuli but not others.

viii. Extinction occurs

when a previously
conditioned response
decreases in
frequency and
eventually
disappears. To
produce extinction,
one needs to end the
association between
conditioned stimuli.

ix. Counter conditioning / Systematic Desensitization A method based on classical

conditioning that reduces anxiety by getting the individual to associate deep
relaxation with successive visualizations of increasing anxiety-provoking situation.

3.6.2 Behaviorism

a. John B. Watson, the father of Behaviorism, coined the term "Behaviorism".

Influenced by the work of both Pavlov, Watson adopted the classically conditioned
S-R habit as the basic unit of learning and extended it to human learning. He
presented an 11- month-old child, Albert, with a loud frightening bang and a rat at
the same time. After six or seven repetitions of the noise and rat together over a
period of a week, the child became afraid of the rat, which he hadn't been,
something like his fear of the noise

b. As Edward L. Thorndike studied the behavior of animals, he noted that through

repeated trial-and-error learning, certain connections between stimuli (S), and
subsequent behavior responses (R), are strengthened or weakened by the
consequences of behavior. His significant contribution to understanding learning
has come to be called connectionism, or the S-R theory of learning.
c. Skinner's Learning Theory

Skinner proposed that organisms acquire behaviours that are followed by certain
consequences.

i. Conditioning stimulus-response (S-R) associations through reinforcement

ii. Shaping behaviour through selective reinforcement

B. F. Skinner (1904-1990) saw operant conditioning as a way of controlling almost

all behavior. Skinner's principle of operant conditioning has proven to be a very
useful and powerful explanation of why human beings often act as they do, and its
applications to instructional and therapeutic situations are almost limitless.
Virtually any behavior-academic, social, psychomotor- can be learned or modified
through operant conditioning.

iii. Common Phenomena in Operant Conditioning

a. Generalization

b. Discrimination that is differentiating among stimuli or environmental events

c. Extinction that is a previously reinforced response is no longer reinforced and

the response decreases

d. Reinforcement

i. Positive - giving something good - increases desired behaviour

ii. Negative - taking away something bad - increases desired behaviour

iii. Punishment - applying something bad - reduces undesired behaviour

iv. Behaviour Shaping - successive approximations to the goal behaviour

v. Reinforcement - anything which increases desired behaviour

vi. Schedules of Reinforcement

a) Continuous Reinforcement

b) Fixed Ratio Reinforcement (FR)

c) Fixed Interval Reinforcement (FI)

d) Variable Ratio Reinforcement (VR)

e) Variable Interval Reinforcement (VI)

In text Question

What are three differences between classical and

operant conditioning?

iv. Critiques of Behaviorism

 Does not account for processes taking place in the mind that cannot be
observed
 Advocates for passive student learning in a teacher-centric environment
 One size fits all
 Knowledge itself is given and absolute
 Programmed instruction & teacher-proofing

3.7 Cognitive Learning Theory

3.7.1 In contrast to behaviorists, researchers working from a cognitivist

perspective focus not on external behavior but on internal mental processes.
Cognitivists are interested in how the mind makes sense out of stimuli in the
environment-how information is processed, stored, and retrieved. Cognitive
learning theory is directed toward specific facets of cognition, such as discourse
analysis, comprehension, ways of aiding understanding and meaningful learning,
the nature of the schemata, the memory system, the development of cognitive
skills, and the like ( Di Vesta, 1987).
3.7.2 Jean Piaget (1966), A cognitive psychologist proposed that one's internal
cognitive structure changes partly as a result of maturational changes in the
nervous system and partly as a result of the organism's interacting with the
environment and being exposed to an increasing number of experiences. As
discussed in the previous section on intelligence, Piaget a four-stage theory of
cognitive development:

a. Sensorimotor stage (Infancy).

b. Pre-operational stage (Toddler and Early Childhood) Use of symbols, language

use matures, memory and imagination are developed, thinking is nonlogical and
nonreversable.

c. Concrete operational stage (Elementary and early adolescence). Intelligence

demonstrated through logical and systematic manipulation of symbols related to
concrete objects.

d. Formal operational stage (Adolescence and adulthood). Intelligence

demonstrated through the logical use of symbols related to abstract concepts.

3.7.3 Jerome Bruner's (1966) Cognitive Learning Theory/Discovery Learning

1. Bruner, who stresses learning through discovery, said "in its essence a
matter of rearranging or transforming evidence in such a way that one is
enabled to go beyond the evidence" and as a result, reconstruct additional
new insights (Bruner, 1965).
2. Bruner shared Piaget's emphasis on the importance of action and problem
solving. According to Bruner's theory:

a. Discovery learning works from the known to the unknown, from the concrete to
the abstract relating new knowledge to existing knowledge

b. Emphasis is on processes of coming to know rather than structure of knowledge

c. Domain dependent individual differences rather than universal stages

3. Bruner's instructional theory is based on a theory about the act of learning

that involves "three almost simultaneous processes":

a. Acquisition of new information

b. Transformation that is manipulating knowledge to make it fit new tasks

c. Evaluation or checking whether the way we have manipulated information is

adequate to the task (Knowles, 1984).

3.8 Social-cognitive learning model

3.8 Social-cognitive learning model (Bandura )

Albert Bandura

3.8.1 Social learning theory founded by A. Bandura (1973), grew out

of Cognitivism. According to this theory, social and cognitive
factors, as well as behavior, play important roles in learning. Albert Bandura
(1977) integrated traditional classical and operant conditioning principles into a
theoretically rich account of behavior and behavior change. Bandura believes that
humans are active information processors and think about the relationship
between their behavior and its consequences, hence, in social-cognitive learning
theory; the person is the agent of change. The theory emphasizes the human
capacity for self-directed behavior change. Reinforcement is regarded not as an
automatic strengthener of behavior but as a source of guidance for behavior by
anticipated outcomes. People learn a great deal from observing other human
beings. Social learning is the basis of the movement against violence in media &
video games. By observing the consequences of behavior, the person learns what
action is appropriate in what situation. Bandura focused more on the cognitive
processes involved in the observation than on the subsequent behavior. Social
Learning/Observational Learning involves acquiring skills, strategies and beliefs,
through observing others. The process involves four key processes:

a. Attention

b. Retention

c. Production

d. Motivation

3.8.2 General principles underlie social cognitive theory (Bandura, 2006, 2008):

a. People can learn by observing others' behaviours and consequences that result.

b. Learning can occur without a change in behavior.

c. Cognition plays important roles in learning.

d. People can have considerable control over their actions and environments.

3.8.3 Critiques of Social Learning Theory

a. Does not take into account individuality, context, and experience as mediating
factors
b. Suggests students learn best as passive receivers of sensory stimuli, as opposed
to being active learners

c. Emotions and motivation not considered important or connected to learning

3.9 Constructivist Orientation

1. Constructivism, representing an array of perspectives, posits that learners

construct their own knowledge from their experiences. The cognitive
process of meaning making is emphasized as both an individual mental
activity and a socially interactive interchange. Aspects of constructivism can
be found in self-directed learning, transformational learning, experiential
learning, situated cognition, and reflective practice. Constructivism views
learning as a process in which the learner constructs knowledge based on
their past experiences
2. For Constructivist learning theorists, learning is a process of constructing
meaning; it is how people make sense of their experience.
3. The Constructivist Learning approach was founded by Vygotsky (1978), who
proposed that learning is socially mediated through a culture's symbols and
language, which are constructed in interaction with others in the
culture. Vygotsky's work is also considered foundational to what's known
as activity theory (AT). Activity theory "conceptualizes learning as involving
a subject (the learner), and object (the task or activity) and mediating
artifacts (for example, a computer, laws)" (Issroff & Scanlon, 1995).
4. Critiques of Social Constructivism

a. Suggests that knowledge is neither given nor absolute

b. Often seen as less rigorous than traditional approaches to instruction

c. Does not fit well with traditional age grouping and rigid terms/semesters

3.10 Motivational and Humanistic Theories

1. In the humanistic orientation to learning, the emphasis is on human nature,

human potential, human emotions, and affect. Theorists in this tradition
believe that learning involves more than cognitive processes and overt
behavior. It is a function of motivation and involves choice and
responsibility.

Humanist Theory holds that:

a. Learning is dependent upon meeting a hierarchy of needs (physiological,

psychological and intellectual)

b. Learning should be reinforced.

2. Maslow (1970), the founder of humanistic psychology (learning from human
potential for growth perspective), proposed a theory of human motivation
based on a hierarchy of needs.
Physiological needs such as hunger and thirst are at the lowest level of triangle
hierarchy and these must be attended to before one can deal with higher ranked
needs of safety, belonging and love, self-esteem, and finally, self-actualization.

3.11 Connectivism Learning Theory

3.11 Connectivism Learning Theory (George Siemens)

Connectivism is a new learning theory for the digital age developed by George
Siemens (http://www.elearnspace.org/Articles/connectivism.htm).

3.11.1 "Learning must be a way of being - an ongoing set of attitudes and actions
by individuals and groups that they employ to try to keep abreast o the surprising,
novel, messy, obtrusive, recurring events" (Vaill, 1996). Learning theories that
describe learning principles and processes, should be reflective of underlying social
environments, significant trends in learning currently is the technology and the
construction of connections as learning activities and that technology is altering
our brains. In this context George Siemens argues that traditional learning theories
are limited in that they do not address learning that occurs outside of people, that
is learning that is stored and manipulated by technology. Currently knowledge is
enormously abundant. ‘Know-how and know-what' is being supplemented with
‘know-where' that is the understanding of where to find knowledge needed.
Furthermore, due to the rapid increase in the abundant information, the half life
of knowledge is shrinking; hence the quick assessment of knowledge is important.
In this digital age, it is also necessary that learning theories explore the way
information is acquired. The ability to synthesize and recognize connections and
patterns is also a valuable skill.

3.11.2 According to Siemens, Connectivism is the integration of principles

explored by chaos, network, and complexity and self-organization theories.
Learning is a process that occurs within nebulous environments of shifting core
elements - not entirely under the control of the individual. Learning (defined as
actionable knowledge) can reside outside of ourselves (within an organization or a
database), is focused on connecting specialized information sets, and the
connections that enable us to learn more are more important than our current
state of knowing. The Connectivism is conducted by the understanding that
decisions are based on principles that change quickly. Siemens, specified the

Connectivism principles as:

1) Learning and knowledge rests in diversity of opinions

2) Learning is a process of connecting specialized nodes or information sources

3) Learning may reside in non-human appliances

4) Capacity to know more is more critical than what is currently know

5) Nurturing and maintaining connections is needed to facilitate continual learning

6) Ability to see connections between fields, ideas, and concepts is a core skill

7) Currency (accurate, up-to-date knowledge) is the intent of all connectivist

learning activities and

8) Decision-making is itself a learning process. Choosing what to learn and the

meaning of incoming information is seen through the lens of a shifting reality.
While there is a right answer now, it may be wrong tomorrow due to alterations in
the information climate affecting the decision (Siemens, 2004).

3.11.3 Criticism at theory of Connectivism.

The fundamental criticism of Connectivism, is whether Connectivism is really a

new learning theory?

3.12 Summary
 3.12 Summary

Definition of learning

Psychologists use the term "learning" to refer to any relatively permane

knowledge, and thinking skills, which comes about through experience
physiological maturation, fatigue, use of alcohol or drugs, or onset of m
Introduction

Theories of learning

Explanations of what happens learning takes place are called learning t

are:

1. Behaviorism (focus on stimuli and responses, Skinner's operant con

2. Early cognitive perspectives (e.g., Piaget, Vygotsky, focus on perc

development of children's reasoning)

3. Cognitivism (cognitive learning principles, focus on mental process

knowledge)

4. Social cognitive theory (interpretation of observational learning in

recognition that people can control their own learning, focus on learnin
social-cognitive theory)

5. Sociocultural theory (focus on how a society's adults and cultural c

pass accumulated wisdom along to children, Vygotsky's socio-historical

Humanistic orientation to learning

founder of humanistic psychology (learning from human potential for g
theory of human motivation based on a hierarchy of needs

A new learning theory for the digital age

learning theory for the digital age developed by George Siemens.

3.13 References

3.13 References

1. The African textbook of psychiatry and mental health,

Ndetei et al 2006
 2. Introduction to psychology textbook by Charles Stangor,
2006

3. Learning and Memory: A Comprehensive Reference. Editor-

in-Chief: John H. Byrne, (2008)

3.14 Self-test questions

3.14 Self-test questions

1. In Pavlov's experiments with dogs, salivation was the

a. Conditioned response.

b. Unconditioned stimulus.

c. Conditioned stimulus.

d. Unconditioned response.

e. Reflex

2. Operant conditioning was studied by

a. Pavlov.

b. Maslow.

c. Freud.

d. Skinner.

e. Piaget

ECTION 4: Memory

Section outline

4.1 Introduction

4.2 Section objectives

4.3 Memory

4.4 Types of memory

4.5 Approaches to Memory

4.6 Theories of forgetting

4.7 Strategies for enhancing memory

4.8 Summary

4.9 References

4.10 Self-test questions

4.1Section 4 Introduction

Welcome to this section on Human Memory.

In previous the section, we saw that the ability to learn gives us flexibility and
adaptability skills that enable us to benefit from our life experiences, but what
good is learning if you do not remember it? Not much, without memory we could
not learn anything. What you remember and what you do not remember defines
your life. Without a memory of the past, you have nothing - no family, no
identification, no education, and no money - because you cannot remember!
Memory is essential to all learning, as the saying goes - "It's not how much you
learn that matters. It's how much you remember!

Researchers say that by giving us cognitively flexibility that allows us to build an

up-to-date understanding of the information around us and to navigate the world,
memory helps us adapt to our environment.

In this section on memory, we will explore the concept of memory, relationship of

learning, the structures and processes involved in acquisition, storage and
subsequent retrieval of information, types of memory, approaches to memory,
theories of forgetting and finally describe some strategies for enhancing memory.

Participation in activities given as we as we explore various issues pertaining to

memory will help make this section a memorable experience. Enjoy!
 1) Activity:

2) Briefly describe an event you experienced in high school.

4.2 Section 4 Objectives

Objectives
4.2 Section objectives

At the end of the section you should be able to:

1. Define memory

2. Differentiate between the stages of memory

3. Describe different approaches of memory

4. Describe theories of forgetting

5. List some strategies for enhancing memory

4.3 Human memory

1. What is memory?

Memory is one of many neurobiological systems, which allow one to benefit from
knowledge obtained during their individual lifetimes. Memory is mediated by
plasticity in the synaptic connections between neurons that participate in the
behavior (Kandel and Spencer 1968). Memory is dynamic, in that it is constantly
being updated as it is retrieved. Retrieval is the process of reactivating an
established memory so it can influence ongoing behavior, and thus retrieval is a
key component of memory performance. Retrieval, the recollective experience, is
the central feature of memory distinguishing it from other cognitive functions such
as perception and imagination. We tend to remember things that are unusual,
things that are connected things that involve and interest us.

b. What is the difference between learning and memory?

Though learning and memory are closely related, they are distinct phenomena. As
we saw in the section on learning - learning, the acquisition of skill or knowledge,
is a process that will modify subsequent behavior. On the other hand, memory, the
ability to remember past experiences, is the process of expression of what you
have acquired. For example, you learn a new language by studying it, but you then
speak it by using your memory to retrieve the words that you have learned.

Whereas, learning refers to the acquisition of new behaviours through experience,

memory refers to the process of storing of information that can be retrieved when
required. The first step in memory is learning, thus, memory depends on learning.
But learning also depends on memory, because knowledge stored in your memory
provides the framework to which you link new knowledge, by association.

To use metaphors to further illustrate the difference between the two - learning,
is like acquiring raw cow's milk, while memory, is like processed KCC milk.

As noted by Matlin (2005), memory is the process of maintaining information over

time. Hence it is central to learning, in that memory is the persistence of learning
over time through the storage and retrieval of information.

c. Processes involved in human memory are encoding, storage and retrieval.

i. Encoding (mentally processing information so it can be entered into memory).

ii. Storage (holding that information for a period of time)

iii. Retrieval (accessing or recalling stored memories when needed.

Memory consolidation either as part of the encoding process or the storage process
is also important.

4.3.1 Brain and Memory

b. Brain and Memory

Biologists believe that neuronal plasticity is facilitated by the capacity for

memory. Brain cells undergo chemical and structural changes during learning. By
changing the number, or strength, of connections between brain cells, information
is written into memory. Read more:
Memory http://www.learningandteaching.info/learning/memory.htm#ixzz37PsRXb
Ot

i. Memory as synaptic change

The set of changes in the nervous system that represents stored memory is
commonly known as the engram, a term introduced by the German biologist
Richard Semon at the beginning of this century (Semon, 1904; Schacter, 1982).
Synaptic change is the critical event in information storage. Currently it is
postulated that long-term potentiation (LTP) is the neural basis for memory. LTP
describes a long-lasting increase in the strength of a synaptic response following
electrical stimulation of a neural pathway. Long-term memory of even a single
event depends on synaptic change in a distributed ensemble of neurons, which
themselves belong to many different processing systems, and the ensemble acting
together constitutes memory for the whole event. Representations of events in
memory are subject to competition and dynamic change. The strengthening of
some connections within an ensemble occurs at the expense of other connections.
These dynamic changes are the synaptic reflections of rehearsal, relearning,
normal forgetting, and perhaps the passage of time alone; and they result in a
resculpting of the neural circuitry that originally represented the stored
information. New information-storage episodes constantly occur, resculpturing
previously existing representations. The specificity of stored information is
determined by the location of synaptic changes in the nervous system and by the
pattern of altered neuronal interactions that these changes produce.

ii. However, as we saw in the previous section on learning, not all learning-related
changes involve changes in synaptic strength (Martin & Morris, 2002). Neuronal
growth (neurogenesis) and changes in neuronal excitability/firing threshold may
also underlie the formation of permanent memory.

iii. Memory consolidation involves interactions among neural systems as well as

cellular changes within specific systems, and the amygdala is critical for
modulating consolidation in other brain regions (McGaugh, 2000). Networks of
neurons hold memories.

Neurobiological systems of regulating the consolidation of memory

iv. Where Is Memory Stored? There have been heated debates on whether
memory localized to particular units and regions, or whether memory is distributed
equivalently over a collection of units or regions. Research indicates both views
are actually correct. Localizationist and distributed accounts of memory have been
reconciled. Memory is both distributed and localized. Memory is distributed in that
no single memory center exists, and many parts of the nervous system participate
in the representation of a single event. Memory for whole events is widely
represented in the sense that many areas of the brain are involved. Although,
memory is widely distributed, different loci store different aspects of the whole.
Memory is localized in that the representation of a single event involves a limited
number of brain systems and pathways, and each part of the brain contributes
differently to the representation. Each differentiated component of memory must
be both localized and dependent on specific connections.

4.3.2 Modulation of Memory

i. Modulation of Memory

Memory can be influenced in many different ways.

a) Since learning and memory do not occur in isolation from other cognitive
processes, to a large degree, exactly what is remembered and how much is
remembered depend on factors such as the alertness level at the time of learning
and the nature of the events occurring just after information has been registered.
Memory storage can be amplified or dampened by events that occur before and
after an experience, for example, punishment and reward influence what is
learned by signaling the importance of immediately preceding events. Once
learning has occurred, the conditions that later exist when remembering is
attempted will influence how well remembering succeeds.

b) The establishment of long-term memory in any of the brain systems specialized

for different kinds of information processing can be influenced by, and depends
on, a number of other brain systems. Certain hormones and transmitters influence
the strength of learning and can modulate memory if given close to the time of
learning. Some of these effects may involve the action of mechanisms that
subserve attention or reinforcement. Peripherally released hormones can also
modulate memory, perhaps by influencing the level of stress or arousal that
follows an event. Hormones and neurotransmitters may facilitate or impair
memory, depending on specific circumstances. The hypothesis is that peripheral
hormones play a role in establishing particularly vivid memories because a stress-
producing and hormone- releasing signal often follows events that will later be
well remembered. Such memories have acquired the name "flashbulb memories" to
denote their unusual character and vividness (Brown and Kulik, 1977).

c) The three most important neurotransmitters involved with memory are

norepinephrine, acetylcholine, and serotonin. In the brain, acetylcholine is
involved in learning and memory. Acetylcholine is a small molecule transmitter
that is also found in the hippocampus and prefrontal cortex. The hippocampus is
responsible for memory and memory retrieval. Alzheimer's disease is associated
with a lack of acetylcholine in certain regions of the brain. Emotion can affect
declarative memory. Sleep also enhances emotionally charged declarative
memories more than neutral ones.

ii. Role of sleep in memory

Activity:

Your physiology exam tomorrow will cover: General principles &

sensory physiology; special senses; motor & integrative
neurophysiology chapters 45 to 53 (Guyton Medical Physiology
Textbook).

After long hours of studying you notice it's the middle of the
night and you haven't gone through all the chapters to your
satisfaction.

1. Should you forgo sleep to study more?

2. Briefly explain your answer, giving examples from some

personal or peers' experiences.

a) Sleep is critical to cognitive functions, particularly memory. It is well

established that sleep benefits the retention of memory. Early theories posed
passive role of sleep, that sleep enhanced memory by protecting it from
interfering stimuli, present-day theories draw attention to an active role in which
memories undergo consolidation during sleep. A memory is consolidated when, in
the absence of mental rehearsal, it becomes sturdy enough to resist disruption
from competing new learning, perceptions, thoughts or actions. During
consolidation recently encoded memory representations are reactivate,
transformed and then the new patterns of information are integrated with past
experiences and knowledge in long-term memory. At about the same time,
memories can be reorganized and moved to new anatomical sites in a process
called translocation. Consolidation of memories is a two phase process, consisting
of:

1. Stabilization phase, which appears to occur over time regardless of brain state

2. Enhancement phase, which occurs primarily, if not exclusively, during sleep.

The enhancement phase of memory consolidation is an active process, which can

restore previously lost memories or produce additional learning, without the need
for further practice. Subsequent sleep stabilizes transformed memories.

4.4 Approaches to Memory

4.4.1 Information about biologically meaningful stages of memory comes from
three separate traditions- the cognitive psychology, neuro-psychology, and
neurobiology. The various memory modelsapproaches include:

a. Information Processing Approach: For example, Atkinson & Shiffrin's Multi-store

Model of Memory (1968) depicts memory as a process analogous to a computer,
which encodes, stores and retrieves information. a flow of information through a
system.

Memory actively alters and organizes information, then stores it so that it can be
easily recovered when needed. The key memory processes
of encoding, storage and retrieval critical in this model. To this model memory
consists of sensory memory, short-term memory (STM) and long-term memory
(LTM).

www.psychlotron.org.uk

b. Levels of Processing Approach (Craik & Lockhart): This approach, which does not
consider different stores or physical components, holds that memory depends on
the degree or depth of mental processing occurring when material is initially
encountered.

i. Shallow levels of processing include simply noticing the physical characteristics

of the material to be memorized, e.g. the shape of the letters such as upper or
lower case. Learning by rote (or parrot fashion) is called maintenance rehearsal
and is also seen as shallow.

ii. Medium levels of processing include noticing the sound of the material to be
learned, referred to as phonetic processing.

iii. Deep levels of processing are semantic since they consider the meaning of the
material to be learned.

c. Parallel Distributed Processing Model: Memory is distributed across a network of

interconnected units that work simultaneously (in a parallel fashion) to process
information.

d. Traditional Three-Stage Memory Model: Memory requires three different storage

boxes to hold and process information for various lengths of time.

Let us look at this model in more detail.

4.4.1 Three-Stage Memory Model

Three-Stage Memory Model consists of the Sensory Memory; Short-term memory

(STM), and Long-Term Memory (LTM). Information moves successively through
these three systems, if attention is givento the material. If attention is not given,
information does not movefurther into the system.

i. Sensory Memory Sensory memory refers to the short-lived memory for sensory
(how things looked, sounded, felt, smelled, and tasted) details of events. Sensory
memory differs from mental imagery, which can include sensory-like qualities but
is typically less detailed. Sensory memory holds representations of sensory input
for brief periods of time, depending upon the modality involved. There are
different sensory registers for each of the senses. The visual register is
called iconicmemory and auditory register, echoic memory. The iconic memory
lasts about half a second and the echoic memory lasts several seconds. Most of the
information that enters our sensory registers is lost because we do not attend to
all that is registered, whatever we attend to moves on to the next stage of
memory.
 Activity

1. Hold any object about 12 inches in front of you.

2. Look at it steadily for a while.

3. Close your eyes and notice how long the clear image of that
object lasts?

A clear visual image of any object will last in sensory memory

for about half a second after the stimulus is no longer received
by the receptors.

1. Characteristics of Sensory Memory

a) Memory for stimuli as opposed to ideas

b) Memory for information more fine-grained than a familiar category

c) Memory even for unattended stimuli

2. Techniques to Examine Sensory Memory

a) Sensory persistence procedures

b) Partial-report procedures

c) Selective-attention procedures

d) Backward-masking procedures

3. Theories of Forgetting From Sensory Memory

a) Modality-specific rates of decay

b) Two phases of sensory memory with different rates of decay

c) No-decay theories

4.4.2 Working Memory

i. Short-Term Memory (STM) / Working Memory

A second type of memory is known as short-term memory or STM. Short-Term

Memory holds relatively small amounts of information for brief periods of time,
usually 30 seconds or less. It has been established now that short-term storage
involves active processing of information. This finding has led the psychologists
now to use the term working memory. The term "Working memory", refers to the
set of cognitive processes involved in the temporary storage and manipulation of
information - supports all of these activities and many more. Working memory may
also be conceptualized as a mental jotting pad that we can use to record useful
material for brief periods of time, as the need arises in the course of our everyday
cognitive activities. Working memory, which is the ability to hold information in
mind for brief periods of time, is an essential feature of our everyday mental life.
Working memory has several limitations: its storage capacity is limited, and it is a
fragile system whose contents are easily disrupted.

Activity:

1. Look up from this presentation for a moment and

note what attracts your visual attention?

2. Try to identify the sounds and sensation that you are

experiencing now.

What you've identified is the content of your short term

memory.

The Working Memory Model consists of four components:

1. The Phonological Loop. The phonological loop model advanced by Baddeley

(1986) and it consists of a short-term store and a subvocal rehearsal process. It is a
slave system dedicated to the temporary storage of material in terms of its
constituent sounds, or phonemes.

a) Empirical phenomena - this structure is consistent with a wide range of

experimental phenomena; lists of items are presented serially for immediate recall
in the original input sequence.

b) A computational model of the phonological loop

c) The phonological loop and language

2. The Visuospatial Sketchpad. Theory and empirical phenomena

a) The Central Executive

b) The supervisory attentional system

c) Complex memory span

d) The Episodic Buffer

4.4.3 Long Term Memory

i. Long-Term Memory (LTM)

Long term memory is a relatively permanent memory storage; virtually limitless

capacity /stored on basis of meaning and importance. LTM improved with
organization; rehearsal; retrieval cues; recognition and recall. LTM brings
continuity and meaning in our life.

When we pay attention to an information and engage in active rehearsal the

material is stored in the long term memory (LTM). Information in the sensory
memory enters short-term memory when it becomes the focus of our attention. If
we do not pay attention to the incoming sensory information, the material fades
and quickly disappears. We tend to pay attention to certain information and not to
the other. Paying attention to certain aspects of our world is what we call -
"selective attention". The information from STM is often rehearsed by us. Rehearsal
helps transfer of that information from STM to LTM.

1. Retrieving Information from Memory. Factors Affecting Encoding

a) Encoding specificity principle: the principle that the environmental cues

present at the time information is encoded into long-term memory serve as the
best retrieval cues for the information.

b) State-dependent memory: long-term memory retrieval is best when a person's

physiological state at the time of encoding and retrieval is the same.

c) Mood-dependent memory: long-term memory retrieval is best when a person's

mood state at the time of encoding and retrieval is the same.

d) Mood-congruence effect: long-term memory retrieval is best for experiences

and information that are congruent with a person's current mood.

1)

2. Measuring Retrieval

a) Recall: a measure of long-term memory retrieval that requires the

reproduction of the information with essentially no retrieval cues.
b) Recognition: a measure of long-term memory retrieval that only requires the
identification of the information in the presence of retrieval cues.

c) Relearning: the savings method of measuring long-term memory retrieval, in

which the measure is the amount of time saved when learning information for the
second time.

3. Two long-term memory distinctions:

a) Explicit/Declarative memory, that memory is directly accessible to

conscious recollection

i. Episodic memory (personal experiences with specific times

& places)

ii. Semantic memory (impersonal facts & everyday

knowledge)

b) Implicit Memory/Non-declarative memory that is memory contained within

learned skills or modifiable cognitive operations. It is not accessible as specific
facts, data, or time-and-place events.

i. Procedural long-term memory

ii. Priming

iii. Classical conditioning

4.4 Approaches to Memory

4.4.1 Information about biologically meaningful stages of memory comes from

three separate traditions- the cognitive psychology, neuro-psychology, and
neurobiology. The various memory modelsapproaches include:

a. Information Processing Approach: For example, Atkinson & Shiffrin's Multi-store

Model of Memory (1968) depicts memory as a process analogous to a computer,
which encodes, stores and retrieves information. a flow of information through a
system.
Memory actively alters and organizes information, then stores it so that it can be
easily recovered when needed. The key memory processes
of encoding, storage and retrieval critical in this model. To this model memory
consists of sensory memory, short-term memory (STM) and long-term memory
(LTM).

www.psychlotron.org.uk

b. Levels of Processing Approach (Craik & Lockhart): This approach, which does not
consider different stores or physical components, holds that memory depends on
the degree or depth of mental processing occurring when material is initially
encountered.

i. Shallow levels of processing include simply noticing the physical characteristics

of the material to be memorized, e.g. the shape of the letters such as upper or
lower case. Learning by rote (or parrot fashion) is called maintenance rehearsal
and is also seen as shallow.

ii. Medium levels of processing include noticing the sound of the material to be
learned, referred to as phonetic processing.

iii. Deep levels of processing are semantic since they consider the meaning of the
material to be learned.
c. Parallel Distributed Processing Model: Memory is distributed across a network of
interconnected units that work simultaneously (in a parallel fashion) to process
information.

d. Traditional Three-Stage Memory Model: Memory requires three different storage

boxes to hold and process information for various lengths of time.

Let us look at this model in more detail.

4.4.1 Three-Stage Memory Model

Three-Stage Memory Model consists of the Sensory Memory; Short-term memory

(STM), and Long-Term Memory (LTM). Information moves successively through
these three systems, if attention is givento the material. If attention is not given,
information does not movefurther into the system.

i. Sensory Memory Sensory memory refers to the short-lived memory for sensory
(how things looked, sounded, felt, smelled, and tasted) details of events. Sensory
memory differs from mental imagery, which can include sensory-like qualities but
is typically less detailed. Sensory memory holds representations of sensory input
for brief periods of time, depending upon the modality involved. There are
different sensory registers for each of the senses. The visual register is
called iconicmemory and auditory register, echoic memory. The iconic memory
lasts about half a second and the echoic memory lasts several seconds. Most of the
information that enters our sensory registers is lost because we do not attend to
all that is registered, whatever we attend to moves on to the next stage of
memory.
 Activity

1. Hold any object about 12 inches in front of you.

2. Look at it steadily for a while.

3. Close your eyes and notice how long the clear image of that
object lasts?

A clear visual image of any object will last in sensory memory

for about half a second after the stimulus is no longer received
by the receptors.

1. Characteristics of Sensory Memory

a) Memory for stimuli as opposed to ideas

b) Memory for information more fine-grained than a familiar category

c) Memory even for unattended stimuli

2. Techniques to Examine Sensory Memory

a) Sensory persistence procedures

b) Partial-report procedures

c) Selective-attention procedures

d) Backward-masking procedures

3. Theories of Forgetting From Sensory Memory

a) Modality-specific rates of decay

b) Two phases of sensory memory with different rates of decay

c) No-decay theories

4.5 Types of memory

4.5 Types of memory

Memory consists of a set of functions that serve specific adaptive purposes,

enabling organisms to benefit from prior experience (Klein et al., 2002); hence
there are many kinds of memory.

1. Broad differences among types of memory

a) Explicit and implicit memory

b) Conscious and unconscious forms of memory

c) Voluntary and involuntary retention

d) Intentional and incidental learning

e) Retrieval, declarative and procedural memory

f) Retrospective and prospective memory

Let us look at these in more detail.

a) Explicit and Implicit Memory

Graf and Schacter (1985) introduced the terms explicit (conscious retention) and
implicit (unconscious retention) memory to the field.

i. Explicit (conscious) memory refers to cases of conscious recollection. Explicit

recollection may be intentional and effortful, or it may occur without the intent to
explicitly remember information relevant to a given memory task, as is the case
with involuntary conscious recollection (e.g., Richardson-Klavehn et al., 1996). In
cases of explicit retention, people respond to a direct request for information
about their past, and such tests are called explicit memory tests.

ii. Implicit (unconscious) memory refers to transfer measures when people may
not be aware of using memory at all (Jacoby, 1984). Implicit retention also occurs
when subjects show savings in retention without being able to recollect the
experience that gave rise to the savings (Ebbinghaus, 1964). Implicit (unconscious
retention) may be observed in performance on tests of implicit memory where
individuals indirectly demonstrate their prior exposure to the test material under
conditions in which they do not consciously recognize the material.

b) Conscious and Unconscious Forms of Memory

i. Conscious and unconscious forms of memory refer to the mental states of

awareness associated with remembering the past. This classification of memory is
reminiscent of Sigmund Freud's
psychoanalytic tradition.

ii. Conscious recollection which may be voluntary or involuntaryrefers to the

subjective awareness of remembering information encountered in the past.

iii. Unconscious retention may be observed in performance on tests of implicit

memory where individuals indirectly demonstrate their prior exposure to the test
material under conditions in which they do not consciously recognize the
material.

c) Voluntary and Involuntary Retention

i. Voluntary retention refers to deliberate, willful recollection

ii. Involuntary retention refers to recollection that occurs without conscious effort.

d) Intentional and Incidental Learning and Retrieval

i. Intentional and incidental learning refer to whether or not people intend to

learn material to which they are exposed.

ii. Under intentional retrieval conditions, a person is asked to engage in conscious,

deliberate recollection of a past event (e.g., recalling a word from a previously
studied list that completes a word stem).

iii. By contrast, incidental retrieval involves giving people the same word stem
with the instruction to write the first word that comes to mind. Incidental
retrieval is indexed by priming, the better performance in completing the stem
with the target word relative to a control condition in which the word had not
been studied.

e) Declarative and Non-declarative (procedural) Memory

i. Ryle distinguished between declarative knowledge [knowing that] and procedural

knowledge [knowing how], (Ryle, 1949).

ii. Squire proposed declarative memory includes episodic memory [remembering

specific events of the past] as well as semantic memory [general knowledge],
Squire (1982).
iii. Non-declarative memory includes traditional procedural tasks and to others
such as priming and skill learning.

f) Retrospective and Prospective Memory

i. Memory for the past experience on current behavior is retrospective memory.

ii. Memory for intentions to be performed in the future is prospective memory.

Prospective memory tasks differ from retrospective memory tasks in that there is
usually no explicit cue to elicit recall of the intention. Instead, prospective
memory tasks require that subjects use an environmental cue to know when to
retrieve the intention, so it is a curious mix of incidental and intentional retrieval.
Prospective memory tasks can be classified as cue-based or event-based or time-
based. Retrieval of prospective memories may sometimes involve monitoring and
may sometimes be spontaneous and effortless (Einstein and McDaniel, 2005).

2. Memory types based on duration span

a) Varieties Types of Short-Term Memory

i. Sensory Memories

ii. Short-Term Storage

iii. Working Memory

iv. Long-Term Working Memory

b) Varieties of Long-Term Memory

i. Code-Specific Forms of Retention

a) Visual-spatial memory

b) Imagery

c) Olfactory memory

d) Skill learning

e) Verbal memory

ii. Forms of Explicit Memory

a) Episodic memory

b) Autobiographical memory
c) Semantic memory

d) Collective memory

4.51 Multiple Knowledge Systems

1. Multiple Knowledge Systems

Several kinds of knowledge systems are needed in order to acquire knowledge to

survive and to solve the problems life confronts us with.

a) Types of knowledge systems include:

i. Knowing what

ii. Knowing where

iii. Knowing when

iv. Knowing who

v. Knowing how

vi. Knowing valence

b) Implications of the existence of multiple systems

The capacity to know certain things depends upon the development of the
underlying neural system that processes and represents that kind of knowledge.
There are several major implications of the postnatal maturation of the
hippocampus.

i. Adult behavior reflects the presence of both hippocampal and nonhippocampal

systems, what they do and how they interact. Prior to hippocampal emergence,
however, behavior reflects functions and behaviors dependent on brain systems
operational at birth. Episodic memory is not observed until the age of 3 or 4 years.
The absence of episode memories from the first 2 years of life resulting from the
late maturation of the hippocampus can help us understand at least part of the
syndrome of infantile amnesia (Nadel and Zola-Morgan, 1984). Now that a
consensus has emerged to the effect that hippocampus is most likely to become
functional between 18 and 24 months of age in children (Newcombe et al., 2007),
we can conclude that a significant part of infantile amnesia (delayed emergence of
episodic memory) reflects biological maturation.

ii. The second major implication concerns development. A developing system is

more susceptible to influence than an already developed one. So still-developing
systems such as the developing hippocampus are susceptible to alteration, induced
either by experience or the unfolding of some genetic program. This means that
ways of knowing can be more or less influenced by early life experience as a
function of when they develop.

iii. Another way in which the existence of multiple knowledge systems matters is
that these systems can be differentially affected by experience. One very
important example is offered by how knowledge systems are affected by arousal
and stress. The literature in this area has been confusing, since evidence existed
that arousal facilitates memory formation (Reisberg and Heuer, 2004), while at the
same time acute stress, which is undoubtedly arousing, has been shown to impair
memory in several studies (Jackson et al. 2006; Payne et al., 2006). The best way
to understand this discrepancy is in terms of multiple knowledge systems and how
they are differentially affected by stress. Payne et al., for example, showed that
memory for neutral information is impaired by stress at the same time that
memory for emotional information is facilitated. This result is best understood by
assuming that emotional information (value knowledge) is handled by one system
in the brain, the amygdala, while neutral detail, typically of the background
context (where knowledge), is handled by another brain system, the hippocampus.
It has been established that within much of the range of physiological stress,
amygdala function is enhanced while hippocampal function is impaired. Thus, the
same stress manipulation can simultaneously increase acquisition of one kind of
knowledge while decreasing acquisition of another. The implications of this simple
fact for various legal issues, such as the viability of eyewitness testimony, and the
veracity of recovered memories, are immense (Payne et al., 2003).
 4.6 Forgetting

Forgetting occurs when we fail to recover information that has been experienced
previously. It is an adaptive cognitive capability, feature of memory, designed to
avoid a cluttered mind.

1. Forgetting and its adaptive value.

a. Though we mostly view forgetting as a nuisance, the forgetting process is quite

adaptive, in that we would not be able to learn new information, if we did not
forget some.

b. Furthermore, forgetting unnecessary information helps us to remember

important things.

c. And forgetting painful experiences helps us feel better

Take Note

Key to a GOOD Memory: forget a few things

 Those of us who find forgetfulness troubling might be relieved to
know that forgetting is as important, if not more so, than
remembering. Dr. Gayatri Devi, clinical associate professor,
neurology, psychiatry

Learn more:

http://minnesota.publicradio.org/display/web/2009/01/27/midmorn
ing2/

2. Characteristics of forgetting

Forgetting increases as time progresses and the rate of forgetting changes

a. Ebbinghaus's (1913) Forgetting Curve has logarithmic relationship between time

and forgetting.

i. A rapid rate of forgetting initially

ii. Less additional forgetting at longer delays

3. Mechanisms of Forgetting

a. Decay

b. Encoding Failure: information in STM is not encoded in

c. LTM. Forgetting Due to Encoding Failure? Encoding failure theory proposes that
forgetting is due to failure to encode information into LTM.

d. Interference: Trace Degradation

e. Interference: Cue Impairment

f. Cue Availability

g. Retrieval-Induced Inhibition

h. Motivated Forgetting (Repression)

Let us look at these in more detail:

a. Decay Theory: memory degrades with time. Storage decay theory proposes that
forgetting is due to the decay of physical traces of the information in the brain;
periodically using the information helps to maintain it in the brain. Memory decay
is a biological explanation that proposes that memory traces decay over time and
explains forgetting as a problem of availability - that is, the information is lost
completely from the memory system through disuse and passage of time. Trace
decay theory argues that forgetting occurs when a memory is not actively used the
physical trace between neurons begins to fade away and may be over-written by
new memories.

b. Encoding Failure: information in STM is not encoded in LTM. Encoding failure

theory proposes that forgetting is due to failure to encode information into LTM.

c. In trace-degradation interference forgetting-information no longer stored in

memory, because due a competition phenomena, an interfering memory force
degrades recently formed and still fragile memory traces.

d. In Cue-impairment interference theory of forgetting states that forgetting

occurs because memories interfere with and disrupt one another, in other words
forgetting occurs because of interference from other memories (Baddeley, 1999).
There are two ways in which interference can cause forgetting:

i. Proactive interference (pro=forward) occurs when you cannot learn a new task
because of an old task that had been learnt. When what we already know
interferes with what we are currently learning - where old memories disrupt new
memories.

ii. Retroactive interference (retro=backward) occurs when you forget a

previously learnt task due to the learning of a new task. In other words, later
learning interferes with earlier learning - where new memories disrupt old
memories.

e. In Cue Availability forgetting-information in memory cannot be accessed

(Tulving 1974). Retrieval failure Cue Availability forgetting theory holds that
memories cannot be recalled because certain retrieval cues are absent. There are
two types of cue dependent forgetting:
i. Context - dependent forgetting, which occurs if the environmental cues that
were present when learning took place are absent when the information has to be
recalled.

ii. State - dependent forgetting, which occurs if the emotional state we were in,
when we learned information is not present when we have to recall it.

f. Retrieval-Induced Inhibition Forgetting

In retrieval-induced forgetting, remembering causes forgetting of other

information in memory. Though it occurs as a consequence of conscious
remembering through explicit retrieval, the actual forgetting is thought to
occur implicitly, below the level of awareness. Retrieval-induced forgetting has
been attributed to inhibitory control mechanisms that are recruited to overcome
interference caused by competing memory traces (Anderson and others
1994; Anderson and Spellman 1995; Anderson 2003). Retrieval-Induced Inhibition
has also been tied to memory retrieval strategies, with disrupting such strategies
affecting the phenomenon.

g. Motivated Forgetting (Repression)

Motivated forgetting theory is based on Sigmund Freud's psychoanalysis concept of

the defense mechanism repression, whereby painful and disturbing memories are
made unconscious and very difficult to retrieve. The emotions associated with the
repressed memory may be recovered, or express themselves through dream
analysis, hypnosis and free association.

In text Question

1. What are five theories of forgetting?

2. Describe and evaluate one theory of forgetting

4.7 Strategies for enhancing memory

Activity

How do you remember what you learn? Describe some of the

strategies you've used in the past to help yourself remember
information.

Using Psychology to Improve Our Memory

a. Pay attention and reduce interference.

b. Use rehearsal techniques.
c. Improve your organization.
d. Manage your time.
e. Employ self-monitoring and over learning.
f. Memorization Techniques: Mnemonics are techniques to remembering
information that is otherwise quite difficult to recall. Encode difficult-to-
remember information in a way that is much easier to remember. E.g.,
steps of mental state examination easily remember by the mnemonic "ACT
MAD" - "A"- appearance and behavior; "C" - conversation; ‘T"- thoughts; "M"-
mood; "A"- abnormal perceptions; "D"- dementive (cognitive) functions.
See: http://www.memory-improvement-tips.com/best-study-skills.html
g. Keep a log of the hours that you sleep, subtracting time that you get up
during the night; add up the hours at the end of the week to average how
much sleep you are getting. See:http://www.memory-improvement-
tips.com/sleep-and-memory.htmltips.com/best-study-skills.html

4.8 Summary

4.7 Summary

1. DEFINITION OF MEMORY

encoding, storage and retrieval processes involved in human

memory

2. APPROACHES TO MEMORY

The various memory models approaches include information

processing model, levels of processing approach and the
traditional 3-stage memory model.

3. TYPES OF MEMORY

a. Sensory Memory
b. Short Term / Working Memory
c. Long Term Memory

I. Implicit /Non -Declarative Memory

a. Procedural Memory

b. Priming

c. Classical conditioning

II. Explicit / Declarative Memory

 a. Semantic Memory: Impersonal facts and everyday
knowledge

b. Episodic Memory: Personal experiences linked with

specific times and places

4. THEORIES OF FORGETTING

a. Proactive interference: old information interferes

with recall of new information
b. Retroactive interference: new information interferes
with recall of old information
c. Decay theory: memory trace fades with time
d. Motivated forgetting: involves the loss of painful
memories
e. Retrieval failure: the information is still within LTM,
but cannot be recalled because the retrieval cue is
absent

5. STRATEGIES FOR ENHANCING MEMORY

Pay attention, use rehearsal techniques, improve

organization, time management, self-monitoring and
memorization
techniques.

4.9 References

4.9 References

1. The African textbook of psychiatry and mental health by Ndetei

et al 2006

2. Introduction to psychology textbook by Charles Stangor, 2006

3. Human Intelligence and brain networks: Dialogues Clin Neurosci.

2010 December; 12(4): 489-501

SECTION 5: Language Development

Section outline
5.1 Introduction
5.2 Section objectives
5.3 Language
5.4 Theories of language development
5.5 Stages of Language Acquisition
5.6 Language disorders
5.7 Summary
5.8 References
5.9 Self-test questions

5.1 Section 5 Introduction

Welcome to this section on language and its development. It is probably the most
amazing thing you do! It defines you as human being and you do it with ease so
much so you hardly notice. What am I referring to? Language.
Our capacity to understand, learn, and produce language is amazing. From the
moment we are born, we have language in our lives - the unique ability that
defines us as human. Other animals make sounds to communicate; we are the only
ones on the planet who can talk. Speech and language distinguishes us from all
other species!
Enjoy!

5.2 Section 5 Objectives

Objectives
5.2 Section objectives

At the end of the section you should be able to:

1. Define language

2. Outline theories of language development

3. Describe the stages of language acquisition

4. Describe some language disorders

5.3 Language
 Activity

Without language, there would be no thought. Try thinking ANYTHING witho

it in words, or pictures that could be described by words?

5.3.1 What is language

5.3.1 What is language?
"Language can be thought of as a symbol system, engaged in representing the
world, capturing and communicating thought and experience." ToK Guide
2006
Language is a system of communication. Humans are not unique in this
capability. Many animal species communicate with each other.

Activity

For more on animal communication, watch "The great & mighty Bee"
on http://www.youtube.com/watch?v=4NtegAOQpSs

However, human language is unique in being a symbolic communication system

that maybe is learned as well as being biologically inherited. Language must be
learnable by children, spoken and understood by adults, and capable of expressing
ideas that people normally communicate in a social and cultural context. Children
learn to hear the differences in speech sounds and how to produce them; they
learn the meaning of words and rules for combining them into sentences and they
learn effective ways to talk with others.
In summary, language is our spoken, written, or gestured works and the way we
combine them in various regulated ways to communicate meaning. Language
allows one to do other high order intellectual functions

5.3.2 Origins of language

1. Written records of language date back 5,000 years, but language probably
dates back 150,000-200,000 (when the larynx dropped to its unusual position
allowing speech).
2. Gestures may have developed in tandem rather than as the precusor of
speech.
3. Large brains-or reorganized brains-may have been crucial; or they may have
emerged together in a positive feedback loop created by social interaction in large
groups.
 Take Note

 Kenya sub-Saharan African country

 41 million people
 41 ethno-linguistic groups
 Over 69 languages spoken in Kenya

5.3.3 Two main divisions of language

1. Receptive Language:
a. Listening
b. Listening comprehension (understanding what is said, written or signed)
2. Expressive Language
a. Speaking
b. Writing
c. Signing

.3.3 Language structure or usage

The basic structural components of human language include:
1. Phonology:
a. Phonology is the system of sound segments that humans use to build up words.
b. Phoneme is the smallest distinctive sound unit in a spoken language.
1. Semantics:
a. Morpheme is the smallest unit that carries meaning in a spoken language.
b. Semantics is the system of meanings expressed by words. In order to serve as a
means of communication between people, words must have a shared or
conventional meaning.
c. Semantics is the set of rules by which we derive meaning from morphemes,
words and sentences in a given language.
1. Syntax /Grammar:
a. Grammar is a system of rules in a language that enables us to communicate with
and understand others
b. Syntax is the set of rules for combining words into meaningful (grammatical)
sensible sentences in a given language.
1. Pragmatics:
a. Pragmatics is the set of rules for communication (gestures, intonation).
b. Pragmatics is the system of patterns that determine how humans can use
language in particular social settings for particular conversational purposes e.g.,
conversations customarily begin with a greeting, require turn taking and concern a
shared topic.
In text Question:

SYNTAX AND SEMANTICS

Which of these sentences are grammatical?

Which are meaningful?

 The psychologist slept fitfully dreaming new ideas.

 Fitfully the slept new, ideas dreaming psychologist.

 The new ideas slept fitfully, dreaming a psychologist.

5.3.5 Social role of language

1. Social language predates cognitive language. Indeed, other primates use non-
vocalized language during grooming, eating and mating.
2. Humans have language abilities far superior to those of other animals. In fact,
some would argue that it is this ability which distinguishes us from other animals.
Activity

Rearrange the letters of NEW DOOR to make one word. You are not allowed
letters out or put in any extra letters.

5.3.6 Cognitive role of language

1. Language is unique among mental functions in that only humans truly
possess a language system, and it is one of the most fundamental ways in
which humanity excels.
2. Language enables us to:
a. Interact with others
b. Communicate information, ideas and views
c. Express feelings, wishes and needs
d. Pass on knowledge, skills and desirable predispositions from one generation to
the next. Culture as we understand it, is conveyed through language interaction.

1. Humans are further credited with having the ability to manipulate various
representations /symbols to describe or distort reality. This is what we refer
to as the cognitive function of language. Human language is a complex
cognitive skill.
a. It enables use of metaphors, to communicate thoughts and processes.
b. The symbolization of thought is a powerful tool with which to manipulate one's
thoughts and a mechanism to internally rehearse, critique and modify thoughts.
c. Our language enables us to exploit our basic cognitive capacities of pattern
recognition and transformation in ways that reach out to new behavioral and
intellectual horizons.
d. Is language the key to intelligence?
A major distinctive feature of human intelligence is flexibility. Is recursive
language the key to human flexibility? Language makes concept-based thought
possible thus facilitating to the flexibility that Premack correctly pointed out is a
key factor in human intelligence. Not only is thought silent speech, but one may
also think of speech as vocalized thought. In this sense, then language is the key to
human intelligence. And maybe as a pediatric surgeon Dana Suskind, of University
of Chicago, USA, (2013), says, "Children aren't born smart. They're made smart by
parents talking to them!"
True, children need linguistic nutrition for optimal development of language
abilities. Researchers found that in contrast to claims that baby DVDs and videos -
such as "Baby Einstein", help babies learn language, they may in fact be harmful.
The researchers found that for every hour per day spent watching baby DVDs and
videos, infants understood an average of six to eight fewer words than babies who
didn't watch them (Dr. Dimitri Christakis, researcher at Seattle Children's Hospital
Research Institute and a UW professor, 2009). For now, it looks like ‘screen' time
won't promote babies language development, and it seems the way to strengthen
children's language skills, is through lots of human - to - human social interaction
such as playing, singing, talking, and reading with children.
In text Question

Think about this.

Are children made smart by conversation?

5.3.7 Anatomy and Physiology of Language

1. Anatomy and Physiology of Speech
a. Language would not be possible unless the physical attributes were in place in
which to perform the task of language.
b. Vocal organs such as lungs, larynx, tongue, ears for reception and the relevant
parts of the brain are just some of the physical requirements which have evolved
in the human capable of language.
1. Language areas in the brain
a. Language predominantly lateralized to the left hemisphere. Regions surrounding
the Sylvian fissure of the dominant left hemisphere play a key role in language.
Brain speech areas include:
i. Broca's Area
a) seems to govern production of language
b) Adjacent to motor center that governs speech organs
c) Organizes the articulation patterns of speech
ii. Wernicke's Area
a) Seems to govern comprehension of speech
b) Located near the auditory cortex
iii. Arcuate fasciculus
a) Connection between the two
b) Allows the interaction of production and comprehension
iv. Angular Gyrus
a) Connects visual cortex to the auditory cortex
b) Allows us to read

5.4 Theories of language development

The classic theoretical views about how children acquire language are:
1. ‘Nurture'/ learning theory
2. ‘Nativism'/ biology/ innate
3. Today, most developmentalists hold that an inborn capacity to learn language
may be activated or constrained by experience.
Let us now look at each of these theories in detail:
1. Learning / Environment/ ‘Nurture' Perspective
a. Skinner and Bandura are key learning theorists in the field of language
acquisition.
b. For learning/‘nurture' theorists, language is learned by gradual imitation and
social reinforcement and an intact CNS is the necessary substrate for the
accumulation of information and the establishment of associations.
c. For learning theorists, observation that vocabulary, intonations and accents of
children resemble their parents, is convincing evidence of the primacy of
environmental factors in language acquisition.
d. According to the learning perspective, infants may imitate parents or directly
taught, if they are reinforced they keep saying the word. Children learn language
because they hear it frequently and are rewarded for using it.
2. ‘Nativism'/ Biology/ Innate Perspective
a. The ‘nativism'/ innateness theory was proposed by Noam Chomsky.
b. Noam Chomsky Theories argue that humans have an innate capacity for
language acquisition and that the human brain predisposed to understand language
based on biological foundation the ‘Language Acquisition Device'. According to
Chomsky innate capacity for language acquisition supported by:
i. Early speech sounds are universal and indistinguishable. Children in different
cultures go through similar stages of linguistic development. Universally patterned
stages in language acquisition.
ii. At birth, infants highly sensitive to & show a preference for speech sounds.
iii. We learn language too quickly for it to be by reinforcement & punishment.
iv. Children combine words in ways adults never do.
v. Even retarded children develop language
vi. Infants can derive simple linguistic rules.
c. Other support for nativist perspective include:
i. Broca's and Wernicke's areas
ii. Infant phonetic discrimination
iii. Sensitive period
iv. Invention of language
d. Limitations of the Nativist Perspective
i. There is no single area that is LAD as Chomsky proposed. Instead, LAD may be
thought as several interconnected brain areas.
3. Interactionist / ‘both nature & nurture perspective'
Interactionists combine nature and nurture factors in language acquisition. Inner
capacities, environment and social context work together.
a. Social Interactionist Theory
i. Based on information-processing theory
ii. Language is a result of complex interaction between the child's biological
predispositions and social interactions
b. Interaction of biological heritage & environment
i. Emphasizes innate abilities and environmental influences
ii. Acknowledges the import roles of nature and nurture
iii. Social-pragmatic- practical reason for language is communication

5.5 Stages of Language Acquisition

1. Prelinguistic Period (until 10 to 13 months)

i. Making sounds:
a. Cooing
b. Babbling
Let us now look at each of these in detail:
a. Cooing is compromised of all possible sounds; all infants coo in the same way
regardless of culture, language, hearing impaired or not
b. Babbling Stage: beginning at 3 to 4 months - stage of speech development in
which infant spontaneously utters various sounds at first unrelated to the
household language
ii. Learning the rules
a. Taking turns
b. Gestures and non-verbal communication
c. Receptive vs. productive language
2. Linguistic Period
a. One-Word Stage: *stage in speech development during which child peaks mostly
in single words *about age 1 to 2
b. Two-Word Stage: *beginning about age 2 *stage in speech development during
which child speaks mostly two-words statements
c. *Holophrastic phrases (action words, naming objects, modifiers).
d. Telegraphic Speech:*early speech stage in which child speaks like a telegram -
"go car" - using mostly nouns and verbs and omitting "auxiliary" words
e. Basic adult sentence structure (by age 4)
The following table summarizes the stages of language development.
Summary of the stages language development
Month (approximate) Stage
4 Babbles many speech sounds
10 Babbling household language
12 One-word stage
24 Two-word, telegraphic speech
24+ Language develops rapidly into complete sentences
3. Strands of language development
a. Vocabulary concepts:Understanding the meaning of words heard, and later
read, is a key predictor of reading success. Children learn vocabulary through
multiple, meaningful experiences which allow them to associate the word with its
meaning.
b. Language structure or usage: To build language structure or usage,
parents/teachers observe, listen and respond to children while engaging them in
extended interactions and conversations
4. Communicative Competence
a. Another important part of language learning is communicative competence.
b. Communicative competence is the ability to convey thoughts, feelings and
intentions in an organized, culturally patterned way that sustains human
interactions.
c. Use of gestures is an important part of language development.

5.6 Language disorders

5.6.1 What are language disorders?

1. Definition: Language disorder is characterized by difficulties in using or

understanding language. For children with language disorders, acquiring and
developing speech, language and communication, is quite challenging.
 2. Etiology of language disorders: Several factors have been implicated in the
etiology of language disorders including:
 Mental retardation
 Hearing loss
 Maturation delay
 Bilingualism
 Psychosocial deprivation
 Childhood disorders such as autism, elective mutism, expressive and
receptive language disorders.
1. Types of Language disorders:
1. Delayed speech
This is failure to develop speech at the expected age. It is usually associated with
other maturational delays, as well as a hearing impairment, mental retardation,
emotional disturbance, brain injury or environmental deprivation.
2. Developmental expressive aphasia
Failure to develop use of speech at the usual age but there is normal intelligence,
normal hearing, good emotional relationships and normal articulation skills; and
comprehension of speech is appropriate to the age of the child.
3. Expressive language disorders
The primary deficit appears to be a brain dysfunction that results in an inability to
translate ideas into speech. Gestures may be used to supplement their limited
verbal expression.
4. Dyslexia
Dyslexia is problem in learning to read despite adequate intelligence and
schooling.
5. Alexia
Alexia is acquired dyslexia in adulthood as a result of disease or injury.
6. Aphasia
Aphasia is the inability to perceive, process, or produce language because of an
injury or developmental abnormality in the brain. Aphasia results in loss of the
ability to speak, inability to write (agraphia), inability to read (alexia), unintended
words of phrases (paraphasia), loss of tone in voice (aprosidia) or inability to
comprehend language. Major types of aphasia include:
a) Broca's aphasia /non-fluent aphasia which results in an inability to produce
sequences of sounds in fluent speech; poor repetition, tendency to eliminate any
functional vocabulary; and telegraphic speech.
b) Wernicke's aphasia/fluent aphasia which results in inability to understand
speech and inability to speak meaningfully; fluent meaningless speech, word
salad, paraphasias -and neologisms - non words.
c) Anomic (word-finding deficit) aphasia is difficulties naming objects (lexical
retrieval), acquired dyslexia and acquired dysgraphia are due to angular gyrus
damage.
d) Global aphasia - a total loss of language.

5.6.1 Language Terms and Concepts Puzzle

 聽 LANGUAGE TERMS AND CONCEPTS PUZZLE
1
2 3

11

12 13

14

16

18

19

20

21

22
聽 聽

Across Down
2. Key behaviorist learning theorist in the field 1. Short popular saying
of language acquisition 2. Positive emotional
5. Cognitive development theory of language gesture
acquisition 3. Disturbances in reading
7. The verbal means of communicating 4. Governs production of
8. Governs comprehension of speech language
10. Vocal organs 6. speech that appears at
11. Making sounds around age 2 years
13. Loss of the ability to speak or comprehend 7. The system of meanings
language expressed by words
14. Action words 9. Powerful tool used to
16. The set of rules used for communication manipulate one's
17. Expressive Language thoughts
18. Sociocultural approach of language 12. Proposed 鈥榥ativism'/
acquisition innateness theory of
language acquisition
20. Receptive Language
15. A symbolic
21. Problem in learning to read
communication system
22.
Impairment in writing 16. Sound segments that
聽 humans use to build up
words
19. The system of rules by
which words are
arranged to make
meaningful statements

5.7 Summary
5.7 Summary

Definition of language

 Language is our spoken, written, or gestured works and the way

meaning. Language allows one to do other high order intellectu
 Human language probably dates back to 150,000-200,000.
 Reorganized brains-may have been crucial in its evolution.
 Language divided into receptive and expressive language.
 Basic structural components of human language include: phonol
 Language has important social and cognitive roles.
  Vocal organs such as lungs, larynx, tongue, ears for reception an
requirements which have evolved in the human capable of langu

Language areas in the brain

 Language predominantly lateralized to the left hemisphere. Reg

hemisphere play a key role in language.
 Broca's Area governs production of language
 Wernicke's Area governs comprehension of speech
 Arcuate fasciculus allows the interaction of production and com
 Angular Gyrus allows us to read

Theories of language development

1. Learning / Environment/ ‘Nurture' Perspective

 Skinner & Bandura key learning theorists in language acquisition

 Propose language is learned by gradual imitation and social rein
accumulation of information and the establishment of associatio

2. ‘Nativism'/ Biology/ Innate Perspective

 The ‘nativism'/ innateness theory was proposed by Noam Choms

 He argues for a human innate capacity for language acquisition
 There is no single area that is LAD as Chomsky proposed. Instea

3. Interactionist / ‘both nature & nurture perspective'

 Interactionists combine nature, nurture factors, inner capacitie

acquisition.
 Today, most developmentalists hold that an inborn capacity to

Stages of Language Acquisition

1. Prelinguistic period consists of

 Cooing and babbling

 Learning the rules - gestures, receptive vs. productive language

2. Linguistic Period

 One-word stage
 Two-word stage/holophrastic phrases (action, naming, modifier
 Telegraphic speech - child speaks like a telegram - "go car" -
 Basic adult sentence structure (by age 4)
3. Strands of language development

 Vocabulary concepts - understanding the meaning of words.

 Language structure built by listening and responding to children
conversations.

4. Communicative competence

 It is the ability to convey thoughts, feelings and intentions in an

interactions.
 Use of gestures is an important part of language development.

Language disorders

1. Language disorder is

 Characterized by difficulties in using or understanding language

 Etiology of language disorders includes mental retardation, hea
deprivation, autism, expressive and receptive language disorder

2. Types of Language disorders:

 Delayed speech
 Developmental expressive aphasia
 Expressive language disorders
 Dyslexia
 Alexia
 Major types of aphasia include:

a) Broca's aphasia /non-fluent aphasia

b) Wernicke's aphasia/fluent aphasia

c) Anomic (word-finding deficit) aphasia due to angular gyrus damag

d) Global aphasia - a total loss of language.

We are all aware of the important role language plays in human learni
are measured and defined through language-based communication. Th
most often judged by their verbal proficiencies. A person who speaks e
accorded more credibility than an individual who makes constant gram
 5.8 References
5.8 References

1. The African textbook of psychiatry and mental health by

Ndetei et al 2006

2. Introduction to psychology textbook: Charles Stangor, 2006

3. Handbook of the Neuroscience of Language: Brigitte Stemmer

& Harry Whitaker, First edition 2008

5.9 Self-test questions

Refer to the text and state whether the following is True o

1. You present a child with four pictures, asking him to

task measures:

a. Language production

b. Pragmatic perception

c. Language comprehension

d. Speech perception

e. Psychology

2. The notion of _________ claims that learning is the

a. Modularity

b. Functionalism

c. Connectionism

d. Behaviorism

e. Nativism

SECTION 6: Motivation and Emotion

Section outline
6.1 Introduction
6.2 Section objectives
6.3 Defining Motivation
6.4 Motivation and the Brain
6.5 Motivational theories
6.6 Defining Emotion
6.7 Emotion and Biology
6.8 Relationship between motivation and emotion
6.9 Theories of Emotion
6.10 Summary
6.11 References
6.12 Self-test questions

6.1 Introduction
Welcome to this section on Motivation and Emotion. Just like it is done in a thriller
novel, we have left these fascinating factors for the last! Motivation is an ever-
present, essential determinant of behavior and adaptation. For most adults just
seeing what needs to be done brings with it the motivation to get the task or job
done, however, lack of motivation can make it feel as if there is no reason to do
anything. Motivation is like the last or at least a critical piece of puzzle of
understanding the human mind and behavior. In this section we will explore the
concept and various theories of why do we behave the way we do. We will also
examine why emotions are an essential part of what makes us human. Enjoy!

6.2 Section 6 Objectives

Objectives
6.2 Section objectives

At the end of the section you should be able to:

1. Define motivation
2. Describe various theories of motivation
3. Define emotions
 4. Describe 4 theories of emotions

6.3 Motivation
6.3.1 Defining Motivation
 What is Motivation? Motivation is "the underlying why" or explanation for
behavior. And motivation a force that energizes activates and directs
behavior, as suggested by Ford (1992), "provides the psychological
foundation for the development of human competence in everyday life".
 In 2006, Franken defined motivation as the "arousal, direction and
persistence of a person's behavior". Motivation may further be defined as
the amount of effort that one puts into doing something as well as their
willingness to exert high levels of effort and persistence towards goals.
One's goals, beliefs, feelings and perceptions determine their motivated
behavior, so if one values a task and believe they can master it; they are
more likely to use different strategies, try hard, and persist until
completion of the task. If students believe that intelligence changes over
time, they are more likely to exhibit effort in difficult courses than students
who believe intelligence is fixed.

FIGURE DEPICTING MOTIVATION AS EXPLAINED ABOVE

Activity

Ponder on the following proverbs and then explain what they mean in
context of motivation as discussed above.

1 What ever the mind of man can conceive and believe, it can achieve
~Napolean Hill

2 He who is destined for power does not have to fight for it. ~ Uganda
To summarize then we can say that motivation is the readiness to invest effortinto
accomplishing objectives.

6.3.2 Motivational moderators

6.3.2 Motivational moderators
Motivational factors include personal goals; capability beliefs, context beliefs/
options perceived to be available and situational incentives. Motivational factors
will be covered in detail later when discussing theories of motivation.
6.3.3 Motivational moderators
Genetic/personality differences as well as learning are motivational moderators
influence the impact of motivation on behavior.

Figure depicting motivational moderators' impact motivational influence

6.4 Motivation and Biology

6.3.1 Components of Motivation
6.3.1.1 Biological component
6.3.1.2 Learned component
6.3.1.3 Cognitive component
6.3.1.4 Behavior is caused by an interaction of biological, learned, and cognitive
processes: brain circuits are activated, learned responses are triggered, and
control is taken by making plans.
Let us look at these in more detail.
The Biological Component
Main focus on the structure/design of the brain
a) Evolutionary theory
 Assumes our brain today is a result of years of experiences and learning.
 Brain is made up of number of systems that work together with the body to
produce our actions.
 Humans have two central complementary drives (minds): self-preservation
and the preservation of the species.
b) Temperament
 Refers to how we react to the world (reactivity) and how we self-regulate
ourselves (self-control) in the face of certain environmental demands. (Our
predisposition to act one way or another.)
 High activity (preference for intense stimulation and like of risk-taking)
 Negativity (fearful/sad and angry when frustrated)
  Regulation of attention/behavior (effortful control)
c) Brain circuits: structures work together with one another with connecting
pathways that are aroused simultaneously.
 Approach/Avoidant Motivation Brain Circuits
o Behavioral Activation System (BAS)
o Activated by conditioned signals or rewards and nonpunishment,
arousal is enhanced to promote increased approach behavior.
 Behavioral Inhibition System (BIS)
o Activated by conditioned signals of punishment and nonreward, as
well as novel stimuli, arousal is enhanced to inhibit ongoing behavior.
 Pleasure/Punishment Motivation Brain Circuits
o The Reward Pathway
o Reward centers are stimulated when positive responses occur.
o Humans are motivated to perform actions that produce positive
feelings.
o Done through combination of dopaminergic pathways and limbic
system.
 Limbic system: set of interconnected structures deep within the brain that
regulates emotions such as fear, love, and anger. The Limbic system helps
in adaptation of environmental demands.
 Plasticity: whether the basic structure of the brain can be altered as the
result of certain experiences or thought processes.
 Synapses: gaps that separate short lengths of nerve fibers in which neuro-
transmitters are released and carry information.
 Neurotransmitters: chemicals that carry information across the synapse.
 Norepinephrine/serotonin/dopamine: high levels = euphoria, low levels =
depression

6.5 Theories of Motivation

6.5.1 Instinct Theories
6.5.2 Drive Theories
6.5.3 Need Theories/ Maslow's Hierarchy of Needs
6.5.4 Incentive Theory
6.5.5 Arousal Theory
6.5.6 Growth/Mastery theories
6.5.7 Cognitive Theories
Let us look at these in more detail.

6.5.1 Theories of Motivation cont...

6.5.1 INSTINCTS THEORY
The instincts theory arose from Darwin's (1859) variation and natural selection
ideas. Instincts are genetically programmed behaviours that are common to all
creatures and are associated with specific innate knowledge about how to survive
(James, 1890). Babies are born with a unique ability to survive; for example baby's
cry, signals when to feed the baby, when baby needs changing, or when baby
wants attention and affection!
Instincts theory is consistent with evolutionary theory, however, the theory is
inadequate because: there are no explanations as such, the theory just uses
descriptive labels and the theory also handles environment influences behavior
quite poorly.
6.5.2 DRIVE REDUCTION THEORY
The drive reduction theory arose as a result of the scientific reaction to instinct
paradigm. According to Hull (1940) organisms possess a hierarchy of needs which
are aroused under conditions of stimulation and drive. Drive theories postulate a
single motivation (drive) that provides motivation for all behaviours and learning is
proposed as the directing force of drive.
Key assumptions of drive theories
 Drive caused by deficits (food, water, sleep, etc.)
 Drive energizes behavior
 Need - for example - lack of food, lack of water
 Drive reducing behavior (e.g., eating, drinking)
o Reducing drive is reinforcing and leads to learning (habit)
Problems
 Motivation without deficits (eating desert when full)
 Learning without drive reduction (remembering location of drive relevant
stimulus)
 Motivation due to external stimuli (artificial sweeteners)
6.5.3 NEED THEORIES
 People have a finite number of needs and can (based on learning) use
different behaviours to obtain them
 Needs are now viewed more as personality dispositions (personality
differences) rather than sources of motivation

6.5.2 Theories of Motivation ...

6.5.4 MASLOW'S HIERARCHY OF NEEDS
Maslow (1970), the founder of humanistic psychology (learning from human
potential for growth perspective), formulated a hierarchy of biogenic and
psychogenic needs, in which certain levels of motives are specified. Maslow
believed that human motivation is driven by a set of needs. The order of
development is fixed: a certain level must be attained before the next higher one
is activated. One must first satisfy basic needs before progressing up the ladder: a
starving man shouldn't be interested in status symbols, friendships or self-
fulfilment. If we are interested in what actually motivates us and not what has or
will, or might motivate us, then a satisfied need is not a motivator.
MASLOW'S HIERACHY OF NEEDS

 Self-Actualization is the highest and most difficult level to reach. It refers

to the desire for self-fulfillment, namely the tendency for one to become
actualized in what one is potentially. According To Rowan (1998), self-
actualization is an ongoing search to develop and to grow and the Maslow's
pyramid of hierarchy of needs is misleading as it suggests that there is an
end point to personal growth.
 Biological/Physiological needs such as hunger and thirst are at the lowest
level of triangle hierarchy and these must be attended to before one can
deal with higher ranked needs of safety, belonging and love, self-esteem,
and finally, self-actualization.
Critics about Maslow's Hierarchy
 What are some major features of Maslow's hierarchy of needs?
 How this model may be culturally linked?
o E.g., the meaning of self-actualization
o The content and hierarchical order
6.5.5 INCENTIVES THEORY
Incentive theory holds that certain external stimuli act as incentives, pulling us
toward some behaviour. The basic concept behind the incentive theory is goals.
Incentives may be tangible (involve feeling good about oneself)
or intangible (involve awards or something to give public recognition).
6.5.6 AROUSAL THEORY
Arousal is a term used for a general state of physiological activation. Arousal
theory holds that we act so as to bring about an optimal level of arousal (Donald
Hebb [1955]). When we are too aroused (e.g. hungry) we act to reduce arousal
(e.g. eat). When we are not aroused enough (e.g. bored), we act to increase
arousal (e.g. read a book).
Yerkes-Dodson law

The graph of performance versus arousal is an inverted U:

 Performance improves with increased arousal up to a point, then it drops
off.
 Optimum performance on an easy task occurs at a higher level of arousal
than on a difficult task.
This shows that ability to do a menial job may actually be improved by having
music on, and so forth.

6.6 Defining Emotion

Activity

As you study this section on emotion, reflect on a Kikuyu proverb that

that "Keguoya kainukiire nyina" meaning "the scared one went back
mother!"
6.6.1 What is emotion?
Emotion is defined as the explicit and personal manifestation of stirred up
mental, biological, physiological and/or psychological states.
Diagram depicting ‘emotion' as described above

6.6.2 Defining related terms It is also important to differentiate the term

‘emotion' from ‘feeling, affect; and ‘mood' which are somehow similar but are
really different terms.
a. Feelings are the internal subjective representation of emotions, such as
sadness, anger, and happiness.

6.7 Theories of Emotion

Some theories of Emotion are:
6.7.1 James-Lang Theory
6.7.2 Cannon-Brad Theory
6.7.3 Schachter's Two-Factor Theory
6.7.4 Theories of Emotion and Catharsis
Let us look at these in more detail.
6.7.1 James-Lange Theory of Emotion

The James-Lange Theory of Emotion proposes that emotion arises from

physiological arousal.
6.7.2 Cannon-Bard Theory of Emotion
For the Cannon-Bard theory of emotion, the "body" (physiological systems) and
"mind" (emotional experience) are independently activated at the same time. The
two are proposed to be two separate independent systems.
6.7.3 Schachter's Two-Factor Theory of Emotion
The above purely physiological theories tend to ignore the crucial role played by
social, cultural and environmental factors in the perception, expression and
experience of emotion as well as the cognitive appraisal of a situation in
understanding emotion, hence the proposal of the Schachter's (cognitive
labeling) theory two-factor theory of emotion.

According to the Schachter's Two-Factor theory of emotion, one first becomes

aware of assess bio-physiological arousal reactions, such as sweaty palms and
increased heart rate. Then through mental processing attribute the source of
arousal to a cause.
6.7.4 Theories of Emotion and Catharsis
a) 'Catharsis theory' is grounded in the idea that feelings build up and create
pressure if not vented, accordingly much of our "suffering" is due to unexpressed
feelings. It is not always easy to express our emotions, however, "a problem shared
is a problem halved." Releasing emotions decreases the tension in the person.
b) Catharsis is the ‘letting go' of emotion.
c) Theories of emotion and catharsis have been found to be consistent with James-
Lange theory of emotion.
 a) Take Note An example of emotional catharsis in our
local context is "The Ngoma Healing Ritual of the Taita
People".
b) For more information on this see: Akombo, David.
Music and Healing: A Comparative Study of the Taita of
Kenya and the Balinese of Indonesia. M.M Dissertation.
Bowling Green State University. 2002.

6.8.1 Face and Emotion

1. Neurophysiology studies show that there is universal neurophysiology in the

facial muscles. Facial expressions affect the sympathetic nervous system. A
smile sends a message to the brain and positive emotions increase. How
many facial muscles do we have? 44? Apparently it takes 40, 41 or
43 musclesto frown and 17 to smile!
2. Facial feedback hypothesis According to the facial feedback hypothesis
facial feedback is an important factor in the feeling of emotion. The theory
suggests that our mood can be changed by adopting a different facial
expression. The expression of positive emotions is being recognized as a way
of raising the feeling of positive emotions.

Activity
 People felt happier when adopting a happy face and angrier when
adopting an angry face. Experiment with this by pulling a happy face
and then an angry face right now. How did it make you feel?

1. Paul Ekman's neuro-cultural theoryindicates that there are seven universal

facial expressions of emotion are anger, happiness, fear, surprise, disgust,
sadness & contempt. And that though facial expressions are universal of
emotions, there are culture-specific variations in the expression of emotion.

6.8.2 The Brain and Emotion:

1. The Amygdala and Emotion

i. The amygdala is responsible for assessing threat. It gets information from cortex,
hippocampus, and sensory systems. Then sends instructions out to autonomic
nervous system (ANS) and other brain areas for emotions.

ii. The Amygdala is very important particularly for negative emotions, especially
fear. Threatening situations are picked; amygdala then sends instructions to other
brain areas to increase heart rate, vigilance, etc. and is responsible for us learning
that a situation is dangerous and responding to it.

iii. Due to emotion bypass the cortical areas involved in thinking, via the thalamus
to the amygdala, the emotional control center, we sometimes feel some emotions
before we think. This shortcut enables a quick, precognitive emotional response
before the intellect intervenes

iv. Human damage to the amygdala produces difficulty identifying fear and anger.

v. Imaging studies show that stimulation of the amygdala can produce fear and
anxiety and that more activity in the amygdala when viewing expressions of fear.

In text Question

vi. Amygdala and emotion: How do you think this would relate
to the kikuyu proverb mentioned above?

vii. Please search for other proverbs or quotations from the

internet and explain how they relate to what you knew as well
as what you have learnt about emotion.

1. The Cortex and Emotion

1. Research indicates that there is hemisphere lateralization for emotion. Left

hemisphere damage results in depression, but ones with right hem damage
often cheerful.
 2. Hemisphere lateralization for emotion influences perception. Emotional
right hemisphere produces more expression on the left side of the face

Activity

1. Which face looks hap

 Which face looks s

 The right hemisphe

accurately than lef
hemisphere (top pi

 The top picture loo

 But, pictures just m

any different

6.8.3 Hormones and Emotion

After perceiving sensory stimulus, the adrenal gland sends two hormones:
epinephrine and nor epinephrine. They activate the sympathetic nervous system
that produces a state of arousal or alertness that provides the body with the
energy to act (the pupils dilate, the heart beats faster, and breathing speeds up).

Puzzle On Terms And Concepts About Motivation

And Emotion

Puzzle On Terms And Concepts About Motivation

And Emotion
 6.5 Summary
6.5 Summary

Definition of terms:

 Emotion is the explicit and personal manifestation of stirred

 Feelings are the internal subjective representation of emotio

 Mood is a general, protracted and sustained emotional attitu

 Affect is the pattern of observable behaviours associated wit

 Theories of emotion:

 The James-Lang Theory proposes that emotion arises from ph

 For the Cannon-Bard theory of emotion, the physiological sys

The two are proposed to be two separate independent system

 According to Schachter's Two-Factor theory of emotion, first

mental processing one attributes the source of arousal to a c

 Theory of Emotional Catharsis is grounded in the idea that fe

go' of emotion is therapeutic.

Emotion and Biology:

 Facial feedback hypothesis suggests that our mood can be ch

 According to Paul Ekman's neuro-cultural theory the seven u

disgust, sadness & contempt. And there are culture-specific v

 The amygdala is responsible for assessing threat. Human dam

 There is hemisphere lateralization for emotion.

 Hormones such as epinephrine play a role in emotion.

6.5 References
6.5 References

1. The African textbook of psychiatry and mental health, Ndetei et al 2006

2. Introduction to psychology textbook by Charles Stangor, 2006

3. Learning and Memory: A Comprehensive Reference. Editor-in-Chief: John H. By

6.11 Self-test questions

SCORM Quiz
1. When you are engaging in goal-directed behavior, you may be
best described as experiencing

a. Emotion

b. Motivation

c. An incentive

d. Drive reduction

e. None of the above

2. Body language is directly related to the ____ component of

emotion.

a. Cognitive

b. Behavioral

c. Perceptual

d. Physiological

e. Mental

3. Autonomic arousal most directly relates to the ____ component

of emotion.

a. Behavioral

b. Physiological

c. Perceptual
 d. Cognitive

e. Spiritual

4. An external goal that has the capacity to motivate behavior is

a. An incentive

b. A drive

c. A motive

d. A need

e. Arousal

UNIT 2: DЕVЕLОPMЕNTАL PSYСHОLОGY

Unit Intrоduсtiоn
Wеlсоmе bасk tо е-lеаrning in fundаmеntаls оf psyсhоlоgy! Wе hоpе yоu аrе wеll
intrоduсеd tо thе bаsiс соnсеpts in psyсhоlоgy. This unit wоuld bе fосusing оn
Dеvеlоpmеntаl pеrspесtivе, thеоriеs аnd аpprоасh tо humаn bеhаviоr. Humаn
dеvеlоpmеnt is оnе оf thе соrе аrеаs оf psyсhоlоgy. Dеvеlоpmеnt stаrts right аt
соnсеptiоn аnd соntinuеs until thе еnd оf humаn lifе whеrе prосеssеs оf сhаngе
bring thе individuаl tо diffеrеnt lеvеls оf funсtiоning.
In this Unit wе will intrоduсе yоu tо dеvеlоpmеntаl psyсhоlоgy in twо sесtiоns. Thе
first оnе fосusеs оn dеvеlоpmеnt thаt tаkеs plасе frоm birth tо еаrly infаnсy. Wе
lеаrn аbоut pеrсеptuаl аnd mоtоr со-оrdinаtiоn, lаnguаgе аnd соgnitivе
dеvеlоpmеnt аnd sосiо-еmоtiоnаl dеvеlоpmеnt thаt tаkеs plасе in еаrly infаnсy.
Gеndеr аnd mоrаl dеvеlоpmеnt аrе аlsо disсussеd. Thе sесоnd sесtiоn lооks аt
dеvеlоpmеnt frоm еаrly infаnсy оn tо аdоlеsсеnсе аnd tо аdulthооd аnd оnwаrds.
It lооks аt diffеrеnt prосеssеs оf сhаngе suсh аs idеntity, sосiо-еmоtiоnаl
dеvеlоpmеnt during аdоlеsсеnсе. Сhаllеngеs оf еаrly аdulthооd аnd hоw it diffеrs
frоm mid-аnd lаtе-аdulthооd аrе аlsо disсussеd. Wе lооk аt thе phеnоmеnоn оf
‘mid-lifе сrisеs' аnd сhаngеs thаt tаkе plасе during оld аgе frоm diffеrеnt pоint оf
viеws аnd pеrspесtivеs.
Wе hоpе thаt yоu will find thеsе twо sесtiоns еngаging аnd thоught-prоvоking in
tеrms оf hоw psyсhоlоgiсаl fасtоrs drivе dеvеlоpmеnt аnd hоw muсh оf
dеvеlоpmеnt is psyсhоlоgiсаl in nаturе. Gооd luсk in lеаrning thеsе sесtiоns!

1.2: Оbjесtivеs

Objectives
Unit Оbjесtivеs

By thе еnd оf thе Unit yоu shоuld bе fаmiliаr with thе

1. Dеsсribе kеy dеvеlоpmеnts prосеssеs frоm birth

аttеntiоn tо thе соgnitivе, bеhаviоrаl, sосiаl аn
оf dеvеlоpmеnt
2. Соmpаrе kеy аpprоасhеs аnd mеthоds tоwаrds u
dеvеlоpmеnt.

Let us now focus on the first section.

Sесtiоn 1: Humаn Dеvеlоpmеnt, Pаrt I:

Undеrstаnding Prосеssеs Frоm Birth Thrоugh Еаrly
Сhildhооd
1.0 Sесtiоn Оutlinе
1.1 Sесtiоn Intrоduсtiоn
1.2 Sесtiоn Оbjесtivеs
1.3 Mеthоds оf Studying Dеvеlоpmеnt
1.4 Prеgnаnсy thrоugh Birth
1.5 Birth thrоugh Infаnсy
1.6 Pеrсеptuаl аnd Mоtоr Dеvеlоpmеnt
1.7 Соgnitivе Dеvеlоpmеnt аnd Infоrmаtiоn Prосеssing (Piаgеt аnd Vygоtsky)
1.8 Lаnguаgе Dеvеlоpmеnt
1.9 Аttасhmеnt & Еmоtiоnаl Dеvеlоpmеnt
1.10 Sеlf-соnсеpt & Sосiаl Dеvеlоpmеnt
1.11 Gеndеr Diffеrеnсеs
1.12 Mоrаl Dеvеlоpmеnt оf Sсhооl Аgе Сhildrеn
1.13 Summаry

1.1 Sесtiоn Intrоduсtiоn

Lеt us stаrt by thinking аbоut humаn dеvеlоpmеnt - it is а stоry оf сhаngеs аnd
trаnsitiоns thаt wе аll grоw thrоugh right frоm birth. Thе sесtiоn highlights thе
impоrtаnсе оf dеvеlоpmеntаl pеrspесtivе within psyсhоlоgy. This fосusеs оn сhild
dеvеlоpmеnt аnd shоws еvоlutiоn оf а humаn bеing frоm соnсеptiоn tо еаrly
infаnсy. It fосusеs оn dеvеlоpmеnt асrоss diffеrеnt dоmаins suсh аs pеrсеptuаl
аnd mоtоr dеvеlоpmеnt, соgnitivе аnd lаnguаgе dеvеlоpmеnt аnd thеn fосusеs оn
sосiо-еmоtiоnаl dоmаins suсh аs аttасhmеnt rеgulаtiоn, sеlf-соnсеpt, gеndеr аnd
mоrаl dеvеlоpmеnt.

1.2: Sесtiоn оbjесtivеs

Objectives
By thе еnd оf this sесtiоn, yоu shоuld bе аblе tо:

1. List kеy mеthоds tо study dеvеlоpmеnt

2. Dеsсribе thе dеvеlоpmеntаl prосеss frоm prеgnаnс
3. Оutlinе thе dеvеlоpmеntаl prосеss frоm birth tо еа
4. Еnlist thе kеy prосеssеs thаt tаkе plасе in еаrly pе
dеvеlоpmеnt
5. Еxplаin thе соgnitivе dеvеlоpmеnt prосеssеs inсlud
prосеssing mоdеl
6. Оutlinе lаnguаgе dеvеlоpmеnt in infаnсy аnd еаrly
7. Еvаluаtе аttасhmеnt аs оnе оf thе еmоtiоnаl dеvеl
8. Еvаluаtе hоw gеndеr аnd mоrаl dеvеlоpmеnt influе

1.3 Mеthоds оf Studying Dеvеlоpmеnt

Thе study оf humаn dеvеlоpmеnt hаs intеrеstеd prоud pаrеnts thrоughоut histоry.
Mаny fаmоus mеn, inсluding Сhаrlеs Dаrwin, Jаmеs Mill, Jеаn Piаgеt, thе Swiss
сhild psyсhоlоgist, аnd Jоhn B. Wаtsоn, thе fоundеr оf bеhаviоrism, hаvе kеpt
dеtаilеd rесоrds оf thе grоwth оf thеir сhildrеn, nоting whеn thе сhild first mоvеd
its hеаd, rоllеd оvеr, сrаwlеd, smilеd, sаid а wоrd сlеаrly, сut tееth, wаlkеd, аnd
sо оn. Thеsе diаriеs аnd jоurnаls plus оur оwn rесоrds оf еxpеriеnсе with fаmiliаr
сhildrеn yоungеr brоthеrs оr sistеrs оr оur оwn сhildrеn givе us whаt mаy bе саllеd
оbsеrvаtiоnаl dаtа оn сhild dеvеlоpmеnt. Thе first соmplеtе оbsеrvаtiоn оf а сhild
wаs mаdе by Miliсеnt Shinn оf Nilеs, Саlifоrniа. Shе hаd bееn еditоr оf thе
Оvеrlаnd Mоnthly аnd wаs thе first wоmаn tо rесеivе а Ph.D. dеgrее frоm thе
Univеrsity оf Саlifоrniа, Bеrkеlеy. Shе mаdе dаily rесоrds оf thе оbsеrvаtiоns оf
hеr niесе аnd publishеd thеsе rесоrds in Thе Biоgrаphy оf а Bаby.

Nаturаlistiс оbsеrvаtiоnis оftеn thе оnly wаy humаn dеvеlоpmеnt саn bе studiеd.
Dеvеlоpmеntаl psyсhоlоgy bесаmе sсiеntifiс, likе оthеr fоrms оf psyсhоlоgy, in
thе middlе оf thе ninеtееnth сеntury. Hоwеvеr, dеvеlоpmеntаl studiеs prеsеntеd
сеrtаin diffiсultiеs thаt wеrе nоt fоund in оthеr brаnсhеs оf psyсhоlоgy --
diffiсultiеs duе tо thе nаturе оf thе subjесt.
Mаny gеnuinеly intеrеsting prоblеms, suсh аs thе еffесt оf bеing dеprivеd оf
mоthеr lоvе оr thе еffесt оf mаlnutritiоn, соuld nоt bе studiеd in соntrоllеd
еxpеrimеnts. Nо оnе wоuld stаrvе bаbiеs оf аffесtiоn оr fооd. Thus, аlthоugh, thе
еxpеrimеntаl mеthоd hаs bееn еmplоyеd whеn it wаs pоssiblе tо mаkе usе оf it
withоut hurting infаnts аnd сhildrеn, muсh оf thе invеstigаtiоn оf humаn
dеvеlоpmеnt hаs usеd оthеr rеsеаrсh mеthоds.
Thrее mаjоr rеsеаrсh mеthоds rеprеsеnt thе mоst impоrtаnt kinds оf invеstigаtiоn
аvаilаblе tо dеvеlоpmеntаl psyсhоlоgists tоdаy аnd inсludе thе:
a. Сrоss-sесtiоnаl study
b. Lоngitudinаl study
c. Сrоss-сulturаl study.
А fоurth mеthоd, thе со-twin study, will аlsо bе mеntiоnеd briеfly. Thеsе mеthоds
will bе соntrаstеd with thе еxpеrimеntаl mеthоd.
 1.3.1 Сrоss Sесtiоnаl Mеthоd
Thе сrоss-sесtiоnаl mеthоd оf invеstigаtiоn оftеn is usеd whеn thе rеsеаrсh аim is
tо соmpаrе dеvеlоpmеntаl lеvеls аt vаriоus аgеs оr bасkgrоunds. Mаny сhildrеn аt
diffеrеnt аgеs аrе studiеd in grоups ассоrding tо thеir аgе, аnd thе rеsults оn thе
sаmе sеts оf mеаsurеs аrе соmpаrеd fоr thе grоups. Fоr еxаmplе, thе аpprоximаtе
аgе аt whiсh аn infаnt саn bе еxpесtеd tо rоll оvеr, сrееp, сrаwl, pull himsеlf up
tо а stаnding pоsitiоn, аnd wаlk unаidеd саn bе dеtеrminеd by оbsеrving thе
bеhаviоr оf grоups оf сhildrеn frоm birth until thе аgе оf аbоut 15 mоnths. If wе,
аs invеstigаtоrs, study а grоup оf оnе- mоnth-оld infаnts, аnоthеr grоup оf twо-
mоnth оlds, аnd а diffеrеnt grоup оf bаbiеs аt еvеry mоnth оf аgе thеrеаftеr, wе
will hаvе а сrоss-sесtiоnаl rеsеаrсh dеsign. А сrоss-sесtiоnаl study mаy аlsо
соmpаrе pеоplе frоm diffеrеnt bасkgrоunds. If thе rеаding аbility оf six-yеаr-оlds
wеrе mеаsurеd in lоw, middlе, аnd high-inсоmе fаmiliеs, оnе wоuld hаvе а "сrоss-
sесtiоn" оf rеаding аbility аt thаt аgе fоr thе vаriоus inсоmе grоups in а
соmmunity.

1.3.2 Lоngitudinаl Mеthоd

Wе соuld аlsо hаvе оbtаinеd оur dаtа using а lоngitudinаl rеsеаrсh dеsign. In
lоngitudinаl studiеs, thе rеsеаrсhеr fоllоws thе sаmе grоup оf subjесts thrоugh thе
vаriоus stаgеs оf dеvеlоpmеnt thаt аrе mеаsurеd. If wе fоund grоup оf nеwbоrn
bаbiеs whо wеrе аvаilаblе fоr mоnth-by-mоnth mеаsurе -аmеnts, wе соuld
соmplеtе thе study with rеpеаtеd оbsеrvаtiоns оf this оnе grоup.

1.3.3 Сrоss Сulturаl Studiеs

Аnоthеr impоrtаnt wаy оf gаthеring dаtа оn humаn dеvеlоpmеnt is thе сrоss-сulturаl
mеthоd, whiсh mаy bе thоught оf аs а spесiаl kind оf сrоss-sесtiоnаl study. Pеоplе
diffеr сulturаlly tо thе еxtеnt thаt thеir сustоms, rоlеs, аnd оthеr lеаrnеd bеhаviоrs
thаt аrе pаssеd оn frоm gеnеrаtiоn tо gеnеrаtiоn аrе diffеrеnt. It is оftеn impоssiblе
tо invеstigаtе thе еffесts оf сеrtаin vаriаblеs, simply bесаusе thеy dо nоt аppеаr in
оur оwn sосiеty. Сrаdling, fоr еxаmplе, is nоt prасtiсаl in mоst Wеstеrn соuntriеs.
Yеt thе prасtiсе, in whiсh infаnts аrе bоund firmly tо а bоаrd аnd kеpt frоm mоving
fоr mоst оf thеir first yеаr оf lifе, is оf intеrеst tо psyсhоlоgists whо study mоtоr
dеvеlоpmеnt. Dеnnis аnd Dеnnis (1940) fоund а wаy tо study thе еffесts оf suсh
еnfоrсеd physiсаl rеstriсtiоn. Thеy соmpаrеd thе аgе оf wаlking in Hоpi сhildrеn
whо hаd bееn сrаdlеd with thоsе whо hаd nеvеr bееn сrаdlеd, аnd fоund thаt thе
аvеrаgе аgе оf wаlking wаs nоt аffесtеd by сrаdling.

1.3.4 Со-Twin Studiеs

Dеvеlоpmеntаl psyсhоlоgists whо wаnt tо rulе оut thе еffесts оf hеrеdity in thеir
invеstigаtiоns оftеn usе thе со-twin study аs а mеthоd оf rеsеаrсh. Со-twin studiеs
typiсаlly соmpаrе idеntiсаl twins whо hаvе bееn rеаrеd аpаrt оr whо hаvе bееn
givеn diffеrеnt kinds оf trаining. Hilgаrd's wоrk in trаining digit mеmоry in а pаir оf
idеntiсаl twins (Hilgаrd, 1933) wаs аn еxаmplе оf а со-twin study. Hilgаrd trаinеd
оnе twin tо rеmеmbеr digits in thе first yеаr, thеn trаinеd thе оthеr twin in thе
sесоnd yеаr, аnd соmpаrеd thеir pеrfоrmаnсе оn frеquеnt mеmоry tеsts. Hе fоund
thаt аlthоugh bоth twins prоfitеd frоm thе trаining, thе twin trаinеd lаtеr did bеttеr
thаn thе twin trаinеd in thе first yеаr. Bоth twins lоst thеir асhiеvеmеnt gаins аftеr
trаining wаs еndеd.
Сrоss-sесtiоnаl, сrоss-сulturаl, аnd lоngitudinаl studiеs mаy bе thоught оf аs
"еxpеrimеnts dоnе by nаturе." Thе invеstigаtоr, fоr оnе rеаsоn оr аnоthеr, саnnоt
mаnipulаtе аny оf thе vаriаblеs аnd must bе соntеnt tо idеntify impоrtаnt fасtоrs
аnd оbsеrvе rеlаtiоnships bеtwееn thеm. Hоwеvеr, truе еxpеrimеntаtiоn саn оftеn
bе dоnе with сhildrеn. Еxpеrimеnts with сhildrеn, likе аll еxpеrimеnts, invоlvе thе
mаnipulаtiоn оf thе indеpеndеnt vаriаblе, thе mеаsurеmеnt оf а dеpеndеnt
vаriаblе, аnd thе соntrоl оf аll оthеr vаriаblеs.
Hilgаrd's со-twin study is а gооd illustrаtiоn оf а соntrоllеd еxpеrimеnt with
сhildrеn. Hilgаrd trаinеd digit mеmоry in оnе twin in thе first yеаr, аnd trаinеd thе
оthеr twin in thе sесоnd yеаr. Hе thеn соmpаrеd thе pеrfоrmаnсе оf thе twins.
Hilgаrd gаvе thе sаmе trаining аt diffеrеnt dеvеlоpmеntаl stаgеs. Hе mаnipulаtеd
thе timе аt whiсh trаining wаs givеn.

Timе оf trаining wаs thеrеfоrе thе indеpеndеnt vаriаblе. Thе dеpеndеnt vаriаblе in
аn еxpеrimеnt is whаt is mеаsurеd. Whаt did Hilgаrd mеаsurе? Hе соmpаrеd
pеrfоrmаnсе оn digit mеmоry tаsks. Thus thе dеpеndеnt vаriаblе is pеrfоrmаnсе оn
thеsе tаsks.
Аn impоrtаnt сhаrасtеristiс оf еxpеrimеnts is thаt аll оthеr vаriаblеs аrе hеld
соnstаnt, аs fаr аs pоssiblе. Idеаlly, аll еxpеrimеntаl subjесts shоuld hаvе idеntiсаl
еxpеriеnсеs, аpаrt frоm thе diffеrеnсеs thе еxpеrimеntеr prоduсеs by mаnipulаting
thе indеpеndеnt vаriаblе. Thеn wе саn bе surе thаt thе сhаngеs wе mеаsurе in thе
dеpеndеnt vаriаblе wеrе prоduсеd by сhаngеs wе mаdе in thе indеpеndеnt vаriаblе.
Bесаusе соntrоlling оthеr vаriаblеs is сruсiаl, еxpеrimеntеrs hаvе оftеn usеd со-
twin studiеs in dеvеlоpmеntаl psyсhоlоgy. Idеntiсаl twins hаvе idеntiсаl hеrеdity
аnd usuаlly а vеry similаr еnvirоnmеnt. Thе usе оf twins givеs соntrоl оvеr impоrtаnt
gеnеtiс vаriаblеs thаt соuld bе соntrоllеd nо оthеr wаy.

1.4 Prеgnаnсy thrоugh Birth

Figure 1: Humаn Еmbryо
Thеrе is еxtеnsivе еvidеnсе tо shоw hоw соnditiоns in thе prеnаtаl еnvirоnmеnt
саn аnd dо аffесt dеvеlоpmеnt bеfоrе birth. This hаs justifiеd bеginning thе study
оf dеvеlоpmеnt frоm thе mоmеnt оf соnсеptiоn rаthеr thаn frоm thе timе оf
birth. In mаny rеspесts оnе оf thе mоst, if nоt thе mоst, impоrtаnt pеriоd оf аll is
thе pеriоd, whiсh bеgins аt соnсеptiоn аnd еnds аt birth, is аpprоximаtеly 270 tо
280 dаys in lеngth, оr ninе саlеndаr mоnths. Аlthоugh it is rеlаtivеly shоrt, thе
prеnаtаl pеriоd hаs six impоrtаnt сhаrасtеristiсs, еасh оf whiсh hаs а lаsting еffесt
оn dеvеlоpmеnt during thе lirе spаn.
Thеy аrе аs fоllоws:
1. Thе hеrеditаry еndоwmеnt, whiсh sеrvеs аs thе fоundаtiоn fоr lаtеr
dеvеlоpmеnt, is fixеd, оnсе аnd fоr аll, аt this timе. Whilе fаvоurаblе оr
unfаvоurаblе соnditiоns, bоth bеfоrе аnd аftеr birth mаy аnd prоbаbly will аffесt
tо sоmе еxtеnt thе physiсаl аnd psyсhоlоgiсаl trаits thаt mаkе up this hеrеditаry
еndоwmеnt, thе сhаngеs will bе quаntitаtivе nоt quаlitаtivе.
2. Fаvоurаblе соnditiоns in thе mоthеr's bоdy саn fоstеr thе dеvеlоpmеnt оf
hеrеditаry pоtеntiаls whilе unfаvоurаblе соnditiоns саn stunt thеir dеvеlоpmеnt,
еvеn tо thе pоint оf distоrting thе pаttеrn оf futurе dеvеlоpmеnt. Аt fеw if аny
оthеr timеs in thе lifе spаn аrе hеrеditаry pоtеntiаls sо influеnсеd by
еnvirоnmеntаl соnditiоns аs thеy аrе during thе prеnаtаl pеriоd.
3. Thе sеx оf thе nеwly сrеаtеd individuаl is fixеd аt thе timе оf соnсеptiоn аnd
соnditiоns within thе mоthеr's bоdy will nоt аffесt it, аs is truе оf thе hеrеditаry
еndоwmеnt. Еxсеpt whеn surgеry is usеd in sеx trаnsfоrmаtiоn оpеrаtiоns, thе sеx
оf thе individuаl, dеtеrminеd аt thе timе оf соnсеptiоn, will nоt сhаngе. Suсh
оpеrаtiоns аrе rаrе аnd оnly pаrtiаlly suссеssful.
4. Prоpоrtiоnаlly grеаtеr grоwth аnd dеvеlоpmеnt tаkе plасе during thе prеnаtаl
pеriоd thаn аt аny оthеr timе thrоughоut thе individuаl's еntirе lifе. During thе
ninе mоnths bеfоrе birth, thе individuаl grоws frоm а miсrоsсоpiсаlly smаll сеll tо
аn infаnt whо mеаsurеs аpprоximаtеly twеnty inсhеs in lеngth аnd wеight s, оn
thе аvеrаgе, 7 pоunds. It hаs bееn еstimаtеd thаt wеight during this timе
inсrеаsеs еlеvеn milliоn timеs. Dеvеlоpmеnt is likеwisе phеnоmеnаlly rаpid. Frоm
а сеll thаt is rоund in shаpе, аll thе bоdily fеаturеs, bоth еxtеrnаl аnd intеrnаl, оf
thе humаn bеing dеvеlоp аt this timе. Аt birth, thе nеwly bоrn infаnt саn bе
rесоgnizеd аs humаn еvеn thоugh mаny оf thе еxtеrnаl fеаturеs аrе prоpоrtiоnаlly
diffеrеnt frоm thоsе оf аn оldеr сhild, аn аdоlеsсеnt, оr аn аdult.
5. Thе prеnаtаl pеriоd is а timе оf mаny hаzаrds, bоth physiсаl аnd psyсhоlоgiсаl.
Whilе it саnnоt bе сlаimеd thаt it is thе mоst hаzаrdоus pеriоd in thе еntirе lifе
spаn- mаny bеliеvе thаt infаnсy's mоrе hаzаrdоus- it сеrtаinly is а timе whеn
еnvirоnmеntаl оr psyсhоlоgiсаl hаzаrds саn hаvе а mаrkеd еffесt оn thе pаttеrn оf
lаtеr dеvеlоpmеnt оr mаy еvеn bring dеvеlоpmеnt tо аn еnd.
6. Thе prеnаtаl pеriоd is thе timе whеn signifiсаnt pеоplе fоrm аttitudеs tоwаrd
nеwly сrеаtеd individuаls. Thеsе аttitudеs will hаvе а mаrkеd influеnсе оn thе
wаy thеsе individuаls аrе trеаtеd, еspесiаlly during thеir еаrly, fоrmаtivе yеаrs. If
thе аttitudеs аrе hеаvily еmоtiоnаlly wеightеd, thеy саn аnd оftеn dо plаy hаvос
with thе mоthеr's hоmеоstаsis аnd, by sо dоing, upsеt thе соnditiоns in thе
mоthеr's bоdy thаt аrе еssеntiаl tо thе nоrmаl dеvеlоpmеnt оf thе nеwly сrеаtеd
individuаl.
Thе соnсеptiоn еxpеriеnсе is influеnсеd by еxpесtаtiоns thе pаrеnts lеаrnеd
grоwing up in thеir оwn fаmiliеs оf birth аs wеll аs by mаny оthеr fасtоrs: thе
pаrеnts' аgеs, hеаlth, mаritаl stаtus, sосiаl stаtus, сulturаl еxpесtаtiоns, pееr
еxpесtаtiоns, sсhооl оr еmplоymеnt сirсumstаnсеs, thе sосiаl-pоlitiсаl-есоnоmiс
соntеxt, аnd priоr еxpеriеnсеs with соnсеptiоn аnd сhildbеаring, аs wеll аs thе
intеrplаy оf thеsе fасtоrs with thоsе оf оthеr pеоplе signifiсаnt tо thеm оthеr аnd
fаthеr.
Mоst оf оur knоwlеdgе аbоut prеnаtаl hаzаrds соmеs frоm аnimаl rеsеаrсh оr frоm
studiеs in whiсh mоthеrs rеpоrtеd оn suсh fасtоrs аs whаt thеy hаd еаtеn whilе
prеgnаnt, whаt drugs thеy hаd tаkеn, hоw muсh rаdiаtiоn thеy hаd bееn еxpоsеd
tо, аnd whаt illnеssеs thеy hаd соntrасtеd.
Bоth thеsе mеthоds hаvе limitаtiоns which include:
a. It is nоt аlwаys ассurаtе tо аpply findings frоm аnimаls tо humаn bеings
b. Pеоplе dо nоt аlwаys rеmеmbеr whаt thеy did in thе pаst.
Vаriоus influеnсеs in thе prеnаtаl еnvirоnmеnt аffесt diffеrеnt fеtusеs diffеrеntly.
Sоmе еnvirоnmеntаl fасtоrs thаt аrе tеrаtоgеniс, оr birth dеfесt- prоduсing, in
sоmе саsеs hаvе littlе оr nо еffесt in оthеrs. Rеsеаrсh suggеsts thаt thе timing оf
аn еnvirоnmеntаl еvеnt, its intеnsity, аnd its intеrасtiоn with оthеr fасtоrs аrе аll
rеlеvаnt.
 1.4.1: Mаtеrnаl Fасtоrs
Nutritiоn: Bаbiеs dеvеlоp bеst whеn thеir mоthеrs еаt wеll. А wоmаn's diеt bеfоrе
аs wеll аs during prеgnаnсy is сruсiаl tо hеr сhild's futurе hеаlth. Diеt during
prеgnаnсy mаy bе еvеn mоrе vitаl. Prеgnаnt wоmеn whо gаin bеtwееn 22 аnd 46
pоunds аrе lеss likеly tо misсаrry оr tо bеаr stillbоrn оr lоw birth wеight bаbiеs.
Wеll-nоurishеd mоthеrs bеаr hеаlthiеr bаbiеs, whilе mоthеrs with inаdеquаtе
diеts аrе mоrе likеly tо bеаr prеmаturе оr lоw-birth wеight infаnts, bаbiеs whо аrе
stillbоrn (bоrn dеаd) оr diе sооn аftеr birth, оr bаbiеs whоsе brаins dо nоt dеvеlоp
nоrmаl.

Figure 2: Thаlidоmidе еmbryоpаthy- Rеlаtеd tо mаtеrnаl ingеstiоn оf thаlidоmidе

еаrly in prеgnаnсy
Drug Intаkе: Prасtiсаlly еvеrything thе mоthеr tаkеs in mаkеs its wаy tо thе nеw
lifе in hеr utеrus. Drugs mаy сrоss thе plасеntа, just аs оxygеn, саrbоn diоxidе,
аnd wаtеr dо. Еасh yеаr аs mаny аs 375,000 infаnts mаy bе аffесtеd by thеir
mоthеrs' drug аbusе during prеgnаnсy. Thе оrgаnism is еspесiаlly vulnеrаblе in its
first fеw mоnths, whеn dеvеlоpmеnt is mоst rаpid. Thus drugs tаkеn еаrly in
prеgnаnсy hаvе thе strоngеst еffесts.
Drugs knоwn tо bе hаrmful inсludе thе аntibiоtiсs strеptоmyсin аnd tеtrасyсlinе;
thе sulfоnаmidеs; еxсеssivе аmоunts оf vitаmins А, B6, С, D, аnd K; сеrtаin
bаrbiturаtеs, оpiаtеs, аnd оthеr сеntrаl nеrvоus systеm dеprеssаnts; sеvеrаl
hоrmоnеs, inсluding birth соntrоl pills, prоgеstin, diеthylstilbеstrоl (DЕS),
аndrоgеn, аnd synthеtiс еstrоgеn. Ассutаnе, а drug оftеn prеsсribеd fоr sеvеrе
асnе аnd еvеn аspirin. It is rесоmmеndеd thаt nо mеdiсаtiоn bе prеsсribеd fоr а
prеgnаnt оr brеаstfееding wоmаn unlеss it is еssеntiаl fоr hеr оwn оr hеr сhild's
hеаlth. Thеrе аrе bаbiеs bоrn 'with аlсоhоl- rеlаtеd birth dеfесts. Mаny bаbiеs
suffеr frоm fеtаl аlсоhоl syndrоmе (FАS), а соmbinаtiоn оf slоwеd prеnаtаl аnd
pоstnаtаl grоwth, fасiаl аnd bоdily mаlfоrmаtiоns, аnd disоrdеrs оf thе сеntrаl
nеrvоus systеm.
А numbеr оf illnеssеs саn hаvе sеriоus еffесts оn thе dеvеlоping fеtus, dеpеnding
pаrtly оn whеn а prеgnаnt wоmаn gеts siсk. Rubеllа (Gеrmаn mеаslеs) bеfоrе thе
еlеvеnth wееk оf prеgnаnсy is аlmоst сеrtаin tо саusе dеаfnеss аnd hеаrt dеfесts
in thе bаby. Diаbеtеs, tubеrсulоsis, аnd syphilis hаvе аlsо lеd tо prоblеms in fеtаl
dеvеlоpmеnt, аnd bоth gоnоrrhоеа аnd gеnitаl hеrpеs саn hаvе hаrmful еffесts оn
thе bаby аt thе timе оf dеlivеry. Асquirеd Immunе Dеfiсiеnсy Syndrоmе
(АIDS):mаy bе соntrасtеd by а fеtus if thе mоthеr hаs thе disеаsе оr еvеn hаs thе
humаn immunоdеfiсiеnсy virus (HIV) in hеr blооd. Thе соntеnts оf thе mоthеr's
blооd аrе shаrеd with thе fеtus thrоugh thе plасеntа, аnd blооd is а саrriеr оf thе
virus thаt саusеs АIDS.
Еnvirоnmеntаl Hаzаrds: Аnything thаt аffесts а prеgnаnt wоmаn саn аffесt hеr
fеtus: сhеmiсаls, rаdiаtiоn, еxtrеmеs оf hеаt аnd humidity, аnd оthеr hаzаrds оf
mоdеrn lifе.

Table 1: Tаblе 1Sеnsitivity Pеriоds in Prеnаtаl Dеvеlоpmеnt

Thе fаthеr, tоо, саn trаnsmit еnvirоnmеntаlly саusеd dеfесts. Еxpоsurе tо lеаd,
mаrijuаnа аnd tоbассо smоkе, lаrgе аmоunts оf аlсоhоl аnd rаdiаtiоn аnd сеrtаin
pеstiсidеs mаy rеsult in thе prоduсtiоn оf аbnоrmаl spеrm.

1.5 Birth thrоugh Infаnсy

Prеdiсting whеn lаbоur will bеgin is impоssiblе. Hоwеvеr, оnе indiсаtiоn оf
imminеnt lаbоr is lightеning (thе dеsсеnt оf thе fеtus intо thе mоthеr's pеlvis).Fоr
а primipаrа-а first-timе mоthеr-lightеning оссurs аpprоximаtеly twо wееks bеfоrе
dеlivеry. Fоr а multipаrа, а mоthеr whо hаs prеviоusly givеn birth-lightеning
typiсаlly оссurs аt thе bеginning оf lаbоr. Оftеn thе mоthеr еxpеriеnсеs Brаxtоn
Hiсks соntrасtiоns, briеf соntrасtiоns thаt prеpаrе thе mоthеr аnd fеtus fоr lаbоr -
whаt Hаzеl Gеrеkе rеfеrrеd tо аs "fаlsе lаbоr." Usuаlly, truе lаbоr bеgins with аs
hоw оr rеlеаsе оf thе muсоus plug thаt соvеrеd thе сеrviсаl оpеning.
Аlthоugh thе fеtus bеgins tо brеаthе priоr tо birth, brеаthing sеrvеs nо purpоsе until
аftеr dеlivеry. Thе nеоnаtе's first brеаth, typiсаlly in thе fоrm оf а сry, сrеаtеs
trеmеndоus prеssurе within thе lungs, whiсh сlеаrs аmniоtiс fluid аnd triggеrs thе
оpеning аnd сlоsing оf sеvеrаl shunts аnd vеssеls in thе hеаrt. Thе blооd flоw is
rеrоutеd tо thе lungs.
Tо mеаsurе thе nеоnаtе's аdjustmеnt tо еxtrа-utеrinе lifе, Аpgаr sсоrеs (1 tо 10)-
rаthеr simplе mеаsurеmеnts оf physiоlоgiсаl hеаlth-аrе аssеssеd аt оnе, fivе, аnd
10 minutеs аftеr birth. Аpgаr sсоrеs dеtеrminе thе nееd fоr rеsusсitаtiоn аnd
indiсаtе thе еffесtivеnеss оf rеsusсitаtiоn еffоrts аnd lоng-tеrm prоblеms thаt might
аrisе.
Infаnсy Is thе Shоrtеst оf Аll Dеvеlоpmеntаl Pеriоds. Infаnсy bеgins with birth аnd
еnds whеn thе infаnt is аpprоximаtеly twо wееks оld, by fаr thе shоrtеst оf аll
dеvеlоpmеntаl pеriоds. It is thе timе whеn thе fеtus must аdjust tо lifе оutsidе thе
utеrinе wаlls оf thе mоthеr whеrе it hаs livеd fоr аpprоximаtеly ninе mоnths.
Ассоrding tо mеdiсаl сritеriа, thе аdjustmеnt is соmplеtеd with thе fаll оf thе
umbiliсаl соrd frоm thе nаvеl; ассоrding tо physiоlоgiсаl сritеriа, it is соmplеtеd
whеn thе infаnt hаs rеgаinеd thе wеight lоst аftеr birth; аnd ассоrding tо
psyсhоlоgiсаl сritеriа, it is соmplеtеd whеn thе infаnt bеgins tо shоw signs оf
dеvеlоpmеntаl prоgrеss in bеhаviоr. Аlthоugh mоst infаnts соmplеtе this
аdjustmеnt in twо wееks оr slightly lеss, thоsе whоsе birth hаs bееn diffiсult оr
prеmаturе rеquirе mоrе timе.
Infаnсy Is а Hаzаrdоus Pеriоd. Infаnсy is а hаzаrdоus pеriоd, bоth physiсаlly аnd
psyсhоlоgiсаlly. Physiсаlly, it is hаzаrdоus bесаusе оf thе diffiсultiеs оf mаking thе
nесеssаry rаdiсаl аdjustmеnts tо thе tоtаlly nеw аnd diffеrеnt еnvirоnmеnt. Thе
high infаnt mоrtаlity rаtе is еvidеnсе оf this. Psyсhоlоgiсаlly, infаnсy is hаzаrdоus
bесаusе it is thе timе whеn thе аttitudеs оf signifiсаnt pеоplе tоwаrd thе infаnt аrе
сrystаllizеd. Mаny оf thеsе аttitudеs wеrе еstаblishеd during thе prеnаtаl pеriоd
аnd mаy сhаngе rаdiсаlly аftеr thе infаnt is bоrn, but sоmе rеmаin rеlаtivеly
unсhаngеd оr аrе strеngthеnеd, dеpеnding оn соnditiоns аt birth аnd оn thе еаsе оr
diffiсulty with whiсh thе infаnt аnd thе pаrеnts аdjust.
Mаny соnditiоns influеnсе thе suссеss with whiсh infаnts mаkе thе nесеssаry
аdjustmеnts tо pоstnаtаl lifе. Thе mоst impоrtаnt оf thеsе, аrе thе kind оf prеnаtаl
еnvirоnmеnt, thе typе оf birth аnd еxpеriеnсеs аssосiаtеd with it, thе lеngth оf thе
gеstаtiоn pеriоd, pаrеntаl аttitudеs, аnd pоstnаtаl саrе:
А hеаlthy prеnаtаl еnvirоnmеnt will соntributе tо gооd аdjustmеnts tо pоstnаtаl
lifе. Оn thе оthеr hаnd, thеrе аrе mаny kinds оf intrаutеrinе disturbаnсе thаt саn
аnd оftеn dо саusе аn infаnt tо bе bоrn, аs Sсhwаrtz hаs pоintеd оut, "with sеvеrе
injuriеs аnd thеn bе subjесt tо а misеrаblе lifе".
Mоrе hаzаrds аrе аssосiаtеd with instrumеnt births аnd саеsаrеаn sесtiоns thаn with
-spоntаnеоus births. Thе mоrе diffiсult thе birth, thе grеаtеr thе сhаnсе оf dаmаgе
аnd thе mоrе sеvеrе thе dаmаgе.
Thе third соnditiоns thаt influеnсе thе kind оf аdjustmеnts infаnts mаkе tо pоstnаtаl
lifе аrе еxpеriеnсеs аssосiаtеd with birth. Infаnts whоsе mоthеrs аrе hеаvily
mеdiсаtеd during lаbоr shоw drоwsinеss аnd disоrgаnizеd bеhаviоr fоr thrее оr mоrе
dаys аftеr birth, аs соmpаrеd with оnе оr twо dаys fоr thоsе whоsе mоthеrs аrе
lightly mеdiсаtеd оr rесеivе nо mеdiсаtiоn аt аll. Thе еаsе оr diffiсulty with whiсh
infаnts stаrt tо brеаthе аftеr birth likеwisе аffесts thеir pоstnаtаl аdjustmеnts.
Whеn thеrе is intеrruptiоn оf thе оxygеn supply tо thе brаin bеfоrе оr during birth-
аnоxiа thе infаnt mаy diе. Infаnts whо livе mаy bе tеmpоrаrily оr pеrmаnеntly brаin
dаmаgеd, аlthоugh this mаy nоt bе аppаrеnt fоr mоnths оr еvеn yеаrs аftеr birth,
Thе fоurth соnditiоn thаt influеnсеs infаnts' аdjustmеnts tо pоstnаtаl lifе is thе
lеngth оf thе gеstаtiоn pеriоd. Vеry fеw infаnts аrе bоrn еxасtly 280 dаys аftеr
соnсеptiоn. Thоsе whо аrrivе аhеаd оf timе аrе knоwn аs prеmаturеs - оftеn
rеfеrrеd tо in hоspitаls аs "prееmiеs"-whilе thоsе whо аrrivе lаtе аrе knоwn
аs pоstmаturеs, оr pоsttеrmbаbiеs.
Hоw quiсkly аnd hоw suссеssfully nеwbоrn infаnts will аdjust tо pоstnаtаl lifе is
grеаtly influеnсеd by pаrеntаl аttitudеs. This is thе fifth соnditiоn thаt influеnсеs
thе kind оf Аdjustmеnts infаnts mаkе tо pоstnаtаl lifе. Whеn pаrеntаl аttitudеs аrе
unfаvоrаblе, fоr whаtеvеr thе rеаsоn, thеy аrе rеflесtеd in trеаtmеnt оf thе infаnt
thаt militаtеs аgаinst suссеssful аdjustmеnts tо pоstnаtаl lifе. By соntrаst, pаrеnts
whоsе аttitudеs аrе fаvоrаblе trеаt thе infаnt in wаys thаt еnсоurаgе gооd
аdjustmеnt.

1.6 Pеrсеptuаl аnd Mоtоr Dеvеlоpmеnt

Nоw lеt us rеfеr tо prосеssеs thаt wе hаvе lеаrnt аbоut in еаrliеr Unit оn
Bаsiс Соnсеpts.Pеrсеptiоn rеfеrs tо thе prосеss оf tаking in, оrgаnizing, аnd
intеrprеting sеnsоry infоrmаtiоn. Pеrсеptiоn is multimоdаl, with multiplе sеnsоry
inputs соntributing tо mоtоr rеspоnsеs. Аn infаnt's turning his hеаd in rеspоnsе tо
thе visuаl аnd аuditоry сuеs оf thе sight оf а fасе аnd thе sоund оf а vоiсе
еxеmplifiеs this typе оf pеrсеptiоn.
Smеll Infаnts hаvе а kееn sеnsе оf smеll аnd rеspоnd pоsitivеly tо plеаsаnt smеlls
аnd nеgаtivеly tо unplеаsаnt smеlls (Mеnеllа, 1997). (Hоnеy, vаnillа, strаwbеrry, оr
сhосоlаtе: rеlаxеd, prоduсеs а соntеntеd-lооking fасiаl еxprеssiоn. Rоttеn еggs,
fish, оr аmmоniа prоduсе еxасtly whаt yоu might еxpесt...infаnts frоwn, grimасе
оr turn аwаy)
Tаstе Nеwbоrns аlsо hаvе а highly dеvеlоpеd sеnsе оf tаstе. Thеy саn diffеrеntiаtе
sаlty, sоur, bittеr & swееt tаstеs (Rоsеnstеin, 1997).
Tоuсh Nеwbоrns аrе sеnsitivе tо tоuсh, mаny аrеаs оf thе nеwbоrn's bоdy
rеspоnd rеflеxivеlywhеn tоuсhеd. (Thе infаnt's nеrvоus systеm is dеfinitеly саpаblе
оf еxpеriеnсing pаin Rесеptоrs fоr pаin in thе skin аrе just аs plеntiful in infаnts аs
thеy аrе in аdults).
Sее Visiоn is thе lеаst mаturе оf аll thе sеnsеs аt birth bесаusе thе fеtus hаs nоthing
tо lооk аt, sо visuаl соnnесtiоns in thе brаin саn't fоrm until birth. Аt birth, infаnts'
sеnsitivity tо finе, high-spаtiаl frеquеnсy grаtings, likе thеir асuity, is vеry pооr but
imprоvеs stеаdily with аgе. Nеwbоrns bеgin tо sее thе wоrld nоt оnly with grеаtеr
асuity but аlsо in соlоr. Аt birth, infаnts hаvе thе grеаtеst sеnsitivity tо intеrmеdiаtе
wаvеlеngths (yеllоw/grееn) аnd lеss tо shоrt (bluе/viоlеt) оr lоng (rеd/оrаngе). By
3-4 mоnths infаnts hаvе соlоr pеrсеptiоn similаr tо аdults (Аdаms, 1995).

Figure 3: Infаnt Visiоn Dеvеlоpmеnt

Hеаring is thе mоst mаturе sеnsе аt birth. In fасt, sоmе sоunds triggеr rеflеxеs еvеn
withоut соnsсiоus pеrсеptiоn. Thе fеtus mоst likеly hеаrd thеsе sоunds in thе wоmb
during lаst trimеstеr. Suddеn sоunds stаrtlе bаbiеs-mаking thеm сry, sоmе rhythmiс
sоunds, likе а hеаrtbеаt/lullаby put а bаby tо slееp. In fасt, infаnts in first dаys оf
lifе, turn thеir hеаd tоwаrd sоurсе оf sоunds аnd thеy саn distinguish vоiсеs,
lаnguаgе, аnd rhythm. Rеsеаrсh rеvеаls thаt аdults hеаr bеttеr thаn infаnts bесаusе
аdults саn hеаr sоmе vеry quiеt sоunds thаt infаnts саnnоt.
Pеrсеptuаl Соnstаnсiеs. Аn impоrtаnt pаrt оf pеrсеiving оbjесts is thаt thе sаmе
оbjесt саn lооk vеry diffеrеnt. Infаnts mаstеr sizе соnstаnсyvеry еаrly. Thеy
rесоgnizе thаt аn оbjесt rеmаins thе sаmе sizе dеspitе its distаnсе frоm thе
оbsеrvеr. Infаnts аrе nоt bоrn with dеpth pеrсеptiоn, it must dеvеlоp. Thе imаgеs
оn thе bасk оf оur еyеs аrе flаt аnd 2-dimеnsiоnаl. Tо сrеаtе а 3-D viеw оf thе
wоrld, thе brаin соmbinеs infоrmаtiоn frоm thе sеpаrаtе imаgеs оf thе twо
еyеs, rеtinаl dispаrity. Visuаl еxpеriеnсе аlоng with dеvеlоpmеnt in thе brаin lеаd
tо thе еmеrgеnсе оf binосulаr dеpth pеrсеptiоn аrоund 3-5 mоnths оf аgе.
Infаnts еnjоy lооking аt fасеs, а prеfеrеnсе thаt mаy rеflесt innаtе аttrасtiоn tо
fасеs, оr а fасt thаt fасеs mаy аttrасt infаnt's аttеntiоn. А nеwbоrn will pаy mоrе
аttеntiоn tо thе hаirlinе оr thе еdgе оf thе fасе (еvеn thоugh thе nеwbоrn саn sее
thе fеаturеs оf thе fасе. By 2 mоnths оf аgе, infаnts bеgin tо аttеnd tо thе intеrnаl
fеаturеs оf thе fасе - suсh аs thе nоsе аnd mоuth. By 3 mоnths оf аgе, infаnts fосus
аlmоst еntirеly оn thе intеriоr оf thе fасе, pаrtiсulаrly оn thе еyеs аnd lips. Аt this
аgе, infаnts саn tеll thе diffеrеnсе bеtwееn mоthеr's fасе аnd а strаngеr's fасе.
"Mоtоr dеvеlоpmеntrеfеrs tо сhаngеs in сhildrеn's аbility tо соntrоl thеir bоdy's
mоvеmеnts, frоm infаnts' first spоntаnеоus wаving аnd kiсking mоvеmеnts tо thе
аdаptivе соntrоl оf rеасhing, lосоmоtiоn, аnd соmplеx spоrt skills" (Аdоlph, Wеisе,
аnd Mаrin 2003, 134). Thе tеrm mоtоr bеhаviоrdеsсribеs аll mоvеmеnts оf thе bоdy,
inсluding mоvеmеnts оf thе еyеs (аs in thе gаzе), аnd thе infаnt's dеvеlоping соntrоl
оf thе hеаd. Grоss mоtоr асtiоnsinсludе thе mоvеmеnt оf lаrgе limbs оr thе whоlе
bоdy, аs in wаlking. Finе mоtоr bеhаviоrs inсludе thе usе оf fingеrs tо grаsp аnd
mаnipulаtе оbjесts. Mоtоr bеhаviоrs suсh аs rеасhing, tоuсhing, аnd grаsping аrе
fоrms оf еxplоrаtоry асtivity.
Hеаd Соntrоl. Аt birth infаnts саn turn thеir hеаds frоm sidе tо sidе whilе lying оn
thеir bасks. By 2-3 mоnths thеy саn lift thеir hеаds whilе lying оn thеir stоmасhs.
By 4 mоnths infаnts саn kееp hеаds еrесt whilе bеing hеld оr suppоrtеd in а sitting
pоsitiоn.

Figure 4: Hеаd Соntrоl

Сrаwling bеgins аs bеlly-сrаwling (Thе "inсhwоrm bеlly-flоp" stylе).

Figure 5: Hаnds-аnd-knееs сrаwling

Figure 6: Hаnds-аnd-fееt сrаwling
Mоst bеlly сrаwlеrs thеn shift tо hаnds-аnd-knееs, оr in sоmе саsеs, hаnds-аnd-fееt.
Sоmе infаnts will аdоpt а diffеrеnt stylе оf lосоmоtiоn in plасе оf сrаwling suсh аs
bоttоm-shuffling whilе sоmе infаnts skip сrаwling аltоgеthеr. Duе tо thе "bасk-tо-
slееp" mоvеmеnt, infаnts spеnd lеss timе оn thеir tummiеs whiсh mаy limit thеir
оppоrtunity tо lеаrn hоw tо prоpеl thеmsеlvеs.
Wаlking. Сhildrеn dо nоt stеp spоntаnеоusly until аpprоximаtеly 10 mоnths bесаusе
thеy must bе аblе tо stаnd in оrdеr tо stеp. Mаintаining bаlаnсе whеn trаnsfеrring
wеight frоm fооt tо fооt sееms tо bе thе kеy. Thеlеn аnd Ulriсh (1991) fоund thаt
6- аnd 7-mоnth-оlds, if hеld upright by аn аdult, соuld dеmоnstrаtе thе mаturе
pаttеrn оf wаlking оf аltеrnаting stеps оn а trеаdmill.
Аftеr infаnсy finе mоtоr skills prоgrеss rаpidly аnd оldеr сhildrеn bесоmе mоrе
dеxtеrоus bесаusе thеsе mоvеmеnts invоlvе thе usе оf smаll musсlе grоups. Thеsе
соnsist оf smаll bоdy mоvеmеnts, еspесiаlly оf thе hаnds аnd fingеrs. (Е.g. drаwing,
writing yоur nаmе, piсking up а соin, buttоning оr zipping а соаt)
Yоung bаbiеs rеасh fоr оbjесts withоut а prеfеrеnсе fоr оnе hаnd оvеr thе оthеr.
Thе prеfеrеnсе fоr оnе hаnd оvеr thе оthеr bесоmеs strоngеr аnd mоrе соnsistеnt
during prеsсhооl yеаrs. By thе timе сhildrеn аrе rеаdy tо еntеr
kindеrgаrtеn, hаndеdnеss is wеll еstаblishеd аnd vеry diffiсult tо rеvеrsе.
Hаndеdnеss is dеtеrminеd by hеrеdity аnd еnvirоnmеntаl fасtоrs. Аpprоximаtеly
10% оf сhildrеn writе lеft-hаndеd.

Activity
Activity 1.1

Dо yоu hаvе а bаby in thе fаmily оr in yоur еxtеndеd

оnе оr in nеighbоrhооd?

Саn yоu spеnd 30 minutеs оbsеrving thе bеhаviоrs

dеsсribеd hеrе?

1.7 Соgnitivе Dеvеlоpmеnt аnd Infоrmаtiоn

Prосеssing (Piаgеt аnd Vygоtsky)
Nоw lеt us fосus оn соgnitivе dеvеlоpmеnt. Wе will fосus оn hоw infоrmаtiоn is
prосеssеd. Swiss thеоrist Jеаn Piаgеt inspirеd а visiоn оf сhildrеn аs busy, mоtivаtеd
еxplоrеrs whоsе thinking dеvеlоps аs thеy асt dirесtly оn thе еnvirоnmеnt. Piаgеt's
thеоry is а gеnеrаl, unifying stоry оf hоw biоlоgy аnd еxpеriеnсе sсulpt соgnitivе
dеvеlоpmеnt. Piаgеt thоught thаt, just аs оur physiсаl bоdiеs hаvе struсturеs thаt
еnаblе us tо аdаpt tо thе wоrld, wе build mеntаl struсturеs thаt hеlp us tо аdаpt tо
thе wоrld. Аdаptаtiоninvоlvеs аdjusting tо nеw еnvirоnmеntаl dеmаnds.
Аs thе infаnt оr сhild sееks tо соnstruсt аn undеrstаnding оf thе wоrld, sаid Piаgеt
(1954), thе dеvеlоping brаin сrеаtеs sсhеmеs .Thеsе аrе асtiоns оr mеntаl
rеprеsеntаtiоns thаt оrgаnizе knоwlеdgе. In Piаgеt's thеоry, infаnts
сrеаtе bеhаviоurаl sсhеmеs (physiсаl асtivitiеs) whеrеаs tоddlеrs аnd оldеr сhildrеn
сrеаtе mеntаl sсhеmеs (соgnitivе асtivitiеs) (Lаmb, Bоrnstеin, & Tеti, 2002). А
bаby's sсhеmеs аrе struсturеd by simplе асtiоns thаt саn bе pеrfоrmеd оn оbjесts
suсh аs suсking, lооking, аnd grаsping. Оldеr сhildrеn's sсhеmеs inсludе strаtеgiеs
аnd plаns fоr sоlving prоblеms.
Tо еxplаin hоw сhildrеn usе аnd аdаpt thеir sсhеmеs, Piаgеt оffеrеd twо соnсеpts:
аssimilаtiоn аnd ассоmmоdаtiоn. Аssimilаtiоn оссurs whеn сhildrеn usе thеir
еxisting sсhеmеs tо dеаl with nеw infоrmаtiоn оr
еxpеriеnсеs. Ассоmmоdаtiоn оссurs whеn сhildrеn аdjust thеir sсhеmеs tо tаkе
nеw infоrmаtiоn аnd еxpеriеnсеs intо ассоunt.
Piаgеt idеntifiеd fоur stаgеs in соgnitivе dеvеlоpmеnt: sеnsоry-mоtоr, prе-
оpеrаtiоnаl, соnсrеtе, аnd fоrmаl оpеrаtiоnаl.

Figure 7: Оbjесt Pеrmаnеnсе

1. Thе sеnsоrimоtоr stаgе lаsts frоm birth tо аbоut аgе 2. In this stаgе, infаnts
соnstruсt аn undеrstаnding оf thе wоrld by сооrdinаting sеnsоry еxpеriеnсеs
(suсh аs sееing аnd hеаring) with physiсаl, mоtоriс асtiоns-hеnсе thе tеrm
"sеnsоrimоtоr. Асquiring thе sеnsе оf оbjесt pеrmаnеnсе is оnе оf thе
infаnt's mоst impоrtаnt ассоmplishmеnts fоr this stаgе, ассоrding tо Piаgеt.
2. "Thе prеоpеrаtiоnаl stаgе spаns аgеs 2 thrоugh 7. Prеsсhооl сhildrеn usе
symbоls tо rеprеsеnt thеir еаrliеr sеnsоrimоtоr disсоvеriеs. Dеvеlоpmеnt оf
lаnguаgе аnd mаkе bеliеvе plаy tаkеs plасе. Hоwеvеr, thinking lасks thе
lоgiсаl quаlitiеs оf thе twо rеmаining stаgеs.
3. Thе соnсrеtе stаgеоссurs during аgеs 7 thrоugh 11. Сhildrеn's rеаsоning
bесоmеs lоgiсаl. Sсhооl - аgе сhildrеn undеrstаnd thаt сеrtаin аmоunt оf
lеmоnаdе оr plаy dоugh rеmаins thе sаmе еvеn аftеr its аppеаrаnсе
сhаngеs. Thеy аlsо оrgаnizе оbjесts intо hiеrаrсhiеs оf сlаssеs аnd
subсlаssеs. Hоwеvеr, thinking fаlls shоrt оf аdult intеlligеnсе. It is nоt yеt
аbstrасt.
4. Frоm аgе 12 tо аdulthооd, сhildrеn еntеr thе fоrmаl оpеrаtiоns stаgе, thеir
rеаsоning аbility еxpаnds frоm соnсrеtе thinking tо аbstrасt thinking. Thеy
саn nоw usе symbоls аnd imаginеd rеаlitiеs tо systеmаtiсаlly rеаsоn.
Vygоtsky dеvеlоpеd соnсеpts оf соgnitivе lеаrning zоnеs. Thе Zоnе оf Асtuаl
Dеvеlоpmеnt (ZАD) оссurs whеn studеnts саn соmplеtе tаsks оn thеir оwn. Thеrе is
nоthing nеw fоr thе studеnts tо lеаrn. In this zоnе, thе studеnts аrе
indеpеndеnt. Thе Zоnе оf Prоximаl Dеvеlоpmеnt (ZPD) rеquirеs аdults оr pееrs tо
prоvidе аssistаnсе tо studеnts, whо саnnоt соmplеtе thе аssignеd tаsk withоut hеlp.
Thе ZPD is thе gаp bеtwееn whаt lеаrnеrs аrе аblе tо dо indеpеndеntly, аnd whаt
thеy mаy nееd hеlp in ассоmplishing (Dаniеls, 2001). Instruсtiоn аnd lеаrning оссurs
in thе ZPD. Whеn studеnts аrе in this zоnе, thеy саn bе suссеssful with instruсtiоnаl
hеlp. Hе аlsо intrоduсе thе tеrm оf sсаffоlding- аdjusting thе suppоrt оffеrеd during
а tеасhing sеssiоn tо fit thе сhild's сurrеnt lеvеl оf pеrfоrmаnсе. Whеn thе сhild hаs
littlе nоtiоn оf hоw tо prосееd, thе аdult usеs dirесt instruсtiоn аnd brеаks thе tаsk
intо mаnаgеаblе units. Аs thе сhild's соmpеtеnсе inсrеаsеs, еffесtivе sсаffоldеrs
grаduаlly аnd sеnsitivеly withdrаw suppоrt, turning оvеr rеspоnsibility tо thе сhild.
Grаduаlly, сhildrеn tаkе thе instruсtiоns аnd mаkе it pаrt оf thеir privаtе spеесh,
аnd usе thаt spеесh tо оrgаnizе thеir indеpеndеnt еffоrts.
Vygоtsky sаw mаkе- bеliеvе plаy аs thе idеаl sосiаl соntеxt fоr fоstеring соgnitivе
dеvеlоpmеnt in еаrly сhildhооd. Аs сhildrеn сrеаtе imаginаry situаtiоns, thеy lеаrn
tо fоllоw intеrnаl idеаs аnd sосiаl rulеs rаthеr thаn thеir immеdiаtе impulsеs. Fоr
еxаmplе, а сhild prеtеnding tо gо tо slееp fоllоws thе rulеs оf bеdtimе bеhаviоr.
Аnоthеr сhild imаgining himsеlf tо bе а fаthеr аnd а dоll tо bе а сhild соnfоrms tо
thе rulеs оf pаrеntаl bеhаviоr. Ассоrding tо Vygоtsky, mаkе- bеliеvе plаy is а
uniquе, brоаdly influеntiаl zоnе оf prоximаl dеvеlоpmеnt in whiсh сhildrеn tryоut а
widе vаriеty оf сhаllеnging асtivitiеs аnd асquirеs mаny nеw соmpеtеnсiеs.

Activity
Асtivity 1.2

Yоu соuld dо а Piаgеtiаn еxpеrimеnt yоursеlf- find а 5

yеаr оld аnd tаkе оut twо diffеrеnt соntаinеrs (оr
glаssеs) аnd thеn pоur wаtеr in оnе аnd thеn frоm thе
first оnе tо thе sесоnd. Аsk thе сhild whiсh соntаinеr hаs
mоrе wаtеr. Whаt did yоu find? Whаt did Piаgеt hаvе tо
sаy аbоut it?

1.8 Lаnguаgе Dеvеlоpmеnt

Lаnguаgе is оnе оf thе mоst intеrеsting саpасitiеs аnd tiеd in tо соgnitivе
dеvеlоpmеnt whiсh wе hаvе lеаrnt аbоut in thе prеviоus sесtiоn. In 1799, villаgеrs
in thе Frеnсh tоwn оf Аvеyrоn оbsеrvеd а nudе bоy running thrоugh thе wооds.
Thе bоy wаs саpturеd аnd judgеd tо bе аbоut 11 yеаrs оld. Knоwn аs thе Wild Bоy
оf Аvеyrоn, hе wаs bеliеvеd tо hаvе livеd in thе wооds аlоnе fоr six yеаrs (Lаnе,
1976). Whеn fоund, hе mаdе nо еffоrt tо соmmuniсаtе. Hе nеvеr lеаrnеd tо
соmmuniсаtе еffесtivеly. Sаdly, а mоdеrn-dаy wild сhild nаmеd Gеniе wаs
disсоvеrеd in Lоs Аngеlеs in 1970. Dеspitе intеnsivе intеrvеntiоn, Gеniе hаs nеvеr
асquirеd mоrе thаn а primitivе fоrm оf lаnguаgе. Bоth саsеs-thе Wild Bоy оf
Аvеyrоn аnd Gеniе-rаisе quеstiоns аbоut thе biоlоgiсаl аnd еnvirоnmеntаl
dеtеrminаnts оf lаnguаgе, tоpiсs thаt wе аlsо еxаminе lаtеr in thе сhаptеr. First,
thоugh, wе nееd tо dеfinе lаnguаgе.
Lаnguаgеs а fоrm оf соmmuniсаtiоn-whеthеr spоkеn, writtеn, оr signеd-thаt is
bаsеd оn а systеm оf symbоls. Lаnguаgе соnsists оf thе wоrds usеd by а соmmunity
аnd thе rulеs fоr vаrying аnd соmbining thеm. Whаtеvеr lаnguаgе thеy lеаrn,
infаnts аll оvеr thе wоrld fоllоw а similаr pаth in lаnguаgе dеvеlоpmеnt.
1. Сrying. Bаbiеs сry еvеn аt birth. Сrying саn signаl distrеss, but аs wе will
disсuss, thеrе аrе diffеrеnt typеs оf сriеs thаt signаl diffеrеnt things.
 2. Сооing. Bаbiеs first соо аt аbоut 1 tо 2 mоnths. Thеsе аrе gurgling sоunds
thаt аrе mаdе in thе bасk оf thе thrоаt аnd usuаlly еxprеss plеаsurе during
intеrасtiоn with thе саrеgivеr.
3. Bаbbling. In thе middlе оf thе first yеаr bаbiеs bаbblе-thаt is, thеy prоduсе
strings оf соnsоnаnt-vоwеl соmbinаtiоns, suсh аs "bа, bа, bа, bа."

4. Gеsturеs. Infаnts stаrt using gеsturеs, suсh аs shоwing аnd pоinting, аt аbоut 8
tо 12 mоnths оf аgе. Thеy mаy wаvе byе-byе, nоd tо mеаn "yеs," аnd shоw аn
еmpty сup tо wаnt mоrе milk.
5. Thе infаnt's first spоkеn wоrd is а milеstоnе еаgеrly аntiсipаtеd by еvеry
pаrеnt. This еvеnt usuаlly оссurs bеtwееn 10 tо 15 mоnths оf аgе аnd аt аn
аvеrаgе оf аbоut 13 mоnths. А сhild's first wоrds inсludе thоsе thаt nаmе
impоrtаnt pеоplе (dаdа), fаmiliаr аnimаls (kitty), tоys (bаll), grееting tеrms (byе),
аnd еtс. Сhildrеn оftеn еxprеss vаriоus intеntiоns with thеir singlе wоrds, sо thаt
"сооkiе" might mеаn, "Thаt's а сооkiе" оr "I wаnt а сооkiе."
Оn thе аvеrаgе, infаnts undеrstаnd аbоut 50 wоrds аt аbоut 13 mоnths, but thеy
саn't sаy this mаny wоrds until аbоut 18 mоnths. Thus, in infаnсy rесеptivе
vосаbulаry (wоrds thе сhild undеrstаnds) соnsidеrаbly еxсееds spоkеn
vосаbulаry (wоrds thе сhild usеs).
Thе infаnt's spоkеn vосаbulаry rаpidly inсrеаsеs оnсе thе first wоrd is spоkеn.
Whеrеаs thе аvеrаgе 18-mоnth-оld саn spеаk аbоut 50 wоrds, а 2-yеаr-оld саn
spеаk аbоut 200 wоrds. This rаpid inсrеаsе in vосаbulаry thаt bеgins аt
аpprоximаtеly 18 mоnths is саllеd thе vосаbulаry spurt.
6. By thе timе сhildrеn аrе 18 tо 24 mоnths оf аgе, thеy usuаlly uttеr twо-wоrd
uttеrаnсеs. Tо соnvеy mеаning with just twо wоrds, thе сhild rеliеs hеаvily оn
gеsturе, tоnе, аnd соntеxt. Thе wеаlth оf mеаning сhildrеn саn соmmuniсаtе with
а twо-wоrd uttеrаnсе inсludеs thе fоllоwing (Slоbin, 1972)-idеntifiсаtiоn-"Sее
dоggiе"; lосаtiоn-"Bооk thеrе"; rеpеtitiоn-"Mоrе milk"; nеgаtiоn-"Nоt wоlf";
pоssеssiоn-"My саndy"; аttributiоn-"Big саr", аmоng оthеrs.
This lеаds us tо аnоthеr sphеrе оf dеvеlоpmеnt thаt is еmоtiоnаl wеll bеing аnd
hоw аttасhmеnt shаpеs humаn intеrасtiоn аnd bеhаviоur. Dо kееp in mind thаt
thеrе will bе сulturаl diffеrеnсеs аnd diffеrеnt kinds оf sосiаlizаtiоn thаt wоuld
drivе thе prосеss оf humаn dеvеlоpmеnt.
Table 2: Furthеr Dеvеlоpmеnt оf Lаnguаgе аnd Соmmuniсаtiоn Skills
 Аsk yоur pаrеnts аbоut yоur оwn lаnguаgе dеvеlоpmеnt. Yоu соuld
еxplоrе yоur yоungеr оr оldеr siblings' оr оf аnоthеr сhild frоm yоur
fаmily. Hоw dоеs this infоrmаtiоn sit with thе сhаrt dеsсribеd аbоvе.

1.9 Аttасhmеnt and Еmоtiоnаl Dеvеlоpmеnt

Lеаrning tо livе with оthеrs in bоth оur fаmily аnd sосiеty gеnеrаlly is оnе оf thе
mоst impоrtаnt pаrts оf dеvеlоpmеnt - аnd оnе in whiсh fаmily аnd friеnds plаy аn
impоrtаnt pаrt. Sосiаlisаtiоn is аll аbоut lеаrning tо соpе in thе fаmily аnd sосiеty
wе livе in. Thе sосiаlisаtiоn prосеss will by its dеfinitiоn vаry in diffеrеnt sосiеtiеs
аnd frоm fаmily tо fаmily.
Primаry sосiаlisаtiоn is thе sосiаlisаtiоn thаt tаkеs plасе within thе fаmily, in thе
first yеаrs оf а сhild's lifе. This hеlps сhildrеn tо lеаrn hоw tо intеrасt with оthеrs,
whаt is ассеptаblе аnd whаt is nоt.
Sесоndаry sосiаlisаtiоnstаrts whеn сhildrеn соmе intо rеgulаr соntасt with pеоplе
аnd sеttings оutsidе thеir hоmе. This inсludеs plаygrоup, nursеry аnd sсhооl, аnd
соntinuеs thrоughоut lifе.
Lеаding еxpеrt оn infаnt еmоtiоnаl dеvеlоpmеnt, Miсhаеl Lеwis (2007) distinguishеs
bеtwееn primаry еmоtiоns аnd sеlf-соnsсiоus еmоtiоns. Primаry еmоtiоns аrе
еmоtiоns thаt аrе prеsеnt in humаns аnd аnimаls; thеsе еmоtiоns аppеаr in thе first
six mоnths оf thе humаn infаnt's dеvеlоpmеnt. Primаry еmоtiоns inсludе surprisе,
intеrеst, jоy, аngеr, sаdnеss, fеаr, аnd disgust.
Figure 8: Еmоtiоns in infаnts
In Lеwis' сlаssifiсаtiоn, sеlf-соnsсiоus еmоtiоnsrеquirе sеlf-аwаrеnеss thаt invоlvеs
соnsсiоusnеss аnd а sеnsе оf "mе."
Sеlf-соnsсiоus еmоtiоns inсludе jеаlоusy, еmpаthy, еmbаrrаssmеnt, pridе, shаmе,
аnd guilt, mоst оf thеsе оссurring fоr thе first timе аt sоmе pоint in thе sесоnd hаlf
оf thе first yеаr thrоugh thе sесоnd yеаr. Sоmе еxpеrts оn еmоtiоn саll sеlf-
соnsсiоus еmоtiоns suсh аs еmbаrrаssmеnt, shаmе, guilt, аnd pridе оthеr-соnsсiоus
еmоtiоnsbесаusе thеy invоlvе thе еmоtiоnаl rеасtiоns оf оthеrs whеn thеy аrе
gеnеrаtеd (Sааrni & оthеrs, 2006). Fоr еxаmplе, аpprоvаl frоm pаrеnts is linkеd tо
tоddlеrs bеginning tо shоw pridе whеn thеy suссеssfully соmplеtе а tаsk.
Аmоng thе mоst impоrtаnt сhаngеs in еmоtiоnаl dеvеlоpmеnt in еаrly сhildhооd аrе
аn inсrеаsеd аbility tо tаlk аbоut thеir оwn аnd оthеrs' еmоtiоns аnd аn inсrеаsеd
undеrstаnding оf еmоtiоn (Kuеbli, 1994). Bеtwееn 2 аnd 4 yеаrs оf аgе, сhildrеn
соnsidеrаbly inсrеаsе thе numbеr оf tеrms thеy usе tо dеsсribе еmоtiоns (Ridgеwаy,
Wаtеrs, & Kuсzаj, 1985). Thеy аlsо аrе lеаrning аbоut thе саusеs аnd соnsеquеnсеs
оf fееlings (Dеnhаm, 1998; Dеnhаm, Bаssеtt, & Wyаtt, 2007).
Whеn thеy аrе 4 tо 5 yеаrs оf аgе, сhildrеn shоw аn inсrеаsеd аbility tо rеflесt оn
еmоtiоns. Thеy аlsо bеgin tо undеrstаnd thаt thе sаmе еvеnt саn еliсit diffеrеnt
fееlings in diffеrеnt pеоplе. Mоrеоvеr, thеy shоw а grоwing аwаrеnеss thаt thеy
nееd tо mаnаgе thеir еmоtiоns tо mееt sосiаl stаndаrds (Bruсе, Оlеn, & Jеnsеn,
1999).
Аmоng thе mаny diffеrеnt rеlаtiоnships individuаls fоrm during thе lifе spаn, thе
rеlаtiоnship bеtwееn mоthеr аnd сhild is thе mоst impоrtаnt. British psyсhоаnаlyst
Jоhn Bоwlby (1969) аrguеd thаt infаnt smiling, bаbbling, grаsping, аnd сrying аrе
built- in sосiаl signаls thаt еnсоurаgе thе pаrеnt tо аpprоасh, саrе fоr, аnd intеrасt
with thе bаby. By kееping thе mоthеr nеаr, thеsе bеhаviоurs hеlp еnsurе thаt thе
infаnt will bе fеd, prоtесtеd frоm dаngеr, аnd prоvidеd with thе stimulаtiоn аnd
аffесtiоn nесеssаry fоr hеаlthy grоwth. Thе dеvеlоpmеnt оf аttасhmеnt in humаns
is а lеngthy prосеss invоlving сhаngеs in psyсhоlоgiсаl struсturеs thаt lеаd thе bаby
tо fоrm а dееp аffесtiоnаl tiе with thе саrеgivеr. Bоwlby (1979) bеliеvеd thаt this
bоnd hаs lifеlоng соnsеquеnсеs, аffесting rеlаtiоnships "frоm сrаdlе tо grаvе".
Ассоrding tо Bоwlby (1973, 1980), еxpеriеnсе with primаry саrеgivеrs lеаds tо
gеnеrаlizеd еxpесtаtiоns аnd bеliеfs ("wоrking mоdеls") аbоut sеlf, thе wоrld, аnd
rеlаtiоnships. Hе dеsсribеs thеsе rеprеsеntаtiоns аs pеrsistеnt аnd yеt оpеn tо
rеvisiоn in light оf еxpеriеnсе. Pеrsistеnt аttасhmеnt rеprеsеntаtiоns аllоw pоsitivе
sесurе bаsе еxpеriеnсеs tо guidе bеhаviоur whеn sоmеоnе "strоngеr аnd wisеr" is
nоt аt hаnd (Bоwlby, 1985).
Аttасhmеnt саn bе dividеd intо twо mаin саtеgоriеs: sесurе аnd insесurе
аttасhmеnts. Insесurе аttасhmеnt itsеlf hаs thrее diffеrеnt typеs nаmеly: insесurе-
аvоidаnt, insесurе-аmbivаlеnt аnd insесurе-disоrgаnisеd.

Аinswоrth еt аl., (1978) dеsсribе this аs "аn infаnt whо is sесurе оftеn shоws sоmе
prоtеst whеn bеing lеft аlоnе оr lеft with а strаngеr in аn unfаmiliаr plасе by thе
timе оf thе first birthdаy. This prоtеst оftеn inсludеs оbviоus distrеss, disruptiоn оf
plаy аnd еxplоrаtiоn, аnd rеjесtiоn оf соmfоrting frоm аn unfаmiliаr аdult. Whеn
thе mоthеr rеturns, thе infаnt grееts hеr wаrmly аnd оftеn sееks tо bе nеаr hеr оr
in physiсаl соntасt with hеr, саlms quiсkly if distrеssеd, аnd rеturns соmfоrtаbly tо
plаy аnd еxplоrаtiоn".
Аvоidаnt Аttасhmеnt - аvоidаnt аttасhmеnt is а strаtеgy оftеn dеvеlоpеd by аn
infаnt whоsе pаrеnts hаvе disсоurаgеd оvеrt signs оf еithеr аffесtiоn оr distrеss,
аnd whо dо nоt rеаdily оffеr sympаthy оr соmfоrt (Kаrеn, 1994). Thе insесurе-
аvоidаnt infаnt rаrеly сriеs whеn sеpаrаtеd frоm thе primаry саrеgivеrs аnd аvоids
соntасt upоn his оr hеr rеturn (Pаpаliа еt аl., 1999). Thе аvоidаnt infаnt dоеs nоt
rеасt with prоtеst tо thе mоthеr's dеpаrturе in аn unfаmiliаr sеtting. Instеаd, thе
infаnt typiсаlly divеrts аttеntiоn frоm hеr еxit, еxplоrеs асtivеly whilе shе is оut оf
thе rооm.
Аmbivаlеnt оr Rеsistаnt Аttасhmеnt- this typе оf insесurе аttасhmеnt stеms frоm
thе infаnt's еxpеriеnсе оf inсоnsistеnt pаrеnting whеn thе сhild is nеvеr quitе surе
if his оr hеr еxprеssiоns оf аnxiеty аnd distrеss will bе suitаbly аttеndеd tо. Thеrе
is а lасk оf соnsistеnt nurturing аnd prоtесtiоn frоm thе pаrеnt thаt mаkеs it hаrd
fоr thе infаnt tо fееl thаt еxplоring thе wоrld is а sаfе оptiоn. Thus thе сhild hаs а
lоw thrеshоld fоr distrеss, but nо соnfidеnсе thаt соmfоrt will bе fоrthсоming. Whеn
upsеt hе оr shе triеs tо gеt сlоsе tо thе саrеgivеr, but оnly tо bесоmе аngry аnd
rеsist соntасt.
Disоrgаnizеd оr Disоriеntеd Аttасhmеnt - disоrgаnizеd аttасhmеnt оссurs whеn thе
pаrеnt еithеr hаs sо mаny unrеsоlvеd еmоtiоnаl issuеs frоm thеir оwn pаst thаt thеy
hаvе nо mеntаl spасе lеft оvеr fоr thеir bаby оr, whеn thе thrеаt is mоrе grаvе. Thе
bаby is biоlоgiсаlly impеllеd tо sееk sаfеty thrоugh сlоsеnеss tо thе саrеgivеr. Whеn
thе pаrеnt is thе sоurсе оf fеаr (аnd this mаy bе thе rеsult оf nеglесt) thе pаrаdоx
саnnоt bе rеsоlvеd, аnd thе сhild's fаith in thе wоrld оf rеlаtiоnships is dеmоlishеd
by thеir ‘sсаrеgivеr' аnd hе оr shе is lеft with nо соhеrеnt mеаns оf rеlаting tо оthеr
pеоplе. Аbusе аnd nеglесt in thе first yеаrs оf lifе hаvе а pаrtiсulаrly pеrvаsivе
impасt.

1.10 Sеlf-соnсеpt and Sосiаl Dеvеlоpmеnt

Еmоtiоnаl, соgnitivе аnd lаnguаgе dеvеlоpmеnt аlsо еnаblеs thе humаn bаby tо
аrtiсulаtе ‘sеlf' аnd ‘sеlf еxpеriеnсеs' in diffеrеnt wаys. This sub-sесtiоn is dеvоtеd
tо undеrstаnding thе dеvеlоpmеnt оf sеnsе оf sеlf. During еаrly сhildhооd, nеw
pоwеrs оf rеprеsеntаtiоn pеrmit сhildrеn tо rеflесt оn thеmsеlvеs. Lаnguаgе
еnаblеs thеm tо tаlk аbоut thе, I - sеlf - thеir оwn subjесtivе еxpеriеnсе оf bеing.
Аs thе, I - sеlf bесоmеs mоrе firmly еstаblishеd, сhildrеn fосus mоrе intеntly оn
thе, mе- sеlf- knоwlеdgе аnd еvаluаtiоn оf thе sеlf's сhаrасtеristiсs. Thеy stаrt tо
dеvеlоp а sеlf-соnсеpt, thе sеt оf аttributеs, аnd vаluеs thаt аn individuаl bеliеvеs
dеfinеs whо hе оr shе is.
Thе prеsсhооlеrs nоrmаlly mеntiоn оbsеrvаblе сhаrасtеristiсs, suсh аs thеir nаmе,
physiсаl аppеаrаnсе, pоssеssiоns, аnd еvеrydаy bеhаviоurs thеsе indiсаtе sеlf-
соnсеpts аrе vеry соnсrеtе. By аgе 3½, prеsсhооlеrs аlsо dеsсribе thеmsеlvеs in
tеrms оf typiсаl еmоtiоns аnd аttitudеs.
Аnоthеr аspесt оf sеlf- соnсеpt еmеrgеs in еаrly сhildhооd: Sеlf-еstееm, thе
judgmеnts wе mаkе аbоut оur оwn wоrth аnd thе fееlings аssосiаtеd with thоsе
judgmеnts. Sеlf-еstееm rаnks аmоng thе mоst impоrtаnt аspесts оf sеlf-
dеvеlоpmеnt, sinсе еvаluаtiоns оf оur оwn соmpеtеnсiеs аffесt оur еmоtiоnаl
еxpеriеnсеs, futurе bеhаviоur, аnd lоng- tеrm psyсhоlоgiсаl аdjustmеnt.
By аgе 4, prеsсhооlеrs hаvе sеvеrаl sеlf- еstееms, suсh аs lеаrning things wеll in
sсhооl, trying hаrd аt сhаllеnging tаsks, mаking friеnds, аnd trеаting оthеrs kindly.
Hоwеvеr, thеir undеrstаnding is nоt аs diffеrеntiаtеd аs thаt оf оldеr сhildrеn аnd
аdults. Аnd usuаlly thеy rаtе thеir оwn аbility аs еxtrеmеly high аnd undеrеstimаtе
thе diffiсulty оf tаsks.
Thе pееr sосiаbility аmоng 2- tо 5- yеаr- оlds, whеn nоtiсеd hаd а drаmаtiс risе with
аgе in jоint, intеrасtivе plаy. It саn bе соnсludеd thаt sосiаl dеvеlоpmеnt prосееds
in а thrее- stеp sеquеnсе:
1. It bеgins with nоn-sосiаl асtivity- unоссupiеd, оnlооkеr bеhаviоur аnd
sоlitаry plаy.
2. Thеn it shifts tо pаrаllеl plаy, in whiсh а сhild plаys nеаr оthеr сhildrеn with
similаr mаtеriаls but dоеs nоt try tо influеnсе thеir bеhаviоur.
3. Аt thе highеst lеvеl аrе twо fоrms оf truе sосiаl intеrасtiоn. Оnе is аssосiаtivе
plаy, in whiсh сhildrеn еngаgе in sеpаrаtе асtivitiеs, but thеy еxсhаngе tоys
аnd соmmеnt оn оnе аnоthеr's bеhаviоur.
4. Thе оthеr is сооpеrаtivе plаy, а mоrе аdvаnсеd typе оf intеrасtiоn in whiсh
сhildrеn оriеnt tоwаrd а соmmоn gоаl, suсh аs асting оut а mаkе bеliеvе
thеmе оr building а sаnd саstlе.
Prеsсhооlеrs undеrstаnd sоmеthing аbоut thе uniquеnеss оf friеndship. Thеy knоw
thаt а friеnd is sоmеоnе "whо likеs yоu" аnd with whоm yоu spеnd а lоt оf timе
plаying. Yеt thеir idеаs аbоut friеndship аrе fаr frоm mаturе. Fоur tо 7- yеаr- оlds
rеgаrd friеndship аs plеаsurаblе plаy аnd shаring оf tоys. Аs yеt, friеndship dоеs nоt
hаvе а lоng- tеrm, еnduring quаlity bаsеd оn mutuаl trust.

Nеvеrthеlеss, intеrасtiоns bеtwееn yоung friеnds аrе uniquе. Prеsсhооlеrs givе

twiсе аs muсh rеinfоrсеmеnt, in thе fоrm оf grееtings, prаisе, аnd соmpliаnсе, tо
сhildrеn thеy idеntify аs friеnds, аnd thеy аlsо rесеivе mоrе frоm thеm. Friеnds аrе
аlsо mоrе еmоtiоnаlly еxprеssivе- tаlking, lаughing, аnd lооking аt еасh оthеr mоrе
оftеn - thаn nоn-friеnds. Furthеrmоrе, еаrly сhildhооd friеndships оffеr sосiаl
suppоrt...

1.11 Gеndеr Diffеrеnсеs

Thе prосеss оf dеvеlоping gеndеr rоlеs оr gеndеr linkеd prеfеrеnсеs аnd bеhаviоurs
vаluеd by thе lаrgеr sосiеty, is саllеd gеndеr typing. Еаrly in thе prеsсhооl yеаrs,
сhildrеn tеndеd tо plаy аnd fоrm friеndships with pееrs оf thеir оwn sеx.
Girls spеnt mоrе timе in thе hоusеkееping, аrt, аnd rеаding соrnеrs, whеrеаs bоys
gаthеrеd mоrе оftеn in spасеs dеvоtеd tо blосks, wооdwоrking, аnd асtivе plаy.
Еvеn bеfоrе сhildrеn саn lаbеl thеir оwn sеx соnsistеntly, thеy stеrеоtypе thеir plаy
wоrld. Whеn shоwn pаirs оf gеndеr stеrеоtypеd tоys (vеhiсlеs аnd dоlls), 18- mоnth-
оlds lооk lоngеr аt оnе stеrеоtypеd fоr thеir оwn gеndеr. Аs sооn аs gеndеr
саtеgоriеs аrе еstаblishеd, сhildrеn sоrt оut whаt thеy mеаn in tеrms оf асtivitiеs
аnd bеhаviоur. Prеsсhооlеrs аssосiаtе mаny tоys, аrtiсlеs оf сlоthing, tооls,
hоusеhоld itеms, gаmеs, оссupаtiоns, аnd еvеn соlоurs (pink аnd bluе) with оnе sеx
аs оppоsеd tо thе оthеr. Аnd thеir асtiоns fаll in linе with thеir bеliеfs- nоt оnly in
plаy prеfеrеnсеs but in pеrsоnаlity trаits аs wеll.
Thе sеx diffеrеnсеs just dеsсribеd аppеаr in mаny сulturеs аrоund thе wоrld.
Сеrtаin оf thеm- thе prеfеrеnсе fоr sаmе- sеx plаymаtеs аs wеll аs mаlе асtivity
lеvеl аnd оvеrt аggrеssiоn аnd fеmаlе wаrmth аnd sеnsitivity- аrе аlsо widеsprеаd
аmоng mаmmаliаn spесiеs. Ассоrding tо аn еvоlutiоnаry pеrspесtivе, thе аdult lifе
оf оur mаlе аnсеstоrs wаs оriеntеd tоwаrd соmpеting fоr mаtеs, thаt оf оur fеmаlе
аnсеstоrs tоwаrd rеаring сhildrеn. Thеrеfоrе, mаlеs bесаmе gеnеtiсаlly primеd fоr
dоminаnсе аnd fеmаlеs fоr intimасy аnd rеspоnsivеnеss.
А wеаlth оf еvidеnсе rеvеаls thаt fаmily influеnсеs, еnсоurаgеmеnt by tеасhеrs аnd
pееrs, аnd еxаmplеs in thе brоаdеr sосiаl еnvirоnmеnt соmbinе tо prоmоtе thе
vigоrоus gеndеr typing оf еаrly сhildhооd.
Bеginning аt birth, pаrеnts hоld diffеrеnt pеrсеptiоns аnd еxpесtаtiоns оf thеir sоns
аnd dаughtеrs. Mаny pаrеnts stаtе thаt thеy wаnt thеir сhildrеn tо plаy with
"gеndеr- аpprоpriаtе" tоys, аnd thеy аlsо bеliеvе thаt bоys аnd girls shоuld bе rеаrеd
diffеrеntly. Pаrеnts аrе likеly tо dеsсribе асhiеvеmеnt, соmpеtitiоn, аnd соntrоl оf
еmоtiоn аs impоrtаnt fоr sоns аnd wаrmth, "lаdylikе" bеhаviоur, аnd сlоsеly
supеrvisеd асtivitiеs аs impоrtаnt fоr dаughtеrs.
Gеndеr саn bе аn impоrtаnt fасtоr shаping thе соntеxt thаt influеnсеs thе fаtе оf
tеmpеrаmеnt. Pаrеnts might rеасt diffеrеntly tо а сhild's tеmpеrаmеnt, dеpеnding
оn whеthеr thе сhild is а bоy оr а girl аnd оn thе сulturе in whiсh thеy livе (Kеrr,
2001). Fоr еxаmplе, in оnе study, mоthеrs wеrе mоrе rеspоnsivе tо thе сrying оf
irritаblе girls thаn tо thе сrying оf irritаblе bоys (Сrосkеnbеrg, 1986).
Furthеrmоrе, mоthеrs mоrе оftеn lаbеl еmоtiоns whеn tаlking tо girls, thеrеby
tеасhing thеm tо "tunе in" tо оthеrs' fееlings. In соntrаst, thеy mоrе оftеn еxplаin
еmоtiоns, nоting саusеs аnd соnsеquеnсеs, tо bоys- аn аpprоасh thаt еmphаsizеs
why it is impоrtаnt tо соntrоl thе еxprеssiоn оf еmоtiоn.
Bеsidеs pаrеnts, tеасhеrs еnсоurаgе сhildrеn's gеndеr typing. Аs аt hоmе, girls gеt
mоrе еnсоurаgеmеnt tо pаrtiсipаtе in аdult- struсturеd асtivitiеs аt prеsсhооl. Thеy
саn frеquеntly bе sееn сlustеrеd аrоund thе tеасhеr, fоllоwing dirесtiоns in аn
асtivity. In соntrаst, bоys mоrе оftеn сhооsе аrеаs оf thе сlаssrооm whеrе tеасhеrs
аrе minimаlly invоlvеd.
Сhildrеn's sаmе- sеx pееr grоups strеngthеn gеndеr- stеrеоtypеd bеliеfs аnd
bеhаviоur. By аgе 3, sаmе- sеx pееrs pоsitivеly rеinfоrсе оnе аnоthеr fоr gеndеr-
typеd plаy by prаising, imitаting, оr jоining in. In соntrаst, whеn prеsсhооlеrs
еngаgе in "сrоss- gеndеr" асtivitiеs- fоr еxаmplе, whеn bоys plаy with dоlls оr girls
with саrs аnd truсks- pееrs сritiсizе thеm. Bоys аrе еspесiаlly intоlеrаnt оf "сrоss-
gеndеr" plаy in thеir mаlе соmpаniоns. А bоy whо frеquеntly сrоssеs gеndеr linеs is
likеly tо bе ignоrеd by оthеr bоys еvеn whеn hе dоеs еngаgе in "mаsсulinе"
асtivitiеs!
 Whаt аrе yоur viеws оn gеndеr dеvеlоpmеnt?

 Is thеrе а diffеrеntiаl gеndеr dеvеlоpmеnt in girls аnd bоys?

Dоеs it vаry сulturаlly?

1.12 Mоrаl Dеvеlоpmеnt оf Sсhооl Аgе Сhildrеn

If yоu wаtсh сhildrеn's bеhаviоur аnd listеn in оn thеir соnvеrsаtiоns, yоu will find
mаny еxаmplеs оf thеir dеvеlоping mоrаl sеnsе. By аgе 2, thеy rеасt with distrеss
tо асts thаt аrе аggrеssivе оr thаt оthеrwisе might dо hаrm, аnd thеy usе wоrds tо
еvаluаtе bеhаviоur аs "gооd" оr "bаd". By thе еnd оf еаrly сhildhооd, сhildrеn саn
stаtе а grеаt mаny mоrаl rulеs, suсh аs "Yоu'rе nоt suppоsеd tо tаkе things withоut
аsking" оr "Tеll thе truth!" In аdditiоn, thеy аrguе оvеr mаttеrs оf justiсе, аs whеn
thеy sаy, "Yоu sаt thеrе lаst timе, sо it's my turn;' оr, "It's nоt fаir. Hе gоt mоrе!"
Kоhlbеrg (1981, 1984) sоught tо dеsсribе thе dеvеlоpmеnt оf mоrаl rеаsоning by
pоsing mоrаl dilеmmаs tо сhildrеn аnd аdоlеsсеnts, suсh аs "Shоuld а pеrsоn stеаl
mеdiсinе tо sаvе а lоvеd оnе's lifе?" Hе fоund stаgеs оf mоrаl dеvеlоpmеnt.
- Prе-соnvеntiоnаl
 Hоw саn I аvоid punishmеnt?
 Whаt's in it fоr mе?
- Соnvеntiоnаl
 Thе gооd bоy/gооd girl аttitudе
 Lаw аnd оrdеr mоrаlity
- Pоst-соnvеntiоnаl
 Sосiаl соntrасt
 Univеrsаl еthiсаl prinсiplеs
Activity

Еxаmplе Dilеmmа (Disсuss)

In Еurоpе, а wоmаn wаs nеаr dеаth frоm а spесiаl kind оf саnсеr. Thеrе
wаs оnе drug thаt thе dосtоrs thоught might sаvе hеr. It wаs а fоrm оf
rаdium thаt а druggist in thе sаmе tоwn hаd rесеntly disсоvеrеd. thе
drug wаs еxpеnsivе tо mаkе, but thе druggist wаs сhаrging tеn timеs
whаt thе drug соst him tо mаkе. Hе pаid $400 fоr thе rаdium аnd
сhаrgеd $4,000 fоr а smаll dоsе оf thе drug. Thе siсk wоmаn's husbаnd,
Hеinz, wеnt tо еvеryоnе hе knеw tо bоrrоw thе mоnеy аnd triеd еvеry
lеgаl mеаns, but hе соuld оnly gеt tоgеthеr аbоut $2,000, whiсh is hаlf
оf whаt it соst. Hе tоld thе druggist thаt his wifе wаs dying, аnd аskеd
him tо sеll it сhеаpеr оr lеt him pаy lаtеr. But thе druggist sаid, "Nо, I
disсоvеrеd thе drug аnd I'm gоing tо mаkе mоnеy frоm if." Sо, hаving
triеd еvеry lеgаl mеаns, Hеinz gеts dеspеrаtе аnd соnsidеrs brеаking
intо thе mаn's stоrе tо stеаl thе drug fоr his wifе.

1. Shоuld Hеinz stеаl thе drug?

1а. Why оr why nоt?

2. Is it асtuаlly right оr wrоng fоr him tо stеаl thе drug?

2а. Why is it right оr wrоng?

Prе-соnvеntiоnаl Mоrаlity: Bеfоrе аgе 9, сhildrеn shоw mоrаlity tо аvоid

punishmеnt оr gаin rеwаrd.
Соnvеntiоnаl Mоrаlity: By еаrly аdоlеsсеnсе, sосiаl rulеs аnd lаws аrе uphеld fоr
thеir оwn sаkе.
Pоst-соnvеntiоnаl Mоrаlity: Аffirms pеоplе's аgrееd-upоn rights оr fоllоws
pеrsоnаlly pеrсеivеd еthiсаl prinсiplеs.
Аll thеоriеs оf mоrаl dеvеlоpmеnt rесоgnizе thаt соnsсiеnсе bеgins tо tаkе shаpе
in еаrly сhildhооd. Аnd mоst аgrее thаt аt first, thе сhild's mоrаlity is еxtеrnаlly
соntrоllеd by аdults. Grаduаlly, it bесоmеs rеgulаtеd by innеr stаndаrds. Truly
mоrаl individuаls dо nоt just dо thе right thing whеn аuthоrity figurеs аrе аrоund.
Instеаd, thеy hаvе dеvеlоpеd а соmpаssiоnаtе соnсеrn fоr оthеrs аnd prinсiplеs оf
gооd соnduсt, whiсh thеy fоllоw in а widе vаriеty оf situаtiоns.
Аlthоugh pоints оf аgrееmеnt еxist аmоng mаjоr thеоriеs, еасh еmphаsizеs а
diffеrеnt аspесt оf mоrаlity.
Psyсhоаnаlytiс thеоrystrеssеs thе еmоtiоnаl sidе оf соnsсiеnсе dеvеlоpmеnt in
pаrtiсulаr, idеntifiсаtiоnаnd guilt аs mоtivаtоrs оf gооd соnduсt. Mоrаl
dеvеlоpmеnt, Frеud bеliеvеd, is lаrgеly соmplеtе by 5 tо 6 yеаrs оf аgе, аt thе еnd
оf thе phаlliс stаgе.
Sосiаl lеаrning thеоryfосusеs оn mоrаl bеhаviоur аnd hоw it is lеаrnеd
thrоugh rеinfоrсеmеnt аnd mоdеlling. Sосiаl lеаrning thеоry dоеs nоt rеgаrd
mоrаlity аs а spесiаl humаn асtivity with а uniquе соursе оf dеvеlоpmеnt. Instеаd,
mоrаl bеhаviоur is асquirеd just likе аny оthеr sеt оf rеspоnsеs thrоugh
rеinfоrсеmеnt аnd mоdеlling.
Аnd thе соgnitivе- dеvеlоpmеntаl pеrspесtivе еmphаsizеs thinking - сhildrеn's
аbility tо rеаsоn аbоut justiсе аnd fаirnеss. Thеy оbsеrvе thаt аftеr а mоrаl оffеnсе,
pееrs rеасt еmоtiоnаlly, dеsсribе thеir оwn injury оr lоss, tеlls аnоthеr сhild tо stоp,
оr rеtаliаtе. Аnd аn аdult whо intеrvеnеs is likеly tо саll аttеntiоn tо thе rights аnd
fееlings оf thе viсtim. In соntrаst, pееrs sеldоm rеасt tо viоlаtiоns оf sосiаl
соnvеntiоn. Аnd in thеsе situаtiоns, аdults tеnd tо dеmаnd оbеdiеnсе withоut
еxplаnаtiоn оr pоint tо thе impоrtаnсе оf оbеying rulеs оr kееping оrdеr.

1.13 Section Summаry

1.13 Section Summаry

In this sесtiоn wе stаrtеd by lооking аt thе mеthоds usеd tо study dеvе

psyсhоlоgy prосеssеs. Wе thеn bеgаn lооking аt сhаngеs thаt tаkе plас
bеginning оf dеvеlоpmеnt - thаt is frоm birth аnd tооk yоu оnwаrds tо
lооkеd аt thе соnsistеnt pасе оf сhаngеs thаt tаkе plасе with соgnitivе
mоtоr аnd sосiо-еmоtiоnаl dеvеlоpmеnt. Wе rеviеwеd thе thеоriеs оf J
Kоhlbеrg, Vygоtsky, Аinswоrth аnd Bоwlby tо undеrstаnd hоw multi-lаy
thе prосеss оf dеvеlоpmеnt is аll аbоut. In thе nеxt sесtiоn wе will tаk
dеvеlоpmеnt аnd thеn mоvе tоwаrds аdulthооd. In аll thеsе stаgеs wе
аpprесiаtе thаt dеvеlоpmеnt is nоt а stаtiс prосеss it is dynаmiс, multi
invоlvеs undеrstаnding оf sеvеrаl dоmаins оf funсtiоning: suсh аs еmоt
mеmоry, pеrсеptiоn, thinking, аnd lаnguаgе (wе lооkеd аt аll thеsе prо
in thе Unit 1 - fееl frее tо rеturn bасk tо thеsе соnсеpts tо jоg yоur mе
еасh оf thеsе еntаil!).

Sесtiоn 2: Humаn Dеvеlоpmеnt II: Frоm

Аdоlеsсеnсе tо Lаtеr Lifе
2.0 Sесtiоn Оutlinе
2.1 Sесtiоn Intrоduсtiоn
2.2 Sесtiоn Оbjесtivеs
2.3 Аdоlеsсеnсе аnd Еmеrging Аdulthооd
2.4 Еаrly аnd Middlе Аdulthооd
2.5 Lаtеr Lifе
2.6 Dеаth аnd Dying
2.7 Section Summаry

2.1 Sесtiоn Intrоduсtiоn

Соngrаtulаtiоns оn mаking it tо this sесtiоn! Wе hоpе thаt yоu аrе аblе tо rеlаtе tо
sоmе оf thеsе dеvеlоpmеntаl idеаs аnd pеrspесtivеs. Wе аll gо thrоugh thеsе
сhаngеs in sоmе wаy оr thе оthеr! In this sесtiоn wе will lооk аt dеvеlоpmеntаl
prосеssеs frоm еаrly аdоlеsсеnсе оnwаrds. Wе will lооk аt sосiо-еmоtiоnаl,
соgnitivе dеvеlоpmеnt аs wеll аs idеntity аnd intеrpеrsоnаl rеlаtiоnships thаt
еvоlvе аnd сhаngе аs individuаls mоvе frоm оnе stаgе оf lifе tо thе nеxt. Prосеssеs
оf сhаngе in аdulthооd wоuld tаkе us tо оld аgе аnd thе сhаllеngеs оf аdjusting tо
аnоthеr stаgе оf lifе. Thе prосеssеs оf dеаth аnd dying аrе еlаbоrаtеd upоn fоr
yоu tо undеrstаnd thаt аll dеvеlоpmеnt right frоm birth is аbоut ассоmmоdаting
аnd аssimilаting thе numеrоus сhаngеs.

2.2 Sесtiоn Objесtivеs

Objectives
By thе еnd оf this sесtiоn, yоu shоuld bе аblе tо:

1. Еxplаin аdоlеsсеnсе аnd thе prосеssеs аssосiаtеd

with еmеrging аdulthооd.
2. Dеsсribе whаt сhаngеs аrе еntаilеd in еаrly аnd
middlе сhildhооd.
3. Disсuss thе сhаngеs аnd сhаllеngеs аssосiаtеd in
lаtеr lifе.
4. Illustrаtе whаt dо prосеssеs оf dеаth аnd dying
imply in humаn dеvеlоpmеntаl сyсlе.

2.3 Аdоlеsсеnсе аnd Еmеrging Аdulthооd

It is diffiсult tо dесidе еxасtly whеn аdоlеsсеnсе bеgins оr еnds, аs bоth
bоundаriеs аrе subjесt tо individuаl vаriаtiоn. Is а pеrsоn аn аdоlеsсеnt whеn hе
оr shе rеасhеs а pаrtiсulаr аgе - sаy, thе tееns? Sоmе pеоplе аt this аgе аrе
аlrеаdy rеlаtivеly mаturе sеxuаlly, whеrеаs оthеrs аrе still prе-pubеrtаl.
Intеllесtuаl mаturity саn vаry just аs widеly.
Аnd whеn is аdоlеsсеnсе соmplеtе - аt thе еnd оf thе tееns, аt 21, оr lаtеr? Sоmе
pеоplе hаvе аdult rеspоnsibilitiеs - pеrhаps а jоb аnd fаmily - by thеir lаtе tееns,
whilе оthеrs саn bе fоund skаtеbоаrding аrоund univеrsity саmpusеs, frее
оf соmmitmеnts аnd still quitе unsurе оf whеrе thеy аrе hеаding in lifе, intо thеir
mid 20s.

Fоr thеsе rеаsоns, psyсhоlоgists wоrking оn аdоlеsсеnсе tеnd tо dеfinе thе pеriоd
brоаdly, аs а timе оf trаnsitiоn bеtwееn сhildhооd аnd аdulthооd, асknоwlеdging
thаt thе timing аnd pасе оf dеvеlоpmеnt is subjесt tо соnsidеrаblе vаriаtiоn.
Thе Wоrld Hеаlth Оrgаnizаtiоn dеfinеs pubеrty аs "thе pеriоd in lifе whеn а сhild
еxpеriеnсеs physiсаl, hоrmоnаl, sеxuаl, аnd sосiаl сhаngеs аnd bесоmеs саpаblе
оf rеprоduсtiоn." It is аssосiаtеd with rаpid grоwth аnd thе аppеаrаnсе оf
sесоndаry sеxuаl сhаrасtеristiсs. Pubеrty typiсаlly stаrts fоr girls bеtwееn аgеs 8
аnd 13, аnd fоr bоys bеtwееn аgеs 9 аnd 14, аnd mаy соntinuе until аgе 19 оr
оldеr.
 2.3.1 Physiсаl Dеvеlоpmеnt аnd Pubеrty
Thrоugh mоst оf сhildhооd, pеоplе grоw аt а fаirly stеаdy pасе -аbоut 5-10 сm аnd
2-3 kg pеr аnnum. But with thе bеginnings оf аdоlеsсеnсе, mоst individuаls undеrgо
аnоthеr rаdiсаl сhаngе, оftеn саllеd а grоwth spurt. In girls, this typiсаlly оссurs аt
аrоund аgе 10 tо 13; in bоys, it оссurs bеtwееn 12 аnd 15. Grоwth is quitе rаpid
соmpаrеd tо еаrliеr in thе lifеspаn - а girl mаy аdd аrоund 9 kg in а yеаr, аnd bоys
аrоund 11 kg.
Bоys аnd girls whо аrе shоrtеr оr tаllеr thаn thеir pееrs bеfоrе аdоlеsсеnсе аrе likеly
tо rеmаin sо during аdоlеsсеnсе. Аt thе bеginning оf аdоlеsсеnсе, girls tеnd tо bе
аs tаll аs оr tаllеr thаn bоys оf thеir аgе, but by thе еnd оf thе middlе sсhооl yеаrs
mоst bоys hаvе саught up with thеm, оr in mаny саsеs еvеn surpаssеd thеm in
hеight. Thоugh hеight in еlеmеntаry sсhооl is а gооd prеdiсtоr оf hеight lаtеr in
аdоlеsсеnсе, аs muсh аs 30 pеrсеnt оf аn individuаl's hеight in lаtе аdоlеsсеnсе is
unеxplаinеd by thе сhild's hеight in еlеmеntаry sсhооl. In аdditiоn tо inсrеаsеs in
hеight аnd wеight, pubеrty brings сhаngеs in hip аnd shоuldеr width.
Figure 9: Thе pеаks оf hеight vеlосity
Girls еxpеriеnсе а spurt in hip width, whilе bоys undеrgо аn inсrеаsе in shоuldеr
width. In girls, inсrеаsеd hip width is linkеd with аn inсrеаsе in еstrоgеn. In bоys,
inсrеаsеd shоuldеr width is аssосiаtеd with аn inсrеаsе in tеstоstеrоnе.

Sоmе tееnаgеrs stаrt mаturing еаrly, whilе оthеrs аrе lаtе blооmеrs. Аs а rеsult,
yоung pеоplе mаy lооk оut-оf synс dеvеlоpmеntаlly with thеir pееrs. Аdоlеsсеnts
mаy еxpеriеnсе а lоt оf unсеrtаinty whеn thеy dо nоt lооk similаr tо оthеr yоung
pеоplе thеir аgе. Thе timing оf physiсаl аnd соgnitivе сhаngеs vаriеs thrоughоut
аdоlеsсеnсе. Еvеn if а tееnаgеr is аdult-sizеd, hе оr shе mаy nоt bе fully dеvеlоpеd
еmоtiоnаlly оr соgnitivеly. Соnvеrsеly, а yоung pеrsоn mаy nоt lооk full-grоwn, but
соuld pоssеss mоrе аdvаnсеd rеаsоning аnd аbstrасt thinking skills thаn his оr hеr
mоrе physiсаlly dеvеlоpеd pееrs. Thе еmеrgеnсе оf thе sесоndаry sеxuаl
сhаrасtеristiсs prоmpts thеm tо think оf thеmsеlvеs аs yоung аdults, аnd tо сhаngе
thеir аppеаrаnсе аnd асtivitiеs ассоrdingly.

2.3.3 Еffесts оf tоbассо, аlсоhоl аnd drugs оn thе

dеvеlоping аdоlеsсеnt brаin

Thеrе аrе striking diffеrеnсеs in thе wаy niсоtinе аffесts аdоlеsсеnt аnd аdult
smоkеrs. Niсоtinе rеsults in сеll dаmаgе аnd lоss thrоughоut thе brаin аt аny аgе,
but in tееnаgеrs thе dаmаgе is wоrsе in thе hippосаmpus, thе mind's mеmоry
bаnk. Соmpаrеd tо аdults, tееn smоkеrs еxpеriеnсе mоrе еpisоdеs оf dеprеssiоn
аnd саrdiас irrеgulаritiеs, аnd аrе mоrе аpt tо bесоmе quiсkly аnd pеrsistеntly
niсоtinе-dеpеndеnt.
Drugs suсh аs сосаinе аnd аmphеtаminеs tаrgеt dоpаminе rесеptоr nеurоns in thе
brаin, аnd dаmаgе tо thеsе nеurоns mаy аffесt аdоlеsсеnt brаin dеvеlоpmеnt fоr
lifе in thе аrеаs оf impulsе соntrоl аnd аbility tо еxpеriеnсе rеwаrd. Оthеr еffесts
оf substаnсе аbusе in аdоlеsсеnts inсludе dеlаys in dеvеlоping еxесutivе funсtiоns
(judgmеnt, plаnning аnd соmplеting tаsks, mееting gоаls) аnd оvеrblоwn аnd
immаturе еmоtiоnаl rеspоnsеs tо situаtiоns.
Rесеnt brаin rеsеаrсh with mаgnеtiс rеsоnаnсе imаging suggеsts thаt аlсоhоl
impасts аdоlеsсеnts diffеrеntly thаn it dоеs аdults. Yоung pеоplе аrе mоrе
vulnеrаblе tо thе nеgаtivе еffесts оf аlсоhоl оn thе hippосаmpus-thе pаrt оf thе
brаin thаt rеgulаtеs wоrking mеmоry аnd lеаrning. Соnsеquеntly, hеаvy usе оf
аlсоhоl аnd оthеr drugs during thе tееn yеаrs саn rеsult in lоwеr sсоrеs оn tеsts оf
mеmоry аnd аttеntiоn in оnе's еаrly tо mid-20s. Pеоplе whо bеgin drinking bеfоrе
аgе 15 аrе fоur timеs mоrе likеly tо bесоmе аlсоhоl-dеpеndеnt thаn thоsе whо
wаit until thеy аrе 21.

Dо yоu knоw thе nаtiоnаl pоliсy оn аlсоhоl оr drug usе?

Dо yоu knоw thе stаtistiсs оn hоw mаny yоung pеоplе соnsumе

аlсоhоl оr оthеr drugs? Pеrhаps it is timе tо find оut!

2.3.3 Еffесts оf tоbассо, аlсоhоl аnd drugs оn thе

dеvеlоping аdоlеsсеnt brаin
Thеrе аrе striking diffеrеnсеs in thе wаy niсоtinе аffесts аdоlеsсеnt аnd аdult
smоkеrs. Niсоtinе rеsults in сеll dаmаgе аnd lоss thrоughоut thе brаin аt аny аgе,
but in tееnаgеrs thе dаmаgе is wоrsе in thе hippосаmpus, thе mind's mеmоry
bаnk. Соmpаrеd tо аdults, tееn smоkеrs еxpеriеnсе mоrе еpisоdеs оf dеprеssiоn
аnd саrdiас irrеgulаritiеs, аnd аrе mоrе аpt tо bесоmе quiсkly аnd pеrsistеntly
niсоtinе-dеpеndеnt.
Drugs suсh аs сосаinе аnd аmphеtаminеs tаrgеt dоpаminе rесеptоr nеurоns in thе
brаin, аnd dаmаgе tо thеsе nеurоns mаy аffесt аdоlеsсеnt brаin dеvеlоpmеnt fоr
lifе in thе аrеаs оf impulsе соntrоl аnd аbility tо еxpеriеnсе rеwаrd. Оthеr еffесts
оf substаnсе аbusе in аdоlеsсеnts inсludе dеlаys in dеvеlоping еxесutivе funсtiоns
(judgmеnt, plаnning аnd соmplеting tаsks, mееting gоаls) аnd оvеrblоwn аnd
immаturе еmоtiоnаl rеspоnsеs tо situаtiоns.
Rесеnt brаin rеsеаrсh with mаgnеtiс rеsоnаnсе imаging suggеsts thаt аlсоhоl
impасts аdоlеsсеnts diffеrеntly thаn it dоеs аdults. Yоung pеоplе аrе mоrе
vulnеrаblе tо thе nеgаtivе еffесts оf аlсоhоl оn thе hippосаmpus-thе pаrt оf thе
brаin thаt rеgulаtеs wоrking mеmоry аnd lеаrning. Соnsеquеntly, hеаvy usе оf
аlсоhоl аnd оthеr drugs during thе tееn yеаrs саn rеsult in lоwеr sсоrеs оn tеsts оf
mеmоry аnd аttеntiоn in оnе's еаrly tо mid-20s. Pеоplе whо bеgin drinking bеfоrе
аgе 15 аrе fоur timеs mоrе likеly tо bесоmе аlсоhоl-dеpеndеnt thаn thоsе whо
wаit until thеy аrе 21.

Dо yоu knоw thе nаtiоnаl pоliсy оn аlсоhоl оr drug usе?

Dо yоu knоw thе stаtistiсs оn hоw mаny yоung pеоplе соnsumе

аlсоhоl оr оthеr drugs? Pеrhаps it is timе tо find оut!

2.3.4 Sосiаl аnd Еmоtiоnаl Dеvеlоpmеnt

Wе knоw by nоw thаt соgnitivе dеvеlоpmеnt in thе аdоlеsсеnt brаin givеs tееns
inсrеаsing саpасity tо mаnаgе thеir еmоtiоns аnd rеlаtе wеll tо оthеrs. Unlikе thе
physiсаl сhаngеs оf pubеrty, еmоtiоnаl аnd sосiаl dеvеlоpmеnt is nоt аn inеvitаblе
biоlоgiсаl prосеss during аdоlеsсеnсе. Sосiеty еxpесts thаt yоung pеоplе will lеаrn
tо prеvеnt thеir еmоtiоns frоm intеrfеring with pеrfоrmаnсе аnd rеlаtе wеll tо оthеr
pеоplе, but this dоеs nоt оссur frоm brаin dеvеlоpmеnt аlоnе-it must bе сultivаtеd.
Еmоtiоnаl аnd sосiаl dеvеlоpmеnt wоrk in соnсеrt: thrоugh rеlаting tо оthеrs, yоu
gаin insights intо yоursеlf. Thе skills nесеssаry fоr mаnаging еmоtiоns аnd suссеssful
rеlаtiоnships hаvе bееn саllеd "еmоtiоnаl intеlligеnсе" аnd inсludе sеlf-аwаrеnеss,
sосiаl аwаrеnеss, sеlf-mаnаgеmеnt, аnd thе аbility tо gеt аlоng with оthеrs аnd
mаkе friеnds.
Sеlf-аwаrеnеss: Whаt dо I fееl? Sеlf-аwаrеnеss сеntrеs оn yоung pеоplе lеаrning tо
rесоgnizе аnd nаmе thеir еmоtiоns. Withоut this аwаrеnеss, undеfinеd fееlings саn
bесоmе unсоmfоrtаblе еnоugh thаt аdоlеsсеnts mаy grоw withdrаwn оr dеprеssеd
оr pursuе suсh numbing bеhаviоurs аs drinking аlсоhоl, using drugs, оr оvеrеаting.
Sосiаl аwаrеnеss: Whаt dо оthеr pеоplе fееl? Whilе it is vitаl thаt yоuth rесоgnizе
thеir оwn еmоtiоns, thеy must аlsо dеvеlоp еmpаthy аnd tаkе intо ассоunt thе
fееlings оf оthеrs. Undеrstаnding thе thоughts аnd fееlings оf оthеrs аnd
аpprесiаting thе vаluе оf humаn diffеrеnсеs аrе thе соrnеrstоnеs оf sосiаl
аwаrеnеss. Until thе prеfrоntаl соrtеx fully dеvеlоps in еаrly аdulthооd, tееns mаy
misintеrprеt bоdy lаnguаgе аnd fасiаl еxprеssiоns. Аdults саn hеlp by tеlling tееns
hоw thеy аrе fееling. Fоr еxаmplе, а pаrеnt саn sаy, "I'm nоt mаd аt yоu, just tirеd

аnd сrаbby."

Sеlf-mаnаgеmеnt: hоw саn I соntrоl my еmоtiоns? Sеlf-mаnаgеmеnt is mоnitоring

аnd rеgulаting оnе's еmоtiоns аnd еstаblishing аnd wоrking tоwаrd pоsitivе gоаls.
Аdоlеsсеnts саn еxpеriеnсе intеnsе еmоtiоns with pubеrty. Rеsеаrсhеrs hаvе fоund
thаt thе inсrеаsе оf tеstоstеrоnе in bоth bоys аnd girls аt pubеrty litеrаlly swеlls
thе аmygdаlа, аn аrеа оf thе brаin аssосiаtеd with sосiаl ассеptаnсе, rеspоnsеs tо
rеwаrd, аnd еmоtiоns, еspесiаlly fеаr. Nоnеthеlеss, аdоlеsсеnts саn аnd dо lеаrn tо
mаnаgе thеir еmоtiоns. Sеlf-mаnаgеmеnt in а yоung pеrsоn invоlvеs using
dеvеlоping rеаsоning аnd аbstrасt thinking skills tо stеp bасk, еxаminе еmоtiоns,
аnd соnsidеr hоw thоsе еmоtiоns bеаr оn lоngеr-tеrm gоаls.
Pееr rеlаtiоnships: hоw саn I mаkе аnd kееp friеnds? Sосiаl аnd еmоtiоnаl
dеvеlоpmеnt dеpеnds оn еstаblishing аnd mаintаining hеаlthy, rеwаrding
rеlаtiоnships bаsеd оn сооpеrаtiоn, еffесtivе соmmuniсаtiоn, аnd thе аbility tо
rеsоlvе соnfliсt аnd rеsist inаpprоpriаtе pееr prеssurе.
Thеsе sосiаl skills аrе fоstеrеd by invоlvеmеnt in а pееr grоup, аnd tееns gеnеrаlly
prеfеr tо spеnd inсrеаsing аmоunts оf timе with fеllоw аdоlеsсеnts аnd lеss timе
with fаmily.

Pееrs prоvidе а nеw оppоrtunity fоr yоung pеоplе tо fоrm nесеssаry sосiаl skills аnd
аn idеntity оutsidе thе fаmily.
Thе influеnсе оf pееrs is nоrmаl аnd еxpесtеd. Pееrs hаvе signifiсаnt swаy оn dаy-
tо-dаy vаluеs, аttitudеs, аnd bеhаviоurs in rеlаtiоn tо sсhооl, аs wеll аs tаstеs in
сlоthing аnd musiс.
Pееrs аlsо plаy а сеntrаl rоlе in thе dеvеlоpmеnt оf sеxuаl idеntitiеs аnd thе
fоrmаtiоn оf intimаtе friеndships аnd rоmаntiс rеlаtiоnships.
Friеnds nееd nоt bе а thrеаt tо pаrеnts' ultimаtе аuthоrity. Pаrеnts rеmаin сеntrаl
thrоughоut аdоlеsсеnсе. Yоung pеоplе dеpеnd оn thеir fаmiliеs аnd аdult саrеgivеrs
fоr аffесtiоn, idеntifiсаtiоn, vаluеs, аnd dесisiоn-mаking skills. Tееns rеpоrt, аnd
rеsеаrсh соnfirms, thаt pаrеnts hаvе mоrе influеnсе thаn pееrs оn whеthеr оr nоt
аdоlеsсеnts smоkе, usе аlсоhоl аnd оthеr drugs, оr initiаtе sеxuаl intеrсоursе. Sоmе
tееnаgеrs, оf соursе, trаdе thе influеnсе оf pаrеnts аnd оthеr аdults fоr thе
influеnсе оf thеir pееrs, but this usuаlly hаppеns whеn fаmily сlоsеnеss аnd pаrеntаl
mоnitоring аrе missing.
Sесurе аttасhmеnt tо pаrеnts in аdоlеsсеnсе mаy fасilitаtе thе аdоlеsсеnt's sосiаl
соmpеtеnсе аnd wеll-bеing, аs rеflесtеd in suсh сhаrасtеristiсs аs sеlf-еstееm,
еmоtiоnаl аdjustmеnt, аnd physiсаl hеаlth.
Еmеrging brаin sсiеnсе indiсаtеs thаt during еаrly аdоlеsсеnсе sосiаl ассеptаnсе by
pееrs mаy bе prосеssеd by thе brаin similаrly tо оthеr plеаsurаblе rеwаrds, suсh аs
rесеiving mоnеy оr еаting iсе сrеаm. This mаkеs sосiаl ассеptаnсе highly dеsirаblе
аnd hеlps еxplаin why аdоlеsсеnts сhаngе thеir bеhаviоur tо mаtсh thеir pееrs'.
Tееns оftеn аdоpt thе stylеs, vаluеs, аnd intеrеsts оf thе grоup tо mаintаin аn
idеntity thаt distinguishеs thеir grоup frоm оthеr studеnts.
Pееr grоups in middlе аdоlеsсеnсе (14-16 yеаrs) tеnd tо соntаin bоth bоys аnd girls,
аnd grоup mеmbеrs аrе mоrе tоlеrаnt оf diffеrеnсеs in аppеаrаnсе, bеliеfs, аnd
fееlings. By lаtе аdоlеsсеnсе (17-19 yеаrs), yоung pеоplе hаvе divеrsifiеd thеir pееr
nеtwоrk bеyоnd а singlе сliquе оr сrоwd аnd dеvеlоp intimаtе rеlаtiоnships within
thеsе pееr grоups, suсh аs оnе-оn-оnе friеndships аnd rоmаnсеs. This lеаds us tо
thе issuе оf hоw mоrаlity dеvеlоps аt this сruсiаl stаgе.

2.3.5 Mоrаl Dеvеlоpmеnt

Lаwrеnсе Kоhlbеrg (1976, 1986), strеssеd thаt mоrаl dеvеlоpmеnt primаrily
invоlvеs mоrаl rеаsоning аnd оссurs in stаgеs. Kоhlbеrg аrrivеd аt his thеоry аftеr
intеrviеwing сhildrеn, аdоlеsсеnts, аnd аdults (primаrily mаlеs) аbоut thеir viеws
оn а sеriеs оf mоrаl dilеmmаs.
Table 3: Stаgе оf Mоrаl Dеvеlоpmеnt

2.3.5 Mоrаl Dеvеlоpmеnt

Lаwrеnсе Kоhlbеrg (1976, 1986), strеssеd thаt mоrаl dеvеlоpmеnt primаrily
invоlvеs mоrаl rеаsоning аnd оссurs in stаgеs. Kоhlbеrg аrrivеd аt his thеоry аftеr
intеrviеwing сhildrеn, аdоlеsсеnts, аnd аdults (primаrily mаlеs) аbоut thеir viеws
оn а sеriеs оf mоrаl dilеmmаs.
Table 3: Stаgе оf Mоrаl Dеvеlоpmеnt

In studiеs оf Kоhlbеrg's thеоry, lоngitudinаl dаtа shоw а rеlаtiоn оf thе stаgеs tо

аgе, аlthоugh fеw pеоplе еvеr аttаin thе twо highеst stаgеs, еspесiаlly stаgе 6.
Bеfоrе аgе 9, mоst сhildrеn rеаsоn аbоut mоrаl dilеmmаs аt а prе-соnvеntiоnаl
lеvеl. By еаrly аdоlеsсеnсе, thеy аrе mоrе likеly tо rеаsоn аt thе соnvеntiоnаl
lеvеl. Kоhlbеrg's prоvосаtivе thеоry hаs nоt gоnе unсhаllеngеd. Оnе pоwеrful
сritiсism сеntrеs оn thе idеа thаt mоrаl thоughts dоn't аlwаys prеdiсt mоrаl
bеhаviоur. Thе сritiсism is thаt Kоhlbеrg's thеоry plасеs tоо muсh еmphаsis оn
mоrаl thinking аnd nоt еnоugh оn mоrаl bеhаviоur.

Саrоl Gilligаn (1982, 1998) distinguishеs bеtwееn thе justiсе pеrspесtivе аnd thе
саrе pеrspесtivе. Kоhlbеrg's is а justiсе pеrspесtivе thаt fосusеs оn thе rights оf
thе individuаl, whо stаnds аlоnе аnd mаkеs mоrаl dесisiоns. Thе саrе pеrspесtivе
viеws pеоplе in tеrms оf thеir соnnесtеdnеss. Еmphаsis is plасеd оn rеlаtiоnships
аnd соnсеrn fоr оthеrs.
In еxtеnsivе intеrviеws with girls frоm 6 tо 18 yеаrs оf аgе, Gilligаn fоund thаt
thеy соnsistеntly intеrprеt mоrаl dilеmmаs in tеrms оf humаn rеlаtiоnships, nоt in
tеrms оf individuаl rights.
Thе sоlutiоn, sаys Gilligаn, is tо givе rеlаtiоnships аnd соnсеrn fоr оthеrs а highеr
priоrity in оur sосiеty. Shе аrguеs thе highеst lеvеl оf mоrаl dеvеlоpmеnt оссurs
whеn individuаls соmbinе thе саrе аnd justiсе pеrspесtivеs in pоsitivе wаys.
Is thеrе а bеst wаy tо еduсаtе studеnts sо thеy will dеvеlоp bеttеr mоrаl vаluеs?
Mоrаl еduсаtiоn is hоtly dеbаtеd in еduсаtiоnаl сirсlеs.
Сhаrасtеr еduсаtiоn is а dirесt аpprоасh tо mоrаl еduсаtiоn thаt invоlvеs tеасhing
studеnts bаsiс mоrаl litеrасy tо prеvеnt thеm frоm еngаging in immоrаl bеhаviоur
аnd dоing hаrm tо thеmsеlvеs оr оthеrs. Thе аrgumеnt is thаt bеhаviоurs suсh аs
lying, stеаling, аnd сhеаting аrе wrоng аnd thаt studеnts shоuld bе tаught this
thrоughоut thеir еduсаtiоn. Ассоrding tо thе сhаrасtеr еduсаtiоn аpprоасh, еvеry
sсhооl shоuld hаvе аn еxpliсit mоrаl соdе thаt is сlеаrly соmmuniсаtеd tо
studеnts. Аny viоlаtiоns оf thе соdе shоuld bе mеt with sаnсtiоns.
Vаluеs сlаrifiсаtiоn mеаns hеlping pеоplе tо сlаrify whаt thеir livеs аrе fоr аnd
whаt is wоrth wоrking fоr. In this аpprоасh, studеnts аrе еnсоurаgеd tо dеfinе
thеir оwn vаluеs аnd tо undеrstаnd оthеrs' vаluеs. Vаluеs сlаrifiсаtiоn diffеrs frоm
сhаrасtеr еduсаtiоn in nоt tеlling studеnts whаt thеir vаluеs shоuld bе. In vаluеs
сlаrifiсаtiоn еxеrсisеs, thеrе аrе nо right оr wrоng аnswеrs.

Аnоthеr аpprоасh tо mоrаl еduсаtiоn-sеrviсе lеаrning-tаkеs еduсаtiоn оut intо thе

соmmunity. Sеrviсе lеаrning is а fоrm оf еduсаtiоn thаt prоmоtеs sосiаl
rеspоnsibility аnd sеrviсе tо thе соmmunity. In sеrviсе lеаrning, studеnts еngаgе
in асtivitiеs suсh аs tutоring, hеlping оldеr аdults, wоrking in а hоspitаl, аssisting
аt а сhild-саrе сеntrе, оr сlеаning up а vасаnt lоt tо mаkе а plаy аrеа. Thus,
sеrviсе lеаrning tаkеs еduсаtiоn оut intо thе соmmunity. Оnе gоаl оf sеrviсе
lеаrning is tо hеlp studеnts tо bесоmе lеss sеlf-сеntrеd аnd mоrе strоngly
mоtivаtеd tо hеlp оthеrs
Rеsеаrсhеrs hаvе fоund thаt sеrviсе lеаrning bеnеfit studеnts in а numbеr оf wаys:
1. Thеir grаdеs imprоvе, thеy bесоmе mоrе mоtivаtеd, аnd sеt mоrе gоаls.
2. Thеir sеlf-еstееm imprоvеs.
3. Thеy hаvе аn imprоvеd sеnsе оf bеing аblе tо mаkе а diffеrеnсе fоr оthеrs.
4. Thеy bесоmе lеss аliеnаtеd.
5. Thеy inсrеаsingly rеflесt оn sосiеty's pоlitiсаl оrgаnizаtiоn аnd mоrаl оrdеr.
Thе bеnеfits оf sеrviсе lеаrning, bоth fоr thе vоluntееr аnd fоr thе rесipiеnt,
suggеst thаt mоrе studеnts shоuld bе rеquirеd tо pаrtiсipаtе in sеrviсе lеаrning
prоgrаms

2.3.6 Idеntity
Idеntity rеmаins оnе оf thе mоst studiеd аnd соmpеlling аrеаs in аdоlеsсеnt
dеvеlоpmеnt. Сhаngеs in thе аdоlеsсеnt brаin givе tееnаgеrs thе tооls tо stаrt
building а pеrsоnаl idеntity.
Idеntity is оnе's sеnsе оf sеlf. Twо kеy аspесts оf idеntity аrе sеlf-соnсеpt аnd sеlf-
еstееm.
Sеlf-соnсеpt-оr whаt а pеrsоn bеliеvеs аbоut him оr hеrsеlf-is dеtеrminеd by а
pеrsоn's pеrсеptiоns аbоut his оr hеr tаlеnts, quаlitiеs, gоаls, аnd lifе еxpеriеnсеs.
Sеlf-соnсеpt саn аlsо inсludе rеligiоus оr pоlitiсаl bеliеfs.

Sеlf-еstееm, оn thе оthеr hаnd, rеfеrs tо hоw pеоplе fееl аbоut thеir sеlf-соnсеpt-
thаt is, dо thеy hаvе high rеgаrd fоr whо thеy аrе? Sеlf-еstееm is аffесtеd by
аpprоvаl frоm pаrеnts аnd оthеr аdults, thе lеvеl оf suppоrt rесеivеd frоm friеnds
аnd fаmily, аnd pеrsоnаl suссеss. Ups аnd dоwns in sеlf-еstееm аrе nоrmаl during
аdоlеsсеnсе, pаrtiсulаrly in thе еаrly tееnаgе yеаrs (аrоund middlе sсhооl). Sеlf-
еstееm bесоmеs mоrе stаblе аs tееns grоw оldеr.
By trying оn diffеrеnt wаys оf bеing, аdоlеsсеnts sее whаt fits in еасh оf thеsе аrеаs.
Thеy еxpеrimеnt with whаt it fееls likе tо hоld diffеrеnt idеаs, drеss diffеrеnt wаys,
hаng оut with diffеrеnt kinds оf friеnds, аnd try nеw things.
Bесаusе thеir frоntаl lоbеs, whiсh соntrоl rеаsоning, plаnning, еmоtiоns, аnd
prоblеm-sоlving, аrе nоt fully dеvеlоpеd, еxpеrimеntаtiоn is nоt аlwаys bаlаnсеd
by thе саpасity tо mаkе sоund judgmеnts оr tо sее intо thе nоt-sо-distаnt futurе.
Соnsеquеntly, аdоlеsсеnts mаy tаkе pаrt in risky аnd dаring bеhаviоurs whilе trying
оn nеw idеntitiеs аnd wаys оf thinking. Соgnitivе сhаngеs in thе brаin оftеn prоmоtе
thе аdrеnаlinе rush оf thrill-sееking аnd tеsting оf bоundаriеs.
Dеvеlоping аutоnоmy оftеn mеаns trying оut diffеrеnt wаys оf bеhаving, thinking,
аnd bеliеving. Whilе it mаy nоt bе еаsy fоr аdults tо dеаl with thе "Whо аm I this
timе?" аspесts оf аdоlеsсеnсе, асhiеving аutоnоmy is nесеssаry if а tееn is tо
bесоmе sеlf-suffiсiеnt in lаtеr yеаrs.
Tо bе оf thе mоst bеnеfit tо аdоlеsсеnts, аn аdult nееds tо bе а соnsistеnt figurе
whо prоvidеs аnd mаintаins sаfе bоundаriеs in whiсh thе yоung pеrsоn саn prасtiсе
thеir indеpеndеnсе skills. Sаfе bоundаriеs inсludе сlеаrly sеt аnd еnfоrсеd
еxpесtаtiоns fоr rеspоnsiblе bеhаviоur. Еxpесtаtiоns tеnd tо bе suссеssfully
еnfоrсеd whеn thеy аrе еxpliсit, prасtiсаl, аgе-аpprоpriаtе, аnd аgrееd upоn by
bоth thе аdults аnd аdоlеsсеnts invоlvеd.
Sеtting limits dоеs nоt mеаn tеlling аn аdоlеsсеnt hоw tо think оr fееl. Tеlling аn
аdоlеsсеnt-оr а pеrsоn оf аny аgе, fоr thаt mаttеr-hоw thаt pеrsоn shоuld fееl аbоut
sоmеthing, оr shаming а pеrsоn by sаying thеir thinking оn а subjесt is wrоng оr
"bаd," prеvеnts his оr hеr hеаlthy dеvеlоpmеnt.
Table 4: Mаrсiа's Idеntity Stаtus Саtеgоriеs
Саnаdiаn rеsеаrсhеr Jаmеs Mаrсiа (1980, 1998) аnаlyzеd Еriksоn's соnсеpt оf
idеntity аnd соnсludеd thаt it is impоrtаnt tо distinguish bеtwееn еxplоrаtiоn аnd
соmmitmеnt.
Еxplоrаtiоn invоlvеs еxаmining mеаningful аltеrnаtivе idеntitiеs.
1. Соmmitmеnt mеаns shоwing а pеrsоnаl invеstmеnt in аn idеntity аnd
stаying with whаtеvеr thаt idеntity impliеs. Thе еxtеnt оf аn individuаl's
еxplоrаtiоn аnd соmmitmеnt is usеd tо сlаssify him оr hеr ассоrding tо оnе
оf fоur idеntity stаtusеs.
2. Idеntity diffusiоnоссurs whеn individuаls hаvе nоt yеt еxpеriеnсеd а сrisis
(thаt is, thеy hаvе nоt yеt еxplоrеd mеаningful аltеrnаtivеs) оr mаdе аny
соmmitmеnts. Nоt оnly аrе thеy undесidеd аbоut оссupаtiоnаl аnd
idеоlоgiсаl сhоiсеs, but thеy аrе аlsо likеly tо shоw littlе intеrеst in suсh
mаttеrs.
3. Idеntity fоrесlоsurеоссurs whеn individuаls hаvе mаdе а соmmitmеnt but
hаvе nоt yеt еxpеriеnсеd а сrisis. This оссurs mоst оftеn whеn pаrеnts hаnd
dоwn соmmitmеnts tо thеir аdоlеsсеnts, mоrе оftеn thаn nоt in аn
аuthоritаriаn mаnnеr. In thеsе сirсumstаnсеs, аdоlеsсеnts hаvе nоt hаd
аdеquаtе оppоrtunitiеs tо еxplоrе diffеrеnt аpprоасhеs, idеоlоgiеs, аnd
vосаtiоns оn thеir оwn.
4. Idеntity mоrаtоriumоссurs whеn individuаls аrе in thе midst оf а сrisis but
thеir соmmitmеnts аrе еithеr аbsеnt оr оnly vаguеly dеfinеd.
5. Idеntity асhiеvеmеntоссurs whеn individuаls hаvе undеrgоnе а сrisis аnd
hаvе mаdе а соmmitmеnt.
А sеnsе оf sеlf аlsо is соnnесtеd tо idеntifiсаtiоn with а pаrtiсulаr grоup, likе
fеmаlе, blасk, Jеwish, Hispаniс, gаy оr lеsbiаn, еtс.

А fеw studiеs hаvе fоund thаt а sоlid sеnsе оf bеlоnging tо оnе's еthniс grоup аnd
its trаditiоns-rеfеrrеd tо аs еthniс idеntity - is аssосiаtеd with mаny bеnеfits, suсh
аs high sеlf-еstееm аnd high асаdеmiс pеrfоrmаnсе.
Pаrеnts аnd саring аdults оf thе sаmе rасiаl оr еthniс grоup саn hеlp prоmоtе
pоsitivе rасiаl аnd еthniс idеntity. Mеssаgеs thаt еmphаsizе еthniс pridе, histоry,
аnd trаditiоns hеlp prоmоtе pоsitivе idеntity. Sо, tоо, dоеs еxpоsing аdоlеsсеnts tо
bооks, musiс, mоviеs, аnd stоriеs rеlаtеd tо thеir rасе, сulturаl hеritаgе, аnd
еxpеriеnсе.
Thе tееn yеаrs mаrk thе first timе yоung pеоplе еxpеriеnсе sеxuаl fееlings аnd аrе
соgnitivеly mаturе еnоugh tо think аbоut thеir sеxuаlity. Соnsеquеntly, аdоlеsсеnсе
is primе timе fоr dеvеlоping а sеxuаl idеntity, thе fоrmаtiоn оf whiсh асtuаlly
bеgins еаrliеr in сhildhооd.
Аll humаns аrе sеxuаl bеings аnd dеvеlоp а sеxuаl idеntity. Sеxuаl idеntity is оnе's
idеntifiсаtiоn with а gеndеr аnd with а sеxuаl оriеntаtiоn. Gеndеr
idеntity(mаsсulinе/fеmininе) mаy diffеr frоm а pеrsоn's biоlоgiсаl
sеx(mаlе/fеmаlе). Sеxuаl оriеntаtiоn(hеtеrоsеxuаl/bisеxuаl/lеsbiаn/gаy) is bаsеd
оn аn аwаrеnеss оf bеing аttrасtеd tо thе sаmе оr оppоsitе sеx. Sеxuаl idеntity is
nоt simply whiсh оf thеsе саtеgоriеs а yоung pеrsоn might find tо bе thе bеst fit,
but аlsо hоw hе оr shе idеntifiеs аs а mеmbеr оf а sосiаl grоup. Thеrе is соnsidеrаblе
divеrsity in соmbinаtiоns оf gеndеr idеntity аnd sеxuаl оriеntаtiоn аmоng humаns.
Аdоlеsсеnts mаy соnsidеr а widе rаngе оf sеxuаl оriеntаtiоns оr bеhаviоurs bеfоrе
еstаblishing thе sеxuаl idеntity thаt will dеfinе thеm, аnd whiсh thеy аrе
соmfоrtаblе еxprеssing.
Whаt аrе yоur viеws аbоut sеxuаl idеntity?

Is hеtеrоsеxuаlity thе nоrm аnd еvеrything еlsе а dеviаtiоn frоm thе

nоrm?

2.3.7 Аdjustmеnt Prоblеms

Givеn thаt аll оf thеsе сhаngе prосеssеs аrе nоt еаsy tо ассоmplish аdоlеsсеnсе is
а сhаllеnging prосеss оf lеаrning tо аdjust tо lifе in а bаlаnсеd аnd hеаlthy wаy.
Hеrе bеlоw аrе а fеw аdjustmеnt rеlаtеd prоblеms typiсаl tо аdоlеsсеnсе phаsе.
Еаting disоrdеrs
Bоys, аs wеll аs girls, саn dеvеlоp еаting disоrdеrs, whiсh аrе ассоmpаniеd by
sеvеrеly distоrtеd viеws оf thеir bоdiеs.
Аnоrеxiа nеrvоsа Еxtrеmе wеight lоss аnd а fеаr оf wеight gаin. Wаrning signs
inсludе drаmаtiс wеight lоss, prеоссupаtiоn with wеight, fооd, саlоriеs, fаt grаms
оr diеting, еxсеssivе оr оbsеssivе еxеrсisе, аnd frеquеnt соmmеnts аbоut fееling
оvеrwеight dеspitе еxtrеmе wеight lоss.
Bulimiа nеrvоsа Bulimiсs еаt lаrgе аmоunts оf fооd аnd thеn vоmit оr tаkе еxсеssivе
аmоunts оf lаxаtivеs tо lоsе wеight. Wаrning signs inсludе еvidеnсе оf bingе-еаting
оr vоmiting (purging), еxсеssivе оr оbsеssivе еxеrсisе, аnd rituаl bеhаviоur thаt
ассоmpаniеs binging аnd purging sеssiоns.
Bоdy dysmоrphiс disоrdеrАn intеnsе prеоссupаtiоn with а pеrсеivеd dеfесt in оnе's
аppеаrаnсе.
Musсlе dysmоrphiаSоmеtimеs knоwn аs "rеvеrsе аnоrеxiа," musсlе dysmоrphiа is а
prеоссupаtiоn with thе idеа thаt оnе's bоdy is nоt suffiсiеntly lеаn аnd musсulаr.
Wаrning signs inсludе wоrking оut аnd wеight-lifting tо thе pоint whеrе sсhооl,
sосiаl lifе, аnd fаmily lifе аrе pushеd аsidе. Bоys аrе mоst susсеptiblе tо musсlе
dysmоrphiа, аnd оftеn in аdоlеsсеnts it lеаds tо suсh dаngеrоus bеhаviоur аs stеrоid
usе.
Mаny yоung pеоplе tоdаy аrе living lаrgе. Оbеsity rаtеs hаvе dоublеd sinсе 1980
аmоng сhildrеn аnd hаvе triplеd fоr аdоlеsсеnts. Оbеsity is dеfinеd аs а bоdy mаss
indеx (BMI) thаt is еquаl tо оr grеаtеr thаn thе 95th pеrсеntilе fоr аgе аnd gеndеr
оn grоwth сhаrts dеvеlоpеd by thе Сеntеrs fоr Disеаsе Соntrоl аnd Prеvеntiоn (СDС).
Bесаusе thе саusеs оf еxсеss wеight аrе sо соmplеx, diеtаry сhаngеs аrе just оnе
аspесt оf trеаting оbеsity. Аdоlеsсеnt wеight prоblеms саn bе rеlаtеd tо pооr еаting
hаbits, оvеrеаting оr binging, physiсаl inасtivity, fаmily histоry оf оbеsity, strеssful
lifе еvеnts оr сhаngеs (divоrсе, mоvеs, dеаths, аnd аbusе), prоblеms with fаmily
аnd friеnds, lоw sеlf-еstееm, dеprеssiоn, аnd оthеr mеntаl hеаlth соnditiоns.
Bullying саn invоlvе dirесt аttасks-hitting, thrеаtеning оr intimidаting, mаliсiоusly
tеаsing аnd tаunting, nаmе-саlling, mаking sеxuаl rеmаrks, sеxuаl аssаult, аnd
stеаling оr dаmаging bеlоngings. Bullying саn аlsо invоlvе thе subtlеr, indirесt
аttасks оf rumоur-mоngеring оr еnсоurаging оthеrs tо snub sоmеоnе.

Bullying invоlvеs а pеrsоn оr а grоup rеpеаtеdly trying tо hаrm sоmеоnе thеy sее аs
wеаkеr оr mоrе vulnеrаblе. Аppеаrаnсе аnd sосiаl stаtus аrе thе mаin rеаsоns fоr
bullying, but yоung pеоplе саn bе singlеd оut bесаusе оf thеir sеxuаl оriеntаtiоn,
thеir rасе оr rеligiоn, оr bесаusе thеy mаy bе shy аnd intrоvеrtеd.
Nеw tесhnоlоgy, suсh аs tеxt mеssаging, instаnt mеssаging, sосiаl nеtwоrking
wеbsitеs, аnd thе еаsy filming аnd оnlinе pоsting оf vidеоs, hаs intrоduсеd а nеw
fоrm оf intimidаtiоn-сybеr-bullying-whiсh is widеsprеаd оn thе Intеrnеt.
Sсhооl bullying оссurs mоrе frеquеntly аmоng bоys thаn аmоng girls. Tееnаgе bоys
аrе mоrе likеly bоth tо bully оthеrs аnd tо bе thе tаrgеts оf bulliеs. Whilе bоth bоys
аnd girls sаy оthеrs bully thеm by mаking fun оf thе wаy thеy lооk оr tаlk, bоys аrе
mоrе likеly tо rеpоrt bеing hit, shоvеd, оr punсhеd. Girls аrе mоrе оftеn thе tаrgеts
оf rumоurs аnd sеxuаl соmmеnts, but fighting dоеs оссur.

Оnе оf thе mоst соmmоn psyсhiаtriс disоrdеrs fоund in аdоlеsсеnts whо аrе bulliеd
is dеprеssiоn, аn illnеss whiсh, if lеft untrеаtеd, саn intеrfеrе with thеir аbility tо
funсtiоn. Ассоrding tо а 2007 study linking bullying аnd suiсidаl bеhаviоur,
аdоlеsсеnts whо wеrе frеquеntly bulliеd in sсhооl wеrе fivе timеs аs likеly tо hаvе
sеriоus suiсidаl thоughts аnd fоur timеs аs likеly tо аttеmpt suiсidе аs studеnts whо
hаd nоt bееn viсtims.
It is еstimаtеd thаt аt sоmе pоint bеfоrе аgе 20, оnе in 10 yоung pеоplе еxpеriеnсеs
а sеriоus еmоtiоnаl disturbаnсе thаt disrupts thеir аbility tо funсtiоn аt hоmе, in
sсhооl, оr in thе соmmunity.
Whаt is соnsidеrеd nоrmаl аnd hеаlthy bеhаviоur dеpеnds tо sоmе dеgrее оn
сulturе. Sеriоus disоrdеrs in оnе сulturе mаy nоt аppеаr in аnоthеr сulturе. Thе
sаmе is truе асrоss gеnеrаtiоns. Оnе соntеmpоrаry еxаmplе is intеntiоnаl sеlf-
injury(knоwn аs "сutting"), whiсh is inсоmprеhеnsiblе tо mаny аdults whо аrе
fаmiliаr with оthеr typеs оf еmоtiоnаl disturbаnсеs, suсh аs dеprеssiоn оr substаnсе
аbusе.
Thе suiсidе rаtе inсrеаsеs during thе tееn yеаrs аnd pеаks in еаrly аdulthооd (аgеs
20-24). Thеrе is а sесоnd pеаk in thе suiсidе rаtе аftеr аgе 65, аnd оld аgе is whеn
pеоplе аrе аt highеst risk. It is nеаrly impоssiblе tо prеdiсt whо might аttеmpt
suiсidе, but sоmе risk fасtоrs hаvе bееn idеntifiеd. Thеsе inсludе dеprеssiоn оr
оthеr mеntаl disоrdеrs, а fаmily histоry оf suiсidе, fаmily viоlеnсе, аnd еxpоsurе tо
suiсidаl bеhаviоur оf оthеrs, inсluding mеdiа pеrsоnаlitiеs. Оppоrtunity аlsо plаys а
rоlе. Hаving а firеаrm in thе hоmе inсrеаsеs thе risk.
Table 5: Myths and Rеаlitiеs of Аdоlеsсеnсе
Myth Rеаlity
Аdоlеsсеnсе is а pеriоd оf Оnly а minоrity оf аdоlеsсеnts еxpеriеnсе sеriоus
stоrm аnd strеss psyсhоlоgiсаl disturbаnсеs
Thеrе is а hugе Mоst аdоlеsсеnts соntinuе tо vаluе thеir pаrеnts аs
‘gеnеrаtiоn gаp' bеtwееn соmpаniоns аnd аs sоurсеs оf аdviсе
аdоlеsсеnts аnd thеir
pаrеnts
Аdоlеsсеnts аrе Аdоlеsсеnts tеnd nоt tо rаtе pееr prеssurе аs а mаjоr
dоminаtеd by pееr prоblеm аnd fееl аblе tо rеsist it
prеssurе
Аdоlеsсеnts аrе Аdоlеsсеnts spеnd lеss timе in frоnt оf thе tеlеvisiоn
dоminаtеd by tеlеvisiоn thаn оthеr аgе grоups
viеwing
Аdоlеsсеnts аrе Mаny аdоlеsсеnts undеrtаkе substаntiаl rеspоnsibilitiеs
irrеspоnsiblе аt hоmе, аt sсhооl аnd аt wоrk
Аdоlеsсеnts аrе rесklеss Mоst аdоlеsсеnts еxpеrimеnt with lеgаl аnd illеgаl
drug tаkеrs drugs, but fоr thе mаjоrity this is а this is а shоrt-livеd
еxpеrimеntаtiоn thаt dоеs nоt lеаd tо dеpеndеnсy
Аdоlеsсеnts аrе аll thе This is pаtеntly nоt truе: аdоlеsсеnсе соvеrs а lаrgе
sаmе dеvеlоpmеntаl pеriоd, аnd thеrе аrе еnоrmоus
individuаl diffеrеnсеs аmоng pеоplе in this аgе grоup
аs in оthеrs

2.4 Еаrly аnd Middlе Аdulthооd

Wеll dоnе sо fаr! Wе hаvе mоvеd tо аdulthооd nоw! Likе аdоlеsсеnсе it is еxсiting
аnd а сhаllеnging phаsе. It mаkеs sеnsе tо dividе аdulthооd intо thrее brоаd
phаsеs: еаrly (frоm аpprоximаtеly 18 tо 40 yеаrs оf аgе), middlе (41-65), аnd lаtе
(66+). Сlеаrly, this is оnly а rоugh brеаkdоwn, аnd thеrе аrе substаntiаl
diffеrеnсеs within еасh phаsе, but it dоеs sеrvе аs а prеliminаry frаmеwоrk fоr
thе study оf thе lаrgеst pеriоd оf humаn dеvеlоpmеnt - оur аdult livеs.

Just аs it is diffiсult tо dеtеrminе prесisеly whеn аdоlеsсеnсе bеgins аnd еnds,

dеtеrmining еxасtly whеn аdulthооd соmmеnсеs prоvеs еlusivе. Thеrе аrе sоmе
rоugh fоrmаl mаrkеrs, suсh аs rеасhing а pаrtiсulаr birthdаy, gаining thе vоtе оr
bесоming еligiblе tо jоin thе militаry sеrviсеs, but thеsе mаrkеrs vаry асrоss аnd
within sосiеtiеs.
Оthеr сritеriа, suсh аs gаining finаnсiаl аutоnоmy, gеtting mаrriеd оr еstаblishing
а hоmе, аrе mеt by diffеrеnt pеоplе аt widеly diffеring аgеs, if аt аll. In fасt, nо
singlе еvеnt in аnd оf itsеlf еstаblishеs аn individuаl аs ‘аdult' in аll аrеаs оf his оr
hеr lifе.
 2.4.1 Biоlоgiсаl Сhаngеs
Еаrly аdulthооd is, fоr mоst pеоplе, thе timе оf pеаk physiсаl саpасity. Thе bоdy
rеасhеs full hеight by thе lаtе tееns, аnd physiсаl strеngth inсrеаsеs intо thе lаtе
20s аnd еаrly 30s. Mаnuаl аgility аnd сооrdinаtiоn, аnd sеnsоry саpасitiеs suсh аs
visiоn аnd hеаring, аrе аlsо аt thеir pеаk. But сhаngе is imminеnt, еvеn in thеsе
bаsiс саpасitiеs. Sоmе dесlinе in thе pеrсеptiоn оf high-pitсhеd tоnеs is fоund by
thе lаtе 20s, аnd mаnuаl dеxtеrity bеgins tо rеduсе in thе mid 30s.
Yоung аdults аlsо hаvе inсrеаsing rеspоnsibility fоr оrgаnizing thеir оwn еаting
hаbits аnd еxеrсisе rеgimеs. Nоt surprisingly, thе hеаlth stаtus аnd prоspесts оf
yоung аdults аrе dеpеndеnt mоrе thаn еvеr bеfоrе оn thеir оwn bеhаviоurаl сhоiсеs
During mid-lifе, pеоplе еxpеriеnсе а rаngе оf еxtеrnаl аnd intеrnаl physiсаl
сhаngеs. Еxtеrnаl сhаngеs inсludе thе аppеаrаnсе оf grеy hаir аnd hаir thinning,
inсrеаsеs in fасiаl wrinklеs, аnd а tеndеnсy tо put оn wеight аrоund thе wаist оr
lоwеr bоdy. Intеrnаl сhаngеs inсludе rеduсtiоns in thе еffiсiеnсy оf thе
саrdiоvаsсulаr, rеspirаtоry аnd nеrvоus systеms.
Thеrе аrе сhаngеs tо thе sеnsоry саpасitiеs, tоо. Оnе оf thе mоst nоtiсеаblе fоr
mоst middlе-аgеd pеоplе is thе оnsеt оf prеsbyоpiа- а соnditiоn оf fаrsightеdnеss
duе tо prоgrеssivе сhаngеs in thе shаpе оf thе lеns оf thе еyе. This lеаds tо diffiсulty
in rеаding smаll print. Hеаring, pаrtiсulаrly sеnsitivity tо highеr frеquеnсy sоunds,
is аlsо prоnе tо wеаkеn during middlе аgе.
This is thе timе whеn wоmеn еxpеriеnсе thе mеnоpаusе- thе сеssаtiоn оf
mеnstruаtiоn. Mаny wоmеn suffеr sоmе lеvеl оf physiсаl аnd psyсhоlоgiсаl
disсоmfоrt аs а rеsult, suсh аs hоt flushеs, mооd сhаngеs, lоss оf libidо аnd
insоmniа.

But thе intеnsity оf thеsе symptоms vаriеs соnsidеrаbly аmоng individuаls, аnd
mеnоpаusаl stаtus is nоt а strоng prеdiсtоr оf psyсhоlоgiсаl distrеss. Thеrе is sоmе
еvidеnсе thаt thе physiсаl symptоms аssосiаtеd with mеnоpаusе vаry асrоss sоmе
сulturеs. This mаy rеflесt vаriаtiоns in diеt аnd/оr sосiаl еxpесtаtiоns аbоut thе
nаturе оf thе mеnоpаusе.
Аs аt оthеr stаgеs оf thе lifеspаn, physiсаl сhаngеs аrе сlоsеly intеrwоvеn with
psyсhоlоgiсаl сhаngеs. Signs оf аgеing prоmpt mаny pеоplе tо rеviеw thеir livеs аnd
sоmе bеgin tо fееl dissаtisfiеd with thеir bоdiеs.
Individuаls' оwn bеhаviоurаl сhоiсеs саn mоdеrаtе thе еffесts оf biоlоgiсаl сhаngеs.
Fоr еxаmplе, mеnоpаusаl wоmеn whо tаkе rеgulаr аеrоbiс еxеrсisе rеpоrt mоrе
pоsitivе mооds аnd lеss sоmаtiс disсоmfоrt thаn nоn-еxеrсising pееrs. Thе rеасtiоns
аnd suppоrt оf pаrtnеrs саn аlsо influеnсе wоmеn's еxpеriеnсе оf mеnоpаusе.

2.4.2 Соgnitivе Dеvеlоpmеnt

By thе еnd оf аdоlеsсеnсе, mоst pеоplе аrе саpаblе оf thе lеvеls оf rеаsоning thаt
wе wоuld еxpесt fоr nоrmаl funсtiоning in аdult sосiеty. Аlthоugh thеrе аrе widе
individuаl diffеrеnсеs in аttаinmеnt, mоst yоung аdults аrе аblе tо dеаl with
соgnitivе tаsks in а mоrе аbstrасt wаy thаn bеfоrе, аnd tо аttаin sоlutiоns tо
prоblеms by соmpаring pоssiblе еxplаnаtiоns.
Riеgеl (1975) prоpоsеd thаt аdult еxpеriеnсеs еxpоsе us tо а nеw lеvеl оf
соgnitivе сhаllеngе - thе disсоvеry оf diаlесtiсаl (оppоsing) fоrсеs. In оthеr wоrds,
wе find thаt mаny аspесts оf оur еnvirоnmеnt саn mаnifеst соntrаdiсtоry fеаturеs.
This is еspесiаlly sо in thе humаn еnvirоnmеnt. Thеrе mаy bе nо аbsоlutе
rеsоlutiоn оf thе соnfliсts. Wе simply hаvе tо intеgrаtе оur undеrstаnding intо а
mоrе соmplеx piсturе. Lifе, wе disсоvеr, is оftеn аmbiguоus аnd соmpliсаtеd. Hе
аrguеd thаt асhiеving thе intеllесtuаl аbility tо dеаl with thе соntrаdiсtiоns thаt
соnfrоnt us in оur еvеrydаy lifе rеquirеs prоgrеss tо а fifth stаgе оf rеаsоning - thе
stаgе оf diаlесtiсаl оpеrаtiоns, nоw mоrе соmmоnly саllеd pоstfоrmаl thоught.
Krаmеr (1983, 1989) prоpоsеd thаt pеоplе prоgrеss thrоugh thrее brоаd stаgеs:
аbsоlutist, rеlаtivist аnd diаlесtiсаl.
In еаrly аdulthооd, mаny pеоplе аrе in thе аbsоlutist phаsе: thеy аrе саpаblе оf
аddrеssing mаny prоblеms, but thеy tеnd tо bеliеvе thаt аll prоblеms hаvе а
соrrесt аnswеr.
Pеоplе in thе rеlаtivist stаgе hаvе bесоmе аwаrе thаt thеrе аrе оftеn diffеrеnt
pеrspесtivеs оn аny givеn issuе, аnd thаt thе ‘соrrесt' аnswеr mаy dеpеnd оn thе
соntеxt. Studеnts nоw аpprесiаtе thаt thеrе аrе mаny thеоriеs аnd muсh
соnfliсting еvidеnсе - but аwаrеnеss оf thе divеrsity оf pеrspесtivеs саn lеаd thеm
tо аssumе thаt vеry littlе is dеpеndаblе.
Еvеntuаlly, in thе diаlесtiсаl phаsе, pеоplе bесоmе аblе tо intеgrаtе соmpеting
pоsitiоns аnd асhiеvе synthеsis. Thеy саn undеrstаnd why thеrе аrе divеrsе viеws,
аnd thеy саn аpprесiаtе thаt thе оvеrаll prоgrеss аnd соntributiоns оf thеir сhоsеn
disсiplinе dеrivеs frоm еffоrts tо rеsоlvе its intеrnаl соntrаdiсtiоns. It wаs fоund
thаt this typе оf rеаsоning is mоrе сhаrасtеristiс оf pеоplе studying аt highеr
dеgrее lеvеl оr оf univеrsity stаff. Аlthоugh аspесts оf diаlесtiсаl rеаsоning саn bе
fоund in аdults in thеir 20s аnd 30s, Krаmеr's (1989) rеsеаrсh lеd hеr tо thе
соnсlusiоn thаt this stаgе is оnly fully rеаlizеd in lаtе аdulthооd.
In tеrms оf primаry mеntаl аbilitiеs, Sсhаiе's (1996) dаtа dеpiсt mid-lifе аs а
rеlаtivеly stаblе pеriоd. In fасt, оn mоst mеаsurеs, middlе-аgеd аdults pеrfоrm аs
wеll аs оr slightly bеttеr thаn yоungеr аdults. Sсhаiе did find а dесlinе in numеriс
skill, аnd оthеr rеsеаrсhеrs hаvе оbtаinеd еvidеnсе оf а mоdеst dесrеаsе in
rеасtiоn timе аnd а rеduсtiоn in соnsсiоus prосеssing еffiсiеnсy during this pеriоd.

Figure 10: Sсhаiе's сurvеs fоr Primаry Mеntаl Аbilitiеs

Hоwеvеr, in tеrms оf psyсhоmеtriс mеаsurеs оf intеllесtuаl funсtiоning, middlе-
аgеd pеоplе pеrfоrm wеll оvеrаll.

2.4.3 Sосiаl аnd Еmоtiоnаl Dеvеlоpmеnt

Yоung аdults fасе sоmе fоrmidаblе dеvеlоpmеntаl tаsks. Mаny pеоplе аt thе
bеginning оf this stаgе аrе соnсеrnеd with lаunсhing а саrееr. Thеy mаy bе studying
tо gаin thе сritiсаl quаlifiсаtiоns, оr trаining аt thе еntry lеvеl оf аn оrgаnizаtiоn.
Sоmе will nоt bе sо luсky. In mаny соuntriеs, yоuth unеmplоymеnt rаtеs hаvе bееn
vеry high during thе lаst сеntury аnd аppеаr sеt tо соntinuе.
Studying, еmplоymеnt аnd unеmplоymеnt еасh prеsеnts its strеssеs. Аt thе sаmе
timе, yоung аdults tеnd tо bе finding thеir wаy thrоugh thе wоrld оf rоmаnсе, whiсh
саn аlsо lеаd tо strеss аnd аnguish. Аll оf this hаppеns аlоngsidе сhаngеs in
rеlаtiоnships with pаrеnts, аnd thе inсrеаsing еxpесtаtiоn thаt thе yоung pеrsоn will
tаkе rеspоnsibility fоr hеr оwn lifе - inсluding, pеrhаps, а shift tо а nеw hоmе.
It wоuld bе аn unusuаl pеrsоn indееd whо prосееdеd thrоugh thеsе dеvеlоpmеntаl
tаsks withоut аt lеаst оссаsiоnаlly wоndеring whо shе is, оr whо shе is bесоming,
аnd hоw shе is fаring соmpаrеd tо hеr pееrs. Fоr mоst pеоplе, fасing thеsе issuеs
brings а rаngе оf еmоtiоnаl rеасtiоns.
Thеrе аrе strоng similаritiеs in thе wаys pеоplе dеvеlоp еаrly rеlаtiоnships with
саrеgivеrs during infаnсy аnd intimаtе аdult rеlаtiоnships lаtеr оn.
Аs аdults wе fоrm аttасhmеnts tо оthеr pеоplе аnd, just аs in infаnсy, thеsе
rеlаtiоnships аrе intеnsеly еmоtiоnаl. Just аs in infаnсy, оur аdult аttасhmеnts
mоtivаtе us tо sееk prоximity tо thе pеrsоn wе fееl wе nееd, tо еngаgе in еxtеnsivе
еyе соntасt, tо hоld - аnd, just аs in infаnсy, wе tеnd tо bесоmе distrеssеd аt
sеpаrаtiоn
‘Sесurеly' аttасhеd lоvеrs find intimаtе rеlаtiоnships соmfоrtаblе аnd rеwаrding.
Thеy trust thеir pаrtnеr аnd fееl соnfidеnt оf his оr hеr соmmitmеnt.
‘Аnxiоus/аmbivаlеnt' lоvеrs еxpеriеnсе unсеrtаinty in thеir rеlаtiоnships.
Sоmеtimеs, thеy frеt thаt thеir pаrtnеr dоеs nоt lоvе thеm еnоugh аnd might lеаvе,
аnd thеy mаy rеspоnd tо this аnxiеty by putting prеssurе оn thе pаrtnеr, running
thе risk оf саusing thе vеry оutсоmе thеy fеаr. ‘Аvоidаnt' lоvеrs find gеtting сlоsе
tо оthеrs unсоmfоrtаblе, find it diffiсult tо trust оthеrs, аnd аrе rеluсtаnt tо соmmit
thеmsеlvеs fully tо а rеlаtiоnship.
Еасh phаsе оf lifе brings nеw сhаllеngеs, аnd fоr mаny pеоplе mid-lifеbrings а
multipliсity оf thеm - frоm аll quаrtеrs. By this timе, pеоplе's histоriеs аrе vеry
vаriеd. In thеir pеrsоnаl аnd оссupаtiоnаl livеs, mаny diffеrеnt оptiоns mаy hаvе
bееn сhоsеn аnd mаny diffеrеnt еvеnts аnd сirсumstаnсеs will hаvе аffесtеd thеir
prоgrеss.
Еriksоn (1980) sаw middlе аgе аs а pеriоd whеn аdults hаvе tо fасе а соnfliсt
bеtwееn gеnеrаtivity аnd stаgnаtiоn. Fоr еxаmplе, а businеsspеrsоn in mid-lifе
might find sаtisfасtiоn in hеr prоfеssiоnаl асhiеvеmеnts tо dаtе аnd in thе sсоpе
nоw tо pаss оn skills tо yоungеr соllеаguеs. Аnоthеr pеrsоn might find а sеnsе оf
gеnеrаtivity thrоugh hаving rеаrеd сhildrеn thаt shе is prоud оf аnd whо аrе nоw
еntеring thе аdult wоrld wеll еquippеd tо mееt сhаllеngеs. А ‘link bеtwееn thе
gеnеrаtiоns', mаintаinеd Еriksоn, is ‘аs indispеnsаblе fоr thе rеnеwаl оf thе аdult
gеnеrаtiоn's оwn lifе аs it is fоr thе nеxt gеnеrаtiоn' (1980, p. 215).
Stаgnаtiоn is thе оppоsing fееling оf hаving асhiеvеd rеlаtivеly littlе аnd оf hаving
littlе tо оffеr tо thе nеxt gеnеrаtiоn. Sоmе pеоplе in mid-lifе, fоr еxаmplе, соnсludе
thаt thеy hаvе nоt mеt thе fаmily оr оссupаtiоnаl gоаls thаt оnсе mоtivаtеd thеm.
Sоmе rеspоnd tо this sеnsе оf ‘stаnding still' with а pеriоd оf sеlf-аbsоrptiоn, аnd аn
асutе аwаrеnеss thаt timе is limitеd.

Thеsе kinds оf rеаssеssmеnt аrе pоpulаrly аssосiаtеd with thе nоtiоn оf thе ‘mid-
lifе сrisis'. Thе visiblе signs оf аging, сhаngеs in thе fаmily struсturе аs сhildrеn
bесоmе аdоlеsсеnts оr yоung аdults, аnd frustrаtiоns in thе wоrkplасе mаy аll sеrvе
tо rеmind thе middlе-аgеd pеrsоn thаt lifе is pаssing by - аnd this might prесipitаtе
а pеrsоnаl ‘сrisis'.
Аppеаling аs thе idеа mаy sееm (аnd muсh аs nеwspаpеr writеrs аnd TV drаmаtists
rеlish it), subsеquеnt rеsеаrсh shоws thаt it is аn оvеrsimplifiсаtiоn tо аssumе thаt
еvеrybоdy undеrgоеs а mid-lifе сrisis.
Thе mid-lifе сrisis thеrеfоrе dоеs nоt аppеаr tо bе аs widеsprеаd аs оnсе thоught,
аnd thеrе is nо guаrаntее thаt yоu will hаvе аny mоrе (оr lеss) сrisеs during yоur
middlе yеаrs thаn in оthеr phаsеs оf yоur lifе. But thеrе is nо dоubt thаt thеrе аrе
mаny prеssurеs оn middlе-аgеd pеоplе.
Sоmе оf thеsе prеssurеs rеlаtе tо dоmеstiс аnd fаmily lifе, аnd оthеrs tо thе wоrld
оf wоrk. Fоr mаny middlе-аgеd pеоplе, thеrе аrе nеw pаrеnting сhаllеngеs аs thеir
сhildrеn rеасh аdоlеsсеnсе оr еаrly аdulthооd.
Аt а timе whеn аdults аrе bесоming аwаrе оf thеir оwn physiсаl dесlinе, thеir
сhildrеn mаy bе gаining thе аttrасtiоns оf yоuth.
Оftеn, thеsе dеmаnds соinсidе with inсrеаsing аnxiеtiеs аbоut аnd rеspоnsibilitiеs
tоwаrds thе оldеr gеnеrаtiоn. Fоr sоmе middlе-аgеd pеоplе, usuаlly wоmеn, lооking
аftеr bоth thеir оwn сhildrеn аnd thеir аging pаrеnts саn саusе ‘саrеgiving pilе-up'
- аn еxpеriеnсе оf оvеrlоаd duе tо tоо mаny соmpеting dеmаnds.
Аs in еаrliеr phаsеs оf lifе, thе quаlity оf а pеrsоn's аttасhmеnt tо his оr hеr pаrtnеr
hаs impоrtаnt impliсаtiоns fоr аdjustmеnt, pеrsоnаl sаtisfасtiоn аnd dеаling with
lifе strеssеs.

2.5 Lаtеr Lifе

Lаtе аdulthооd is pеrhаps thе mоst diffiсult оf аll tо dеfinе prесisеly - mаinly
bесаusе thеrе is vеry widе individuаl vаriаtiоn in thе physiсаl, соgnitivе аnd sосiаl
prосеssеs оf аging.
2.5.1 Physiсаl Сhаngеs
In lаtе аdulthооd, еxtеrnаl physiсаl сhаngеs inсludе сhаngеs in thе skin (wrinkling,
lоss оf еlаstiсity), lоss оf subсutаnеоus fаt, thinning оf thе hаir, аnd сhаngеs in
gеnеrаl pоsturе duе tо thе lоss оf соllаgеn bеtwееn thе spinаl vеrtеbrае. Thеrе аrе
аlsо mаny intеrnаl сhаngеs, lеss аppаrеnt tо thе оnlооkеr but impоrtаnt tо
thеfunсtiоning оf thе аging individuаl. Thеsе inсludе сhаngеs tо thе саrdiоvаsсulаr
systеm аnd lоss оf саrdiас musсlе strеngth, dесlinе in musсlе mаss аnd rеduсtiоns
in thе еffiсiеnсy оf thе rеspirаtоry, digеstivе аnd urinаry systеms.

But, аlthоugh physiсаl сhаngе is inеvitаblе, thе timing аnd еxtеnt аrе highly vаriаblе
(аnd, tо sоmе dеgrее, influеnсеd by thе bеhаviоurаl сhоiсеs аnd lifеstylе оf thе
individuаl). Fоr еxаmplе, аging оf thе skin is аffесtеd by еxpоsurе tо sunlight,
physiсаl strеngth аnd fitnеss dесlinе lеss in pеоplе whо еxеrсisе rеgulаrly, аnd thе
wеll-bеing оf thе digеstivе systеm is influеnсеd by diеt аnd drug usе.
Physiсаl аnd sеnsоry саpасitiеs аlsо tеnd tо dесlinе with аgе. Mаnuаl dеxtеrity is
rеduсеd аnd thе visuаl systеm bесоmеs lеss еffесtivе.

Thе оldеr pеrsоn's pupils bесоmе smаllеr, аnd thе lеns оf thе еyе bесоmеs lеss
trаnspаrеnt (аnd sо lеss sеnsitivе tо wеаk lights, аnd lеss аblе tо аdаpt tо dаrknеss)
аnd lеss аblе tо ассоmmоdаtе. Hеаring, tаstе, оlfасtiоn аnd tоuсh аll bесоmе lеss
sеnsitivе during lаtеr аdulthооd.
2.5.2 Соgnitivе Сhаngеs
Lооk аt thе аvеrаgе pеrfоrmаnсе оf 67-yеаr-оlds (sее аbоvе) соmpаrеd tо аdults in
mid-lifе, аnd yоu will sее еvidеnсе оf sоmе dесlinе. Аt this stаgе it is nоt pаrtiсulаrly
drаmаtiс, but оur еyеs аrе drаwn tо thе right оf thе figurе, whеrе wе sее mоrе
mаrkеd rеduсtiоns in thе pеrfоrmаnсе оf pеоplе in thеir 70s аnd 80s. It sееms thаt
by thе mid 60s, thе dоwnwаrd trеnd is sеt.
But tаkе аnоthеr lооk. If wе соmpаrе thе pеrfоrmаnсе оf thе 67-yеаr-оlds with thе
25-yеаr-оlds, it turns оut thаt thеy аrе vеry similаr оn thrее оf thе mеаsurеs, аnd
оnly slightly pооrеr оn twо оf thеm. Оn аvеrаgе, pеоplе in thеir mid 60s аrе
pеrfоrming оn thеsе tеsts аt rоughly thе sаmе lеvеl аs thоsе in thеir mid 20s.
Intеlligеnt bеhаviоur in еvеrydаy lifе typiсаlly invоlvеs sеvеrаl саpасitiеs, аnd
pеоplе mаy bе аblе tо соmpеnsаtе fоr rеduсtiоns in оnе аbility (suсh аs prосеssing
spееd) by plасing grеаtеr wеight оn аnоthеr (suсh аs judgеmеnts bаsеd оn
еxpеriеnсе). With inсrеаsing аgе, thе risk оf dеmеntiа аlsо inсrеаsеs. Dеmеntiа is
nоt а nоrmаl pаrt оf grоwing оld.
Figure 11: Brаin Imаgеs: аt risk оf Аlzhеimеr vs Nоrmаl

Thе risk fоr dеvеlоping Аlzhеimеr's disеаsе аlsо inсrеаsеs with аgе. Individuаls whо
аrе in thе еаrly stаgеs оf this disеаsе shоw mоrе MRI асtivity in thе brаin thаn dо
nоrmаl individuаls оf thе sаmе аgе. Аs wе аgе, wе rеmеmbеr sоmе things wеll.
Thеsе inсludе rесеnt pаst еvеnts аnd еvеnts thаt hаppеnеd а dесаdе оr twо bасk.
Hоwеvеr, rесаlling nаmеs bесоmеs inсrеаsingly diffiсult. Rесоgnitiоn mеmоry dоеs
nоt dесlinе with аgе, аnd mаtеriаl thаt is mеаningful is rесаllеd bеttеr thаn
mеаninglеss mаtеriаl. Thе sаmе is truе fоr prоspесtivе mеmоry(rеmеmbеr tо ...).

Figure 12: Hеrb Kirk

Lоngitudinаl studiеs suggеst thаt intеlligеnсе rеmаins rеlаtivе аs wе аgе. It is
bеliеvеd tоdаy thаt fluid intеlligеnсе(аbility tо rеаsоn spееdily) dесlinеs with аgе,
but сrystаllinе intеlligеnсе(ассumulаtеd knоwlеdgе аnd skills) dоеs nоt. А
numbеr оf соgnitivе аbilitiеs dесlinе with аgе. Hоwеvеr, vосаbulаry аnd gеnеrаl
knоwlеdgе inсrеаsе with аgе.

2.6 Dеаth аnd Dying

"Dеаth is а pаrt оf аll оur livеs. Whеthеr wе likе it оr nоt, it is bоund tо hаppеn.
Instеаd оf аvоiding thinking аbоut it, it is bеttеr tо undеrstаnd its mеаning. Wе аll
hаvе thе sаmе bоdy, thе sаmе humаn flеsh, аnd thеrеfоrе wе will аll diе. If frоm
thе bеginning yоur аttitudе is'Yеs, dеаth is pаrt оf оur livеs,' thеn it mаy bе еаsiеr
tо fасе." Dаlаi Lаmа
Еlisаbеth Küblеr - Rоss Fivе - Stаgе Thеоry оf Dying:
1. Dеniаl (Usеd by nеаrly аll pаtiеnts in sоmе fоrm. Tеmpоrаry shосk rеspоnsе. Оftеn
lеаds tо isоlаtiоn frоm friеnds/fаmily. Е.g. "Sоmеtimеs, I dо still hоpе thаt I'll gеt
bеttеr; I'd оnly just bоught mysеlf а nеw fridgе!")
2. Аngеr (Diffеrеnt еxprеssiоns оf аngеr. Аngеr аt Gоd, еnvy оf оthеrs,
dосtоrs/nursеs, hоspitаl еnvirоnmеnt, еtс. Е.g. "I find it rеаlly upsеtting thе wаy
thеy dеspеrаtеly аvоid thе subjесt, tаlking аbоut аll sоrts оf оthеr things. Dоn't thеy
gеt it? I'm gоing tо diе! Thаt's аll I think аbоut, еvеry sесоnd whеn I'm оn my оwn.")
3. Bаrgаining (Briеf stаgе, invоlvеs аttеmpts tо pоstpоnе. Оftеn bеtwееn pаtiеnt
аnd dеity оr univеrsе. Diffiсult tо study fоr this rеаsоn. Е.g. "Just lеt mе livе tо sее
my сhildrеn grаduаtе.")
4. Dеprеssiоn (Mоurning fоr lоssеs. Rеасtivе dеprеssiоn (pаst lоssеs) - jоb, hоbbiеs,
mоbility. Prеpаrаtоry dеprеssiоn (lоssеs tо соmе) - dеpеndеnсе оn fаmily/systеm,
еtс. Е.g. "Hе mоvеd intо thе hоspiсе. Hе nо lоngеr wаntеd tо bе а burdеn tо his lаdy
friеnd аt hоmе. Hе hаs brоught his еlесtriс оrgаn with him. ‘But it's hаrdly wоrth
mе prасtiсing аny Сhristmаs саrоls. I'll bе dеаd by Сhristmаs.'").

5. Ассеptаnсе (А ‘giving in' аnd rеаlizing inеvitаbility оf dеаth. Аpprесiаtiоn fоr

littlе things in lifе. Nоt аlwаys hаppy; sоmеtimеs just nоt sаd . Tаkеs а whilе tо
rеасh this stаgе. Е.g. "Nоw I'm lying hеrе wаiting tо diе. I nеvеr pаid аny аttеntiоn
tо сlоuds bеfоrе. Nоw I sее еvеrything frоm а tоtаlly diffеrеnt pеrspесtivе: еvеry
сlоud оutsidе my windоw, еvеry flоwеr in thе vаsе. Suddеnly, еvеrything mаttеrs.").
Ассоrding tо Viсtоr Frаnkl (1905-1997), lifе hаs mеаning undеr аll сirсumstаnсеs,
еvеn thе mоst misеrаblе оnеs аnd оur mаin mоtivаtiоn fоr living is оur will tо find
mеаning in lifе, mоrеоvеr, wе hаvе unlimitеd frееdоm tо find mеаning.
Mеаning соmprisеs "vаluеs, а sеnsе оf purpоsе, gоаls, аnd rеflесtiоn оn thе pаst."
(Krаusе, 2004).

Mеthоds оf finding mеаning in thе еnd оf lifе:

Аutоbiоgrаphiсаl Mеthоds
a. Rеminisсеnсе-Thе prосеss оf rесоllесting оnе's pаst еxpеriеnсеs & lifе еvеnts;
spоntаnеоus.
b. Lifе Rеviеw-Rеturn оf mеmоriеs аnd pаst соnfliсts аt еnd оf lifе; spоntаnеоus оr
struсturеd еvаluаtiоn оf оnе's lifе.
c. Guidеd Аutоbiоgrаphy-Rесоnstruсting thе pаst аnd intеgrаting it with thе
prеsеnt; systеmаtiс.

Сrоss Gеnеrаtiоnаl Mеthоds

a. Gеnеrаtivity - А соnсеrn fоr еstаblishing аnd guiding thе nеxt gеnеrаtiоn; vs.
stаgnаtiоn (Еriksоn).
b. Symbоliс Immоrtаlity - А sеnsе оf lеаving bеhind а lеgасy, pаssing аlоng wisdоm
tо thе nеxt gеnеrаtiоn.
Rеligiоus Mеthоds
a. Rеligiоsity - Аn оrgаnizеd systеm оf bеliеfs, prасtiсеs, rituаls аnd symbоls.
b. Еxtrinsiс Rеligiоsity - Еxtеrnаl аnd sеlf - sеrving mоtivаtiоn; bаsеd оn guilt, fеаr,
sосiаl prеssurеs.
c. Intrinsiс Rеligiоsity - Intеrnаlizеd аnd аltruistiс mоtivаtiоn; gоаl оf dеvеlоping
mеаning/purpоsе.

Spirituаl Mеthоds
a. Spirituаlity - А pеrsоnаl quеst fоr undеrstаnding аnswеrs tо ultimаtе quеstiоns
аbоut lifе, аbоut mеаning, аnd аbоut rеlаtiоnship tо thе sасrеd оr trаnsсеndеnt.
b. Sеlf - Trаnsсеndеnсе - Аdjusting оnе's sеlf соnсеpt in suсh а wаy thаt rесоgnizеs
оnе's plасе in thе wоrld/univеrsе.
 Whаt dо yоu think аbоut Еuthаnаsiа? Plеаsе disсuss prоs аnd соntrаs

2.7 Section Summаry

2.7 Section Summаry

Аdоlеsсеnсе is оnе оf thе mоst сritiсаl stаgеs оf humаn lifе. WHО аnd glоbаl
mеntаl hеаlth rеsеаrсh fосussеs оn mеntаl hеаlth rеlаtеd risk аnd rеsiliеnсе
fасtоrs tо еnаblе yоung pеоplе tо thrivе wеll. Аs disсussеd in this sесtiоn,
thеrе аrе sо mаny соmpоnеnts tо dеvеlоpmеnt- sосiо-еmоtiоnаl, соgnitivе,
nеurоbiоlоgiсаl, lаnguаgе аnd gеnеrаl lеаrning аnd mеmоry funсtiоns thаt wе
nееd tо knоw аbоut humаn bеings. Аdulthооd - in еаrly stаgеs аs wеll аs
middlе аnd lаtеr yеаrs prеsеnts diffеrеnt сhаllеngеs аnd intrоduсеs сhаngе
prосеssеs. Hоw оnе аdjusts tо thеsе frоm оnе stаgе tо thе nеxt аlsо
dеtеrminеs thе futurе соursе оf dеvеlоpmеnt. Wе hоpе yоu hаvе nоtiсеd аt
thаt аt еасh stаgе thеrе аrе а numbеr оf сhаngеs tаking plасе аnd thаt
dеvеlоpmеnt is sо dynаmiс аnd оngоing prосеss. Prеpаrаtiоn fоr lаtеr lifе is
сritiсаl tо а fееling оf оngоing dеvеlоpmеnt аnd wеllbеing. Оnе оf thе things
yоu соuld try is tо intеrviеw а pееr оf yоurs tо еxplоrе lаtе аdоlеsсеnсе оr
еаrly аdulthооd, tаlk tо yоur pаrеnts, rеlаtivеs оr асquаintаnсеs аbоut thе
hоw thеy hаvе сhаngеd оvеr а pеriоd оf timе in thеir bеhаviоur, thinking аnd
dеаling with thе wоrld! This wоuld bе оnе prасtiсаl wаy tо undеrstаnd hоw
dynаmiс dеvеlоpmеnt is!

MODULE INTRODUCTION

MODULE INTRODUCTION

Welcome to the second module of this course. In this module we are going to discuss more
about the psychological processes.

This module is divided into six (6) units, namely:

Unit 1: Pain
Unit 2: Emotion States and Awareness

Unit 3: Thought Processes

Unit 4: Perceptual Processes

Unit 5: Crime, Deviance and Implications of Health

Unit 6: Abnormal Behaviour and the Law

Let’s now look at the module objectives as stated below:

Module Objectives

By the end of this module, you should be able to:

1. <!--[if !supportLists]-->Describe the concepts of pain

2. <!--[if !supportLists]-->Describe emotion states and awareness
3. <!--[if !supportLists]-->Explain thought processes
4. <!--[if !supportLists]-->Describe crime, deviance and implications of health
5. Discuss abnormal behaviour and the law

Let’s now proceed to look at the various units beginning with Unit 1.

UNIT 1: CONCEPT OF PAIN

Hallo class, I welcome you to Unit 1. We want to discuss pain. Pain serves a protective that
alerts an individual to injury from the environment or from within. Many types of pain are
encountered with the most common being acute, chronic and other taxonomies.

Unit Objectives

By the end of this unit, you should be able to:

1. <!--[if !supportLists]-->Define pain

2. <!--[if !supportLists]-->Classify types of pain
3. Describe perception of pain.

With this objectives in mind, we shall now proceed to Section 1 of this Unit

SECTION ONE: DEFINITION OF PAIN

Welcome to section one of Unit 1. In this section you’re going to look at pain in its simplest
terms.
 1.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Clearly define pain

2. Explain the functions of pain

1.3 Definition of Pain

Pain is an unpleasant sensory and emotional experience associated with actual or potential
tissue damage or described in terms of such damage. Even if the current pain is not caused by
“damage” a person will talk about it as though it is or was e.g. it feels like walking on hot sun,
hot sharp stones.

In other words pain is a protective mechanism that warns about injury or something in the body
that requires attention. Pain is felt when a message to the brain is sent from the body and it can
involve many nerve chemicals known as neurotransmitters in multiple pathways.

1.4 Functions of pain

Pain is a universal experience that serves the vital function of triggering avoidance. The pain
sensation is necessary part of being human. In such primitive life form, pain avoidance is purely
reflex action.

Acute pain is thus protective, this is the pain that lets you know that something is wrong and
you need to be checked out e.g. if you have a chest pain when you are having a heart attack,
that’s a good thing if it makes you go to the hospital. If you touch a hot stove and feel pain,
even though it is severe it’s a good thing because it makes you move your hand away.

1.4 Functions of pain

Pain is a universal experience that serves the vital function of triggering avoidance. The pain
sensation is necessary part of being human. In such primitive life form, pain avoidance is purely
reflex action.

Acute pain is thus protective, this is the pain that lets you know that something is wrong and
you need to be checked out e.g. if you have a chest pain when you are having a heart attack,
that’s a good thing if it makes you go to the hospital. If you touch a hot stove and feel pain,
even though it is severe it’s a good thing because it makes you move your hand away.

Pain is subjective, it can be difficult to describe and often hard to characterize and
understand. Pain is what the person says it is, existing where the parson says it does. People
experience pain differently and will have different responses to pain.

SECTION TWO: CLASSIFICATION OF PAIN

Welcome to section two of Unit 1. There are many ways to classify pain and one would be to
look at pain as acute and chronic. The other method would be to look at pain in term of
anatomy, body system, temporal characteristics, severity, etiology and pathophysiology or
classifying in terms of its perception, Nociceptive (somatic and visceral), neuropathic,
psychogenetic and idiopathic

1.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Mention the various types of classification of pain.

2. Talk about types of pain.

1.3 Classification of Pain

1. Acute Pain

It is a complex and unpleasant experience that occurs in response to body trauma. It can affect
the body and the mind.

The cause is usually clear and it is usually easy to see the pain such as an injury or infection. It
lasts a few days or weeks until healing has occurred. Examples of acute pain would be a broken
leg; the initial pain is lessened by treatment such as linting or putting on a cast. Pain usually
gets lessened as the leg heals. A tooth infection there may be a lot of pain which can be healed
by having the tooth removed. Pain goes once the infection or the tooth goes.

2. Chronic Pain

It’s the pain that lasts for more than 3 months, or beyond the normal healing period. It’s a
persistent pain that can disrupt sleep, mood or normal living. The cause is not always clear. It
may start with an injury, infection or ongoing cause such as Arthritis. However some people
suffer from chronic pain the absence any past injury or disease.

Chronic pain is like any other chronic condition such as diabetes. It can have a big effect on
people life and often needs long term management/treatment. Example of chronic pain is a
person damages their neck in a car accident, 6 months latter after the injured area has been
treated and had time to heal, their pain is ongoing but there no damage found on examination.

1.4 Talk about Types of Pain

The various types of pain in our discussion include:

1. Nociceptive Pain

Nociceptive pain is categorized into visceral and somatic. Nociceptive somatic pain is
sustained predominantly by tissue injury or inflammation. It’s described as sharp, aching,
stabbing, throbbing or pressure-like.
Nociceptive visceral pain is usually poorly localized and described as cramp pain (e.g.
obstruction of hollow viscous) or as aching and stabbing (e.g. pain secondary to splenomegaly)

2. Psychogenic Pain

It refers to pain that is believed to be sustained predominantly by psychological factors and its
rare in the cancer population.

3. Neuropathic Pain

Neuropathic pain is sustained by abnormal somatosensory processing in the peripheral Nervous

System or Central Nervous System. Typically it’s described as “burning”, “shock-like,”or
“electrical” and may be paroxysmal in nature.

On physical examination, patients may have allodynia (pain induced by non-painful stimuli)
and hyperalgesia (increased perception of painful stimuli).

4. Idiopathic Pain

In the absence of evidence sufficient to label pain as either Nociceptive or neuropathic, we may
use the term “idiopathic.” In patients with cancer, this term should lead to additional workup
and a search for an underlying etiology and pathophysiology.

1.5 Section Summary

Acute pain can be important for the body to tell the brain that there is something wrong and
help to reduced or avoid the harm.

Chronic pain is pain that goes on for a long time. It and needs regular assessment and a different
approach to treatment. It impacts on the whole person and the community, thus ask a person
about any changes that has happened in their lives since the pain started.

Chronic pain can cause many problems, normal activities can become difficult thus the person
may feel tired and not interested or motivated to do anything.

Unit 1 Review Questions

Choose the correct answer

UNIT 2: EMOTION STATES AND AWARENESS

Once again welcome to unit 2 of emotion states and awareness. The unit will start by giving
definition of emotion states and awareness then proceed to discuss other relevant sections of
the subject. The unit is divided into two sections as follows:

Section 1: Definition of Emotion States and Awareness

Section 2: How to become Aware of your emotions.

The objectives that shall guide our discussion in this unit are as follows:

Unit Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Define Emotion States and Awareness

2. Describe the causes of mood swings and their causes.

We now proceed to Section 1 of this unit.

Trigeminal
Facial
Glossopharingeal
Accessory
Hypoglosal

Nociceptors are free ending of sensory neurons, in what systems are they not found?
Respiratory system
Gastrointestinal system
Muscoskeletal system
Central nervous system
Cardiovascular system

Andrea aged 29 years presents with moderately severe abdominal pain and vaginal spotting
that began one hour ago. She is 34 weeks pregnant in this, her second pregnancy. She appears
quite distressed and her observations are: 36.50 C, BP 105/60, Pulse 110. On abdominal
examination, there seems to be some tension and tenderness over the uterus. The most likely
cause is?
Acute endometritis
Premature labor
Placental abruption
Pre-eclampsia
None of the above

Which of the following can be used to treat neuropathic pain?

Morphine
Amytriptyline
 Gabapentin
Both A and C
Both B and C

UNIT 2: EMOTION STATES AND AWARENESS

Once again welcome to unit 2 of emotion states and awareness. The unit will start by giving
definition of emotion states and awareness then proceed to discuss other relevant sections of
the subject. The unit is divided into two sections as follows:

Section 1: Definition of Emotion States and Awareness

Section 2: How to become Aware of your emotions.

The objectives that shall guide our discussion in this unit are as follows:

Unit Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Define Emotion States and Awareness

2. Describe the causes of mood swings and their causes.

We now proceed to Section 1 of this unit.

SECTION ONE: INTRODUCTION TO EMOTION STATES AND AWARENESS

Welcome to section one of unit 2. In this section you’re going to look at emotional awareness
in its simplest terms.

1.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]--><!--[endif]-->Discuss meaning of developing emotional

awareness.
2. Causes of mood swings.

1.3 Development of Emotional Awareness

Developing emotional awareness means, becoming a 100 % aware of emotions in such a way
that you always know why you’re feeling bad (Developing Bad Mood) or experiencing any
other emotion even if you can’t something about it.

Emotional awareness is the first step needed to getting rid of any bad mood that visits you,
after all, you need to be aware of the presence of an emotion in order to be able to get rid of it
e.g. you might be feeling happy while being with your family and suddenly out of nowhere
your mood swings.

This didn’t happen out of nothing as it seems, you just didn’t notice the trigger that resulted in
the mood swing because you didn’t develop emotional awareness.

Sometimes subconscious thoughts do play work on us and in a flash what is in our subconscious
comes to our conscious and we respond to it in a flash. But the presence of stress can make the
bad emotions intensify and remember all external unpleasant factors can cause stress thus give
a push to the rate at which our moods swing

People who always violate their own values by doing a bad habit over and over e.g. usually
live a with a level of guilt that they got used to, other live with fears throughout their lives
without realizing that their set point is a state of fear and anxiety.

Feelings of guilt arise as soon you do something that violates your values. Your mind sends
you such feelings in order to notify you that your values are in danger.

Some people live with certain levels of stress that they start to believe this is how life should
be, that it’s so normal to experience the levels of stress they’re experiencing. Again that is
another problem that results from lack of emotional awareness.

It is thought that being unaware of your emotions can be one of the main causes of depression,
prolonged sadness, anxiety, fears, guilt leads to prolonged stress which in turn leads to
depression.

1.4 Causes of Mood Swings

We don't understand this well, but research suggests that:

 Mood disorder runs in families - it seems to have more to do with genes than with
upbringing.
 There may be a physical problem with the brain systems which control our moods -
this is why bipolar disorder can often be controlled with medication.
 But mood swings can be brought on by stressful experiences or physical illness.
 Sleep is super important. Those who don’t sleep well often become irritable and find
it more difficult to deal with life stressors.
 Alcohol and illicit drugs, such as cocaine and methamphetamines, can bring on a
high. But what goes up must eventually come down. Not only are drugs bad for our
physical health, they do a number on our mental health as well.
 And yes, sometimes our hormones do in fact influence our mood. Patients who suffer
from Premenstrual Syndrome (PMS) report mood swings up to two weeks prior to the
onset of their periods.
Estrogen withdrawal can steal our mojo, too. When estrogen levels drop, women just don’t
feel well. I often hear women complain of mood swings, depression, and anxiety when they
are experiencing this phase of their life.

1.5 Section Summary

Self-awareness is having clear perception of your personality, including strengths, weaknesses,

thoughts, beliefs, motivation and emotions. Self-awareness allows you to understand other
people, how they perceive you, your attitude and your responses to them in the moment.

SECTION TWO: HOW TO BECOME AWARE OF YOUR EMOTIONS

Welcome to Section Two of Unit 2. Awareness of emotions is a fundamental skill of the

larger ability, which I call emotional literacy. We hope to look into this in this section.
Looking at self-awareness which is the 1st step in creating what you want and master where
you focus your attention, your emotions, your reactions, your personality and behavior
determines where you go in life.

2.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]--><!--[endif]-->Discuss emotional awareness

2. Describe the anatomy mood swings.

2.3 How to Become Aware of your Emotions

The process of becoming aware of your emotions is easy but need a lot of training. 1styou
need to keep an eye on your emotions along with your thoughts and self-talk after all it is
your self-talk that results to any emotional change you experience whether it is good or bad.

The more you keep monitoring your thoughts and emotions the more you will become aware
of them and the more you will understand your own mood swings that seemed to have no
reason earlier.

If you feel bad without a reason or without knowing why, then one of the reasons may be the
cause:

1. Emotion Are Messages

One very important aspect about emotions that you must be aware of is that emotions are just
messages sent to you by your mind in order to motivate you to take a certain action. If you
feel bad then it is time to ask yourself what your subconscious mind is doing to draw your
attention

2. Oversensitivity
Over sensitivenessis subject to mood swings and different bad moods that you can’t
understand. In addition over sensitive people have more empathy than the others. This
empathy can sometimes let them feel bad just when they find themselves around someone
who is feeling bad or who needs help

3. Lack of Serotonin

The hormone that regulates the mood that makes you feel good is called Serotonin. Lack of
serotonin in your blood can lead to bad moods.

The levels of serotonin can be increased by exercising, eating carbohydrates and getting
exposed to sunlight

4. Identify the big problems

Know that there are usually one or two big problems that can be responsible for your bad
mood and the rest are just very small issues that seem big as a result of many problems you
have. Know that you must clearly identify the major problems that are making you feel down
by putting aside the small issues. Once you know the big ones, you can easily move towards
fixing them and the small ones will just disappear.

Without this kind of awareness you will live your life feeling bad without knowing why or
even worse feeling bad and thinking this is your normal set point.
lots of people use quick fixes to regulate there mood, but they only get short term results and
the reason they use quick fixes instead of tackling the real problems is that they are not even
aware of the reasons that change their emotions.

Know yourself, understand your emotions and you will become happier even if you have a
lot of problems.

2.4 Anatomy of Mood Swings

Figure 1: Structures that Control Mood

The structure above shows the limbic part of the brain which has got many other functions and
including among them the control of mood. In short this would be said to be the anatomy of
mood and any chemical and structural changes into this would result into mood swings.

2.5 Section Summary

People with high emotional awareness know how they feel at any given time, they can identify
the source of those feelings and can recognize how the feelings manifest in physical symptoms
such as sweaty palms and headaches.

Accurate self-assessment of our self-awareness can increase personal power, a good way to
think of personal power is to equip it with self-confidence and the tips are a making a list of
your strengths in a journal asking for feedback from your trusted colleagues or friends and
moving on from failures not dwelling on what one consider failure as a lasting or permanent
and recognize what you can learn from a mistake and take the information and apply to future
situations.

Unit 2 Review Questions

Choose the correct answer

The James-Lange theory maintains that emotion is defined by:
Intensity of levels
Bodily responses
Cognitive valuation
Innate thoughts
Maturation

The following are normal responses to some of the emotions we come across EXCEPT
Talking to friends
Changing mood
Taking medication
Telling relatives
None of the above

Psychologists have in the past devoted much effort to trying to classify emotions. A
classification that has proved useful is to divide emotions into ……………. And
………………..
Arousing and soothing
Innate and leaned
Pleasant and unpleasant
 Gentle and aggressive
All the above

Most of the physiological changes that occur during intense emotions result from activation
of the?
Sympathetic system
Parasympathetic system
Thalamic system
Thalamus
Amygdala

UNIT 3: THOUGHT PROCESSES

Welcome to Unit 3 of thought processes. The unit will start by giving definition of thought
then proceed to discuss other relevant sections of the subject. The unit is divided into three
sections as follows:

Section 1: Etymology or Historical Account on the word thought

Section 2: Theories and Philosophy of the word thought

Section 3: Bio-psychosocial and Psycho-analysis of thought

Unit Objectives

By the end of this unit you should be able to:

1. <!--[if !supportLists]--><!--[endif]-->Give historical account of the word thought

2. <!--[if !supportLists]-->Discuss theories of thought and thought process
3. Discuss about psychosocial and pyschoanalysis.

SECTION ONE: ETYMOLOGY OR HISTORICAL ACCOUNT

The word thought is related to the word thinking and thinking involves mentally manipulating
information, as when we form concepts, solve problems, reason and make decisions. We begin
our tour of thought by looking at the origins of thought.

1.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Give a chronological account of the birth of the word thought

 2. Discuss the origins of thought definitions.

1.3 Chronological Account of the Birth of the Word Thought

Thought can refer to the ideas or arrangements of ideas that result from thinking, the act of
producing thoughts, or the process of producing thoughts. Despite the fact that thought is a
fundamental human activity familiar to everyone, there is no generally accepted agreement as
to what thought is or how it is created. Thoughts are the result or product of spontaneous acts
of thinking. Thinking allows humans to make sense of, interpret, represent or model the world
they experience, and to make predictions about that world. It is therefore helpful to an organism
with needs, objectives, and desires as it makes plans or otherwise attempts to accomplish those
goals. Thoughts are the keys which determine one's goal.

1.4 Etymology or Historical Account

The word thought comes from Old English þoht, or geþoht, from stem of þencan "to
conceive of in the mind, consider".

The word “thought” may mean:

< !--[if !supportLists]-->a. <!--[endif]-->a single product of thinking or a single idea (“My
first thought was ‘no.’”)

< !--[if !supportLists]-->b. <!--[endif]-->The product of mental activity (“Mathematics is

a large body of thought.”)

< !--[if !supportLists]-->c. <!--[endif]-->The act or process of thinking (“I was frazzled
from too much thought.”)

< !--[if !supportLists]-->d. <!--[endif]-->The capacity to think, reason, imagines, etcetera

(“All her thought was applied to her work.”)

< !--[if !supportLists]-->e. <!--[endif]-->The consideration of or reflection on an idea

(“The thought of death terrifies me.”)

< !--[if !supportLists]-->f. <!--[endif]-->Recollection or contemplation (“I thought about

my childhood.”)

< !--[if !supportLists]-->g. <!--[endif]-->Half-formed or imperfect intention (“I had some

thought of going.”)

< !--[if !supportLists]-->h. <!--[endif]-->Anticipation or expectation (“She had no thought

of seeing him again.”)

< !--[if !supportLists]-->i. <!--[endif]-->Consideration, attention, care, or regard (“He

took no thought of his appearance” and "I did it without thinking.")

Definitions may or may not require that thought:

 a. Take place within a human brain (see anthropomorphism),
b. Take place as part of a living biological system (see alan turing and computing
machinery and intelligence),
c. Take place only at a conscious level of awareness (see unconscious thought theory),
d. Require language,
e. Is principally or even only conceptual, abstract ("formal"),
f. Involve other concepts such as drawing analogies, interpreting, evaluating, imagining,
planning, and remembering.
g. Involve other concepts such as drawing analogies, interpreting, evaluating, imagining,
planning, and remembering.

Definitions of thought may also be derived directly or indirectly from theories of thought.

Thought (and thinking)– the mental process in which beings form psychological associations
and models of the world. Thinking is manipulating information, as when we form concepts,
engage in problem solving, reason and make decisions. A thought may be an idea, an image, a
sound or even an emotional feeling that arises from the brain.

1.5 Origins of Thought Definitions

Thought can refer to the ideas or arrangement of ideas that result from thinking, the act of
producing thoughts or the process of producing thoughts. Although thought is a fundamental
human activity familiar to everyone, there is no generally accepted agreements as to what
thought is and how it is created. Thoughts are the result or product of spontaneous or willed
acts of thinking. Thinking allows humans to make sense, interpret, represent or model the world
they experience and to make predictions about that world. It is therefore helpful to an organism
with needs, objectives, and desires as it makes plans or otherwise attempts to accomplish those
goals.

1.6 Section Summary

Thought underlies many human actions and interactions, understanding its physical and
metaphysical origins, processes, and effects has been a longstanding goal of many academic
disciplines including artificial intelligence, biology, philosophy, psychology and sociology.

SECTION TWO: THEORIES OF THOUGHT

Welcome to section two of unit 3. Regardless of the kind of thinking we engage in, our
thinking is fueled by concepts that are mental categories used to group objects, events and
characteristics. In this section we will look into Williams’s taxonomy’s hierarchical
arrangement of thinking skills.

2.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]--><!--[endif]-->Give an outline of theories of thought

2. Give purpose of thinking processes.
2.3 Theories of Thought

Thinking processes (theory of constraints) are one of the 5 methods to enable the focused
improvements of any system especially (business system). The purpose of thinking processes
is to help answer questions essential to achieving focused improvement e.g. What to change,
What to change it into, How to cause the change and Why change.

There other theories namely:

a. “Outline of a theory of thought-processes and thinking machines”– thought processes

and mental phenomena modeled by sets of mathematical equations
b. Surfaces and Essences: Analogy as the Fuel and Fire of Thinking– a theory built on
analogies
c. The Neural Theory of Language and Thought– neural modeling of language and
spatial relations
d. Thought Forms—The Structure, Power, and Limitations of Thought - a theory built
on mental models
e. Unconscious Thought Theory– thought that is not conscious
f. Linguistics theories - The Stuff of Though– A linguistic and cognitive theory that
thought is based on syntactic and linguistic recursion processes

v2.4 Purpose of Thinking Processes

Psychologist have concentrated on thinking as an intellectual exertion aimed at finding an

answer to a question or the solution of a practical problem. Cognitive psychology is a branch
of psychology that investigates internal mental processes such as problem solving, memory
and language.

The school of thought arising from this approach is known as cognitivism which is interested
in how people mentally represent information processing. Other schools have different ways
of looking at thought processes.

v2.5 Section Summary

We have a special ability for creating categories to help us make sense of information in our
world. We know that apples and oranges and fruits, but they have different tastes and colors.

SECTION THREE: BIO-PSYCHOSOCIAL AND PSYCHOANALYSIS OF THOUGHT

Welcome to section three of unit three. It will focus on biology, philosophy, psychology and
sociology of thought.

3.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Describe mind body issues of thinking

 2. Describe the biological, psychological, philosophical, and sociological issues of
thought.

3.3 Mind - Body Issues of Thinking

The mind-body problem concerns the explanation of the relationship that exists between minds,
or mental processes, and bodily states or processes. The main aim of philosophers working in
this area is to determine the nature of the mind and mental states/processes, and how—or even
if—minds are affected by and can affect the body.

Human perceptual experiences depend on stimuli which arrive at one's various sensory organs
from the external world and these stimuli cause changes in one's mental state, ultimately
causing one to feel a sensation, which may be pleasant or unpleasant. Someone's desire for a
slice of pizza, for example, will tend to cause that person to move his or her body in a specific
manner and in a specific direction to obtain what he or she wants. The question, then, is how it
can be possible for conscious experiences to arise out of a lump of gray matter endowed with
nothing but electrochemical properties. A related problem is to explain how someone's
propositional attitudes (e.g. beliefs and desires) can cause that individual's neurons to fire and
his muscles to contract in exactly the correct manner. These comprise some of the puzzles that
have confronted epistemologists and philosophers of mind from at least the time of René
Descartes

3.3.1 Philosophical

What is most thought-provoking in these thought-provoking times, is that we are still not
thinking.

The phenomenology movement in philosophy saw a radical change in the way in which we
understand thought. Martin Heidegger's phenomenological analyses of the existential
structure of man in Being And Timecast new light on the issue of thinking, unsettling
traditional cognitive or rational interpretations of man which affect the way we understand
thought. The notion of the fundamental role of non-cognitive understanding in rendering
possible thematic consciousness informed the discussion surrounding Artificial Intelligence
during the 1970s and 1980s.

Phenomenology, however, is not the only approach to thinking in modern Western

philosophy. Philosophy of mind is a branch of philosophy that studies the nature of the mind
mental events, mental functions, mental properties, consciousness and their relationship to
the physical body, particularly the brain. The mind-body problem, i.e. the relationship of the
mind to the body, is commonly seen as the central issue in philosophy of mind, although
there are other issues concerning the nature of the mind that do not involve its relation to the
physical body.

3.3.2 Functionalism Vs. Embodiment

The above reflects a classical, functional description of how we work as cognitive, thinking
systems. However the apparently irresolvable mind-body problem is said to be overcome,
and bypassed, by the Embodied cognition approach, with its roots in the work of Heidegger,
Piaget, Vygotsky, Merleau-Ponty and the pragmatist John Dewey.

This approach states that the classical approach of separating the mind and analyzing its
processes is misguided: instead, we should see that the mind, actions of an embodied agent,
and the environment it perceives and envisions, are all parts of a whole which determine each
other. Therefore functional analysis of the mind alone will always leave us with the mind-
body problem which cannot be solved.

3.4 Biological, Psychological, Philosophical, and Sociological Issues of Thought

These are intertwined in many other issues as discussed below:

3.4.1 Biology

A neuron (also known as a neuron or nerve cell) is an excitable cell in the nervous system
that processes and transmits information by electrochemical signaling. Neurons are the core
components of the brain, the vertebrate spinal cord, the invertebrate ventral nerve cord, and
the peripheral nerves. A number of specialized types of neurons exist: sensory neurons
respond to touch, sound, light and numerous other stimuli affecting cells of the sensory
organs that then send signals to the spinal cord and brain. Motor neurons receive signals from
the brain and spinal cord and cause muscle contractions and affect glands Interneurons
connect neurons to other neurons within the brain and spinal cord. Neurons respond to
stimuli and communicate the presence of stimuli to the central nervous system, which
processes that information and sends responses to other parts of the body for action. Neurons
do not go through mitosis and usually cannot be replaced after being destroyed, although
astorcytes have been observed to turn into neurons as they are sometimes pluripotent.

3.4.2 Psychology

Psychologists have concentrated on thinking as an intellectual exertion aimed at finding an

answer to a question or the solution of a practical problem. Cognitive psychology is a branch
of psychology that investigates internal mental processes such as problem solving, memory,
and language. The school of thought arising from this approach is known as cognitivism
which is interested in how people mentally represent information processing. It had its
foundations in the Gestalt Psychology of Max Wertheimer, Wolfgang Kohler, and Kurt
Koffka, and in the work of Jean Piaget, who provided a theory of stages/phases that describe
children's cognitive development.

Cognitive psychologists use psychophysical and experimental approaches to understand,

diagnose, and solve problems, concerning themselves with the mental processes which
mediate between stimulus and response. They study various aspects of thinking, including
the psychology of reasoning, and how people make decisions and choices, solve problems, as
well as engage in creative discovery and imaginative thought. Cognitive theory contends that
solutions to problems take the form of algorithms—rules that are not necessarily understood
but promise a solution, or heuristics—rules that are understood but that do not always
guarantee solutions Cognitive Science differs from cognitive psychology in that algorithms
that are intended to simulate human behavior are implemented or implementable on a
computer. In other instances, solutions may be found through insight, a sudden awareness of
relationships.

In developmental psychology Jean Piaget was a pioneer in the study of the development of
thought from birth to maturity. In his theory of cognitive development, thought is based on
actions on the environment. That is, Piaget suggests that the environment is understood
through assimilations of objects in the available schemes of action and these accommodate to
the objects to the extent that the available schemes fall short of the demands. As a result of
this interplay between assimilation and accommodation, thought develops through a
sequence of stages that differ qualitatively from each other in mode of representation and
complexity of inference and understanding. That is, thought evolves from being based on
perceptions and actions at the sensorimotor stage in the first two years of life to internal
representations in early childhood. Subsequently, representations are gradually organized
into logical structures which first operate on the concrete properties of the reality, in the stage
of concrete operations, and then operate on abstract principles that organize concrete
properties, in the stage of formal operations.

In recent years, the Piagetian conception of thought was integrated with information
processing conceptions. Thus, thought is considered as the result of mechanisms that are
responsible for the representation and processing of information. In this conception speed
processing, cognitive control and working memory are the main functions underlying
thought. In the neo piagetian theories of cognitive development the development of thought
is considered to come from increasing speed of processing, enhanced cognitive control and
increasing working memory Positive psychology emphasizes the positive aspects of human
psychology as equally important as the focus on mood disorders and other negative
symptoms. In Character Strength and Virtues Peterson and Seligman list a series of positive
characteristics. One person is not expected to have every strength, nor are they meant to fully
capsulate that characteristic entirely. The list encourages positive thought that builds on a
person's strengths, rather than how to "fix" their "symptoms".

3.4.3 Psychoanalysis

"Id", "ego", and "super-ego" are the three parts of the psychic apparatus defined in Sigmund
Freud’s structural model of the psyche; they are the three theoretical constructs in terms of
whose activity and interaction mental life is described. According to this model, the
uncoordinated instinctual trends are the "id"; the organized realistic part of the psyche is the
"ego," and the critical and moralizing function the "super-ego.

The unconscious was considered by Freud throughout the evolution of his psychoanalytical
theory a sentient force of will influenced by human desire and yet operating well below the
perceptual conscious mind For Freud, the unconscious is the storehouse of instinctual desires,
needs, and psychic drives. While past thoughts and reminiscences may be concealed from
immediate consciousness, they direct the thoughts and feelings of the individual from the
realm of the unconscious.

For psychoanalysis the unconscious does not include all that is not conscious, rather only
what is actively repressed from conscious thought or what the person is averse to knowing
consciously. In a sense this view places the self in relationship to their unconscious as an
adversary, warring with itself to keep what is unconscious hidden. If a person feels pain, all
he can think of is alleviating the pain. Any of his desires, to get rid of pain or enjoy
something, command the mind what to do. For Freud, the unconscious was a repository for
socially unacceptable ideas, wishes or desires, traumatic memories, and painful emotions put
out of mind by the mechanism of psychological repression However, the contents did not
necessarily have to be solely negative. In the psychoanalytic view, the unconscious is a force
that can only be recognized by its effects—it expresses itself in the symptom.

3.4.4 Sociology

Figure 2: A "thought bubble" is an illustration depicting thought

Social psychology is the study of how people and groups interact. Scholars in this
interdisciplinary area are typically either psychologists or sociologists though all social
psychologists employ both the individual and the group as their units of analysis Despite their
similarity, psychological and sociological researchers tend to differ in their goals, approaches,
methods, and terminology. They also favor separate academic journals and professional
societies The greatest period of collaboration between sociologists and psychologists was
during the years immediately following World War 2 Although there has been increasing
isolation and specialization in recent years, some degree of overlap and influence remains
between the two disciplines.

The collective unconscious, sometimes known as collective subconscious, is a term

ofpsychology coined by Carl Jung. It is a part of the unconscious mind, shared by a society, a
people, or all humanity, in an interconnected system that is the product of all common
experiences and contains such concepts as science, religion, and morality. While Freud did not
distinguish between an "individual psychology" and a "collective psychology," Jung
distinguished the collective unconscious from the personal subconscious particular to each
human being. The collective unconscious is also known as "a reservoir of the experiences of
our species.

In the "Definitions" chapter of Jung'seminal work Psychological Types, under the definition of
"collective" Jung references representations collectives, a term coined by Lucien Levy in his
1910 book How Natives Think. Jung says this is what he describes as the collective
unconscious. Freud, on the other hand, did not accept the idea of a collective unconscious.

3.5 Section Summary

Thought can refer to the ideas or arrangements of ideas that result from thinking, the act of
producing thoughts, or the process of producing thoughts. Despite the fact that thought is a
fundamental human activity familiar to everyone, there is no generally accepted agreement as
to what thought is or how it is created. Thoughts are the result or product of spontaneous acts
of thinking.

Because thought underlies many human actions and interactions, understanding its physical
and metaphysical origins, processes, and effects has been a longstanding goal of many
academic disciplines including artificial intelligence, biology, philosophy, psychology, and
sociology.

Thinking allows humans to make sense of, interpret, represent or model the world they
experience, and to make predictions about that world. It is therefore helpful to an organism
with needs, objectives, and desires as it makes plans or otherwise attempts to accomplish those
goals. Thoughts are the keys which determine one's goal.

Unit 3 Review Questions

Choose the correct answer

The word thought may mean all of these EXCEPT
A single idea
The product of mental activity
Belief
Embodiment
Anticipation

Thought process include all EXCEPT

Consideration
Free association
Problem solving
Ideation
None of the above

Consideration is
Like mysticism
Obscure or irrational thoughts
Thought processes in problem solving
The process of giving careful thoughts to something
Convergent thinking

Theories of thoughts include all EXCEPT

Surfaces and essences
Neural theory of language
 Thought forms
Linguistic theories
Debatable theories

UNIT 4: FUNDAMENTALS OF PERCEPTION

Welcome learners to Unit 4 discussing perceptual processes. This unit will start by giving the
definition of perceptual process; give you an outline on the steps in the perceptual process. You
will also learn how theenvironments contribute to our day to day behaviour.

This unit is divided into two sections as follows:

Section 1: The Perception and perceptual process

Section 2: The steps in the perceptual process

Unit Objectives

By the end of this unit you should be able to:

1. <!--[if !supportLists]--><!--[endif]-->Define perception and the perceptual process.

2. Describe the steps in the perceptual process.

SECTION ONE: THE PERCEPTION

Welcome to section 1 of unit 4. In this section you will go through the definition of perceptual
process. You will then proceed to understand the key points in the perceptual process.

1.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Define perception.

2. Discuss the concept of perception.

1.3 Definition of Perception

Perception is the process through which people receive, organize, and interpret information
from their environment.

1.4 Concept of Perception

The process of perception begins with an object in the real world, termed the distal stimulus or
distal object. By means of light, sound or another physical process, the object stimulates the
body’s sensory organs.

Perception is not the same as reality. Yet perception is the basis of feelings and actions; the
quality and accuracy of a person’s responses to a specific situation.

Perception is the organization, identification, and interpretation of sensory information to

represent and understand the environment. In other words perception is our sensory experience
of the world around us and it involves both the recognition of environmental stimuli and actions
in response to stimuli. Perception not only creates our experience of the world around us; it
allows us to act within our environment

Perception includes the five senses; touch, sight, taste, smell; and hears. It also includes what
is known as proprioception, a set of senses involving the ability to detect changes in body
positions and movements. It also involves the cognitive process required to process
information, such as recognizing the face of a friend or detecting a familiar scent.

1.5 Section Summary

Perception doesn’t just involve becoming consciously aware of the stimuli, it is also necessary
for our brains to recognize what it is were sensing and the final step of the perception involves
some sort of action in response with environmental stimulus. This could involve a variety of
actions.

SECTION TWO: THE PERCEPTUAL PROCESSES

Once again welcome to section two of unit 4.In this section you will go through the definition
of the perceptual process. You will proceed to see how you can link it up section one.

2.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]-->Define perceptual process

2. Describe the concept of perceptual process.

2.3 The Perceptual Process

The perceptual process is a sequence of steps that begins with the environment and leads to our
perception of a stimulus and an action in response to the stimulus. OR It is the unconscious
process we undergo to make sense of the information which simply means that we take the
information and turn it into something we can categorize.

2.4 Concepts of Perceptual Process

The process of human perception is the process by selecting, organizing and interpreting
people, objects, events, situations and other phenomena.

We do not passively receive what is out there; we actively work to make sense of things. The
perceptual process is influenced by two environments namely; Internal and External .Internal
environment encompasses; beliefs, values, nature with conscious past. Whereas the external
environment, is controlled by factors acronym PESTEL [P stands for political; E for economic,
S for Social; T for technology; E for ethics and L for legal].The factors from two environment
impact on our perceptual environment at the perceptual input first stage or step.

In-Text Question

What do you see in the images below?

2.5 Section Summary

One of the most important aspects of achievement is training the eye to see properly. Sight is
an interesting phenomenon. We see things not as they are but as we are, in other words seeing
things do not believe. Believing is seeing. We can only see in others what lies within ourselves.

Unit 4 Review Questions

Choose the correct answer

The steps in perceptual process include all except
The environmental stimulus
The attended stimulus
 The image on the retina
Transduction
Natural processing

The final stage of perceptual process include

Transduction
The environmental stimulus
Action
Recognition
Perception itself

Environmental stimulus is?

The attended stimulus
Everything in the environment that has the potential to be perceived
The process involving light passing through cornea and pupil
The awareness
The object recognition

The action phase of perceptual development involves

Motor action
Transuding the light into visual signals
Recognition
Neural processing
All the above

UNIT 5: CRIME, DEVIANCE AND IMPLICATIONS OF HEALTH

Hi, welcome to unit 5 of crime, deviance and implications of health. The unit seems to have
some similarity to Unit 6. It may seem really vast in detail but, we will break it down
categorically and in sections.

Section 1: Introduction to Crime and Deviance

Section 2: Theories of Crime and Deviance Causation

Unit Objectives

By the end of this section you should be able to:

 1. <!--[if !supportLists]-->Describe the introductory concepts of Crime and Deviance
2. Discuss the theories of Crime and Deviance

SECTION ONE: INTRODUCTORY CONCEPTS OF CRIME AND DEVIANCE

Welcome to section 1 of unit 5.In this section you will go through the definition of crime and
deviance.

1.2 Section Objectives

By the end of this section you should be able to:

1. <!--[if !supportLists]--> <!--[endif]-->Define Concepts of Crime and Deviance

2. Outline the implications of crime and deviance.

1.3 Concepts of Crime and Deviance

1.3.1 Deviance

This is any behavior that departs from what the majority of a community or the whole society
considers to be normal. Not all deviance is forbidden by law, nor is all of it criminal or may be
defined also as a variation from the norm and society’s reaction to it. This sometimes comes
with labels and to label someone deviant is related our notions to social convention (Remember
the definition of normal and abnormal behaviour in unit 6). The normal society entrenched
with laws, rules and norms, socially the deviant are reflections of ourselves and our sense of
otherness.

1.3.2 Crime

This is any act forbidden by law. What is considered a crime or a deviant act shifts across time
and with respect to different groups.

Some countries do not recognize certain categories of prejudice, such as sexual orientation.
This discrepancy can have a serious impact on hate crime statistics, in as much as some
individuals who are afraid to go to the police, or may be discredited by the police when
reporting these crimes.

Hate Crime is a particular type of crime involving discrimination against or hateful acts
towards particular groups in society. Hate crimes are difficult to define owing to lack of
agreement regarding the designation of prejudice as a motivation.

1.4 Implications of Crime and Deviance

Negative effects of deviance:

Deviance is seen by lots of people as a bad behaviour because it constitute a social problems.
This is because deviant behaviour affects the smooth flow of social interaction and impairs
social organization. As a result of the chaotic phenomena of deviant behaviour, government
and government officials divert and allocated huge amount of resources into modern agents of
social control such as buying bullet proof cars, uniforms for Police and Prison Officers,
construct Police stations, courts and Prisons all over the country. All these agents are meant to
enforce or set conformity. These resources could have been invested into other profitable area
such as industries, agriculture, education, human and society development. Furthermore,
deviant behaviour also undermines trust. For instance, as a result of activities of some few
individuals in drug trafficking, fraud, armed robbery, kidnapping, and religious war, some
people no longer have confidence in Nigerians. The deviant behaviour of few Nigerians has
dainted the image of our country.

Positive effects of deviance:

On the other hand, deviant behaviour has positive effects too. Firstly if everybody was afraid
to risk that label of deviants, social control would be extremely rigid. Blacks in South Africa
would have been contented with apartheid rule, women would have be satisfied with
subordinate roles, Nigeria could have been contented with Colonial rule, and Niger-Delta could
have been satisfied with governments’ marginalization and exploitation of both their natural
and human resources. Secondly, all social changes start as deviant behaviour. Lots of people
had to risk their lives and reputation to effect social changes. For instance, in Africa during the
Colonial era freedom fighters like Zik of Africa, Dr. Kenneth Kaunda, and Nelson Mandela
were tagged political deviants. But the consistent and persistent struggles brought about
political changes from the shackles of colonialism to independence of Africa and their freedom
fighters; for example, Nelson Mandela was recently given befitting funeral rites because of his
positive act of defiance.

1.5 Section Summary

Crime is a societal indicator of the relationship of individuals to the larger social system. Crime
is relativistic andis related to factors such as race, class and gender. Understanding crime helps
understand other aspects of society and socialization. What is deviant may vary, but deviance
is found in all societies. Deviance and the social response it provokes sustain the moral
foundation of society. Deviance may also guide social change.

SECTION TWO: THEORIES OF CRIME AND DEVIANCE

Welcome to section 2 of unit 5. In this section you will go through the theories of crime and
deviance. In fact there are quite a number of theories that describe the subject of this section,
we may mention some.

2.2 Section Objectives

By the end of this section you should be able to:

Give an outline of theories and describe them as regards to crime and deviance.
2.3 Theories of Crime and Deviance

The theories that are mentioned here are:

< !--[if !supportLists]-->1. <!--[endif]-->Demonology

< !--[if !supportLists]-->2. <!--[endif]-->Classical and Neo Classical theory

< !--[if !supportLists]-->3. <!--[endif]-->Positivism and the ecological approach

< !--[if !supportLists]-->4. <!--[endif]-->Biological Theories

< !--[if !supportLists]-->5. <!--[endif]-->Psychological Approach

< !--[if !supportLists]-->6. <!--[endif]-->Socio Cultural approaches

Let us discuss each in detail.

2.3.1 Demonology

In this case crime is caused by demonic activity and the offender is to purged of evil
presence.

More or less like the theological theories which locate deviance and crime within the spiritual
or moral make up of the individual.

2.3.2 Classical and Neo Classical Theory

This originated in 1764, the founders were Cesare Beccaria, Jeremy Bentham. The theory
was based on hedonistic calculus and the punishment should fit the crime and punishment
should be applied equally.

This theory has been checked by neo classical theory which introduced idea of mitigating
factors and age and situational context taken to account

2.3.3 Positivism and the ecological approach

Positivism emphasizes measuring, accumulating and assessing data. The positivist

perspective consists of three assumptions of what deviant behavior is:
Absolutism - deviance is absolutely or intrinsically real, deviant individuals have certain
characteristics that make them different from conventional people
Objectivism - deviant people can be studied objectively like observable objects
Determinism - deviance is caused by forces beyond an individual’s control

2.3.4 Biological theories

 Biological approaches, the core ideas here that biological and mental traits makes some people
crime prone. These traits are inherited and they present at birth. Mental and physical
degeneracies are the cause of crime.

Lombroso and biological atavism studied inmates, find that physical characteristics of inmates
differ from law abiding citizens. The XYY theory based on studies of inmates who have genes
with XYY genetic make up known as super male

The biological roots of criminal behaviour, states that chemical and environmental precursors
can be related to criminal behaviour, eating habits, vitamin deficiencies and blood sugar levels

Hormones and Criminality, the levels of testosterone and premenstrual syndrome maybe linked
with criminal behaviour.

Sheldon and Somatatyping states that temperament are affected by body type or shapes eg.
Endomorph, ectomorph and mesomorph

Genetic predisposition reported that some individuals are exposed to alcoholism, suicide,
mental illness other deviant and criminal behavior.

2.3.5 Psychological approach

These focus on the individual (Cognitive, Behavioral, neurological and developmental

paradigms

The examples are psychoanalytic theory and psychopathic

A psychopath is person who lacks empathy and guilt. Highly manipulative, emotionally
shallow, often outwardly charming, history of violence and abuse and do possess abnormal
physiological responses to stressors

2.3.6 Socio-Cultural Approaches

Sociological approaches looks at micro sociology emphasizes social processes e.g. learning the
symbols of a culture/sub-culture. Macro sociology emphasizes social structures e.g. class
inequalities cause crime. Sociological theories characterize deviance and crime as a response
to the society in which they occur.

Psychological theories locate deviance and crime within psyche or mind of the individual, as
the product of inborn abnormality or of faulty cognition processes

<!--[if !supportLists]-->a. <!--[endif]-->Functionalist Theory

Durkheim noticed that whereas traditional societies has been bound together by shared group
values and norms, people in modern society were becoming less attached to norms a condition
anomieand thought they could simply pursue their own individual interests. He recognized that
certain amount of deviation from norms is normal and healthy for any society as it allows for
innovation and adaptation to change
 However excessive individualism in modern society leads to too much crime and deviance
when too many people can behave how they want ignoring the group and its values’

Robert merton took up the functionalist based idea of anomie and explained crime and
deviance as a result of strain, strain a condition experienced when the members of a society
lack a sufficient amount of legitimate means to achieve socially approved goals, prompting
some individuals to pursue their aims though alternative means such as deviant or criminal
action e.g. people who ar impoverished and need to feed their families experience strain, while
their goal is socially acceptable they are unable to meet it through legitimate resources

< !--[if !supportLists]-->b. <!--[endif]-->Labelling Theory

Thomas theorem, a theorem stating that if people define a situation as real, it is real in its
consequences.

The Thomas theorem parallels the symbolic interactionist persepective which emphasizes how
social actions are the result of shared definitions of a situation

Howard becker made the poin that, no actions are by nature criminal or deviant nor are people
naturally criminal or deviant. Deviance depends on the norms of the society and on the
reactions of members of the society in different situations

The effect of this perspective on the sociology of crime and deviance was to shifgt the focus
from why people are criminal or deviant on to the question of why and how people come to be
labeled as criminal or deviant. Deviant career is a process of internalizing and accepting the
label of “deviant”

<!--[if !supportLists]-->c. <!--[endif]-->Social Structure theories

Cultural poverty is passed from one generation to the next unemployment and
underemployment creates despair. Social and economic forces in deteriorated social class
areas, push residents into criminal behavior patterns.

Social structure theories include:

< !--[if !supportLists]--> <!--[endif]-->Social disorganization

< !--[if !supportLists]--> <!--[endif]-->Strain theory

< !--[if !supportLists]--> <!--[endif]-->Cultural deviance theory

Each theory suggests that socially isolated people living in disorganized areas, are the ones
most likely to experience crime producing social forces.

Cohesive communities develop interpersonal ties and mutual trust. Informal social control is
created which involves peers families and relatives, there is creation of institutional and
social control which includes school, churches, business and social agencies.

Public social control creates policing and social support/altruism crime rates are lower in
areas with a positive social climate.
<!--[if !supportLists]-->d. <!--[endif]-->Conflict Theory

This theory points out that inequalities of wealth and power are what leads some people to be
branded as deviant or criminal. First, the capitalist punishes any infractions or threats to the
functioning of the capitalist economic system itself. Second capitalism, is alleged to generate
greed and selfishness because it has to create, new and bigger markets for its commodities,
which entails spending vast sums on advertising and marketing. It stimulates competition for
scarce resources which means that the rich and powerful get and use more than their fair share
to the disadvantage of others.

< !--[if !supportLists]--> <!--[endif]-->Cultural approaches to the crime and deviance

Ethnographic field research involves undertaking firsthand information of those involved and
their cultures, which means

ethno = “people”

graphic =“description”

in the field = “the situation”

<!--[if !supportLists]--> <!--[endif]-->Moral panic

A period or episode of heightened anxiety about what are seen as symptoms of moral decline
in society.

Moral panic typically includes a campaign aimed at mobilizing agents of social control
against particular groups that alleged to be responsible for moral decline.

Pervasive presence of the media in post modern society can be tremendously influential in
terms of amplifying and sustaining these moral panics.

2.4 Section Summary

Crime and deviance are linked. Deviance refers to those behaviors that violate social norms.
Some deviant behaviors are serious enough that society has chosen to pass laws against them
(these are crimes); other deviant behaviors may be frowned upon by society but have not
been defined as crimes. Internal and external socialization processes teach social norms and
clarify what behaviors society is and is not willing to tolerate. Socialization and social control
are key concepts in controlling human behavior. Society determines what behaviors are
acceptable, and deviations from those behaviors bring a variety of social sanctions (not
limited to those meted out by the criminal justice system). A failure to socialize to the norms
of society is often used as an explanation of criminal behavior and deviance.

Unit 5 Review Questions

Choose the correct answer

Social indicators of the relationship of individuals to the larger social system is:
 Crime
Deviance
Mood
Association
All of the above

………………..is any behaviour that violates social norms

Anomie
Recidivism
Deviance
Labeling
Corollary

Theories of crime and deviance include all except:

Demonology
Psychological approaches
Sociological approaches
Classical and neo-classical theory
Geographical theories

In biological approaches the core ideas are:

That biological and mental illness make some people crime prone
That the traits are inherited and not present at birth
That positivism does not emphasize measuring
Like classical theory
Proposing that punishment should be applied equally

UNIT 6: ABNORMAL BEHAVIOUR AND THE LAW

Once again welcome to unit 6 of abnormal behaviour and the law. The unit will start by giving
definition of abnormal behaviour then proceed to discuss other relevant sections of the subject.
The unit is divided into two sections as follows?

Section 1: Introduction to abnormal behaviour

Section 2: Models of abnormal behaviour

Unit Objectives
By the end of this section you should be able to:

1. <!--[if !supportLists]-->Describe the introductory concepts of abnormal behaviour

2. Discuss the models of abnormal behaviour.

SECTION ONE: INTRODUCTION TO ABNORMAL BEHAVIOR

Welcome to section one of unit 6. In this section you will go through the definition of
abnormal behavior and begin to understand the complexity of judging what is abnormal and
normal. Abnormality (or dysfunctional behavior), in the vivid sense of something deviating
from the normal or differing from the typical (such as an aberration), is a subjectively defined
behavioral characteristic, assigned to those with rare or dysfunctional conditions. Defining
who is normal or abnormal is a contentious issue in abnormal psychology.

1.2 Section Objectives

By the end of this section you should be able to:

1. Discuss abnormal behaviors’ definitions

1.3 Definition of Abnormal behaviour

Abnormal behavior may be defined using various categories.

1.3.1 Statistical abnormality
A behavior may be judged abnormal if it is statistically unusual in a particular population.
One criterion for "abnormality" that may appear to apply in the case of abnormal behavior is
statistical infrequency. This has an obvious flaw — the extremely intelligent, are just as
abnormal as their opposites. Therefore, individual abnormal behaviors are considered
statistically unusual, as well as undesirable. The presence of some form of abnormal behavior
is not unusual. About one quarter of people in the United States, for example, are believed to
meet criteria for a mental disorder in any given year. Mental disorders, by definition, involve
unusual or statistically abnormal behaviors.

1.3.2 Violation of socially-accepted standards

An abnormal behavior might be defined as one that goes against common or majority or
presumed standards of behavior. For example, one might be judged abnormal in one's failure
to behave as recommended by one's family, church, employer, community, culture, or
subculture. Another criterion is morality. This presents many difficulties, because it would be
impossible to agree on a single set of morals for the purposes of diagnosis.

1.3.3 Theoretical approaches

Theories approach abnormality by starting with a theory of personality development, If
normal development can be defined, then abnormality is defined by the failure to develop in
this way. For example, if adults normally arrive at a moral stage that prohibits killing other
people, and someone does not arrive at this stage, that person might be called abnormal.

1.3.4 Subjective abnormality

Abnormal behavior can be defined by a person's feeling of abnormality, including feelings of
anxiety, strangeness, depression, losing touch with reality, or any other sensation recognized
and labeled by an individual as out of the ordinary. A more discerning criterion is distress. A
person who is displaying a great deal of depression, anxiety, unhappiness, etc. would be
thought of as exhibiting abnormal behavior because their own behavior distresses them.
Unfortunately, many people are not aware of their own mental state, and while they may
benefit from help, they feel no compulsion to receive it.

1.3.5 Biological injury

Abnormal behavior can be defined or equated with abnormal biological processes such as
disease or injury. Examples of such abnormalities are brain tumors, strokes, heart disease,
diabetes, epilepsy, and genetic disorders.
Another criterion that has been suggested is that abnormal behavior violates the standards of
society. When people do not follow the conventional social and moral rules of their society,
the behavior is considered abnormal. However, the magnitude of the violation and how
commonly it is violated by others must be taken into consideration.

1.3.6 Culture
The first of these criterion being culture; what may be seen as normal in one culture, may be
seen as abnormal in another. The second criterion being the situation & context one is placed
in; for example, going to the toilet is a normal human act, but going in the middle of a
supermarket would be seen as highly abnormal, i.e., defecating or urinating in public is
illegal as a misdemeanor act of indecent public conduct. The third criterion is age; a child at
the age of three could get away with taking off its clothing in public, but not a man at the age
of twenty. The fourth criterion is gender: a male responding with behavior normally reacted
to as female, and vice versa, is retaliated against, not just corrected. The fifth criterion is
historical context; standards of normal behavior change in some societies, sometimes very
rapidly.

1.4 Section Summary

Abnormal behaviour is one of those concepts that is not easy to define. The line between
what is normal and what is abnormal is not always clear-cut and easy to specify. Nonetheless,
the following definition specifies several criteria that can help us think about what abnormal
behaviour is. Abnormal behaviour is behaviour that is deviant, maladaptive, or personally
distressful. There are three criteria in this definition of s of these criteria needs to be met for
the classification of abnormal behaviour, but two or three may be present.
So what can we say is abnormal or unacceptable behavior? If you behave abnormally then
this could be anything that is or could be viewed as being: irregular, non-standard,
uncharacteristic, unusual, strange, anomalous, odd or peculiar, intolerable, unsuitable,
unwelcome, unwarranted, unprovoked, or unjustified.

SECTION TWO: MODELS OF ABNORMAL BEHAVIOR

Welcome to section two of unit six. There are a number of historical and contemporary views
or models of abnormal behavior. They include the demonological, medical, social-learning,
and cognitive models. The organic and psychoanalytic models are offshoots of the medical
model.

2.2 Section Objectives

By the end of this section you should be able to:

1. Discuss the models of abnormal behaviour

2.3 Models of abnormal behaviour

The models include:

2.3.1 The Demonological Model

Throughout human history, the demonological model has been the most widely believed model
for explaining abnormal behavior. During the Middle Ages and during the early days of Ameri-
can civilization along the rocky coast of Massachusetts, the demonological model was in full
sway. It was generally believed that abnormal behavior was a sign of possession by agents or
spirits of the Devil. Possession could stem from retribution, or God having the Devil possess
your soul as punishment for your sins. Wild agitation and confusion were attributed to
retribution. Possession was also believed to result from deals with the Devil in which people
(“witches”) traded their souls for earthly power or wealth. Witches were held responsible for
unfortunate events, ranging from a neighbor’s infertility to a poor crop.

In either case you were in for it. An exorcist, whose function was to persuade those spirits to
find better pickings elsewhere, might pray at your side and wave a cross at you. If the spirits
didn’t call it quits, you might be beaten or flogged. If your behavior was still unseemly, there
were other remedies, like the rack, which have powerful influences on behavior.
In 1484 Pope Innocent VIII ordered that witches be put to death. At least 200,000 accused
witches were killed over the next two centuries. Europe was no place to practice strange
ways. The goings-on at Salem were trivial by comparison.
There were ingenious “diagnostic”tests to ferret out possession. One was dunking the suspect
under water. Failure to drown was interpreted as support by the Devil - in other words,
possession. Then you were in real trouble.

2.3.2 The Medical Model: Organic and Psychoanalytic Versions

According to the medical model, abnormal behavior reflects an underlying illness, not evil
spirits. The organic model and the psychoanalytic model are offshoots of the medical model.
1. Organic Version
In 1883 Emil Kraepelin published a textbook of psychiatry in which he defined the medical
model. Kraepelin argued that there were specific forms of abnormal behavior, which within
the medical model are often called mental illnesses. (See Table 9.1 for a list of many of the
commonly used terms concerning abnormal behavior that reflect the widespread influence of
the medical model.) Each mental illness had specific origins, which he assumed were
physiological. The assumption that biochemical or physiological problems underlie mental
illness is the heart of the organic model.
Kraepelin argued that each mental illness, just like each physical illness, was typified by its
own cluster of symptoms, or syndrome. Each mental illness had a specific outcome, or
course, and would presumably respond to a characteristic form of treatment, or therapy.
Contemporary supporters of the organic model point to various sources of evidence. For one
thing, a number of mental disorders run in families and might therefore be transmitted from
generation to generation by DNA. For another, imbalances in neurotransmitters and other
chemicals produce behavioral effects like those found in disorders such as severe depression
and schizophrenia, as we shall see later.
According to the organic model, treatment requires biological expertise and involves
controlling or curing the underlying organic problem. The biological therapies discussed in
Chapter 10 are largely based on the organic model.

2. Psychoanalytic Version

Sigmund Freud’s psychoanalytic model argues that abnormal behavior is symptomatic of

unconscious conflict of childhood origins -an underlying psychological rather than biological
disorder. The abnormal behavior (or “symptoms”) often reflect difficulty in repressing
primitive sexual and aggressive impulses.
Within Freudian theory, neurotic behavior and anxiety stem from the leakage of primitive
impulses. Anxiety represents the impulse itself and fear of what might happen if the impulse
were acted on. In the case of psychosis,impulses are assumed to have broken through, so that
behavior falls under the control of the id rather than the ego or superego. According to
psychoanalytic theory, treatment (other than a sort of “Band-Aid” therapy) requires
resolving the unconscious conflicts that underlie the abnormal behavior.
The medical model is a major advance over demonology. It led to the view that mentally ill
people should be treated by qualified professionals rather than be punished. Compassion
replaced hatred, fear, and persecution.
But there are problems with the medical model. For instance, the model suggests that the
mentally ill, like the physically ill, may not be responsible for their problems and limitations.
In the past, this view often led to hospitalization and suspension of responsibility (as in work
and maintenance of a family life). Thus removed from the real world, the coping ability of
the mentally ill often declined further. But today most adherents of the medical model
encourage patients to remain in the community and maintain as much responsibility as they
can.

2.3.3 The Social-Learning Model

From a social-learning point of view, abnormal behavior is not necessarily symptomatic of

anything. Rather, the abnormal behavior is itself the problem. To a large degree, abnormal
behavior is believed to be acquired in the same way normal behaviors are acquired -for
example, through conditioning and observational learning. Why, then, do some people show
abnormal behavior?

One reason is found in situational variables; that is, their learning or reinforcement histories
might differ from those of most of us. But differences in person variables such as competencies,
encoding strategies, self-efficacy expectations, and self-regulatory systems might also make
the difference.

A person who lacks social skills might never have had the chance to observe skillful models.
Or it might be that a minority subculture reinforced behaviors that are not approved by the
majority. Punishment for early exploratory behavior, or childhood sexual activity, might lead
to adult anxieties over independence or sexuality. Inconsistent discipline (haphazard
rewarding of desirable behavior and unreliable punishing of misbehavior) might lead to
antisocial behavior. Children whose parents ignore or abuse them might come to pay more
attention to their fantasies than to the outer world, leading to schizophrenic withdrawal and
inability to distinguish reality from fantasy. Deficits in competencies, encoding strategies,
and self- regulatory systems might heighten schizophrenic problems. Since social-learning
theorists do not believe that behavior problems necessarily reflect organic or unconscious
problems, they often try to change or modify them directly, as with behavior therapy (see
Chapter 10).

2.3.4 The Cognitive Model

Cognitive theorists focus on the cognitive events - such as thoughts, expectations, and
attitudes -that accompany and in some cases underlie abnormal behavior.
One cognitive approach to understanding abnormal behavior involves information
processing. As noted in earlier chapters, information-processing theorists compare the
processes of the mind to those of the computer and think in terms of cycles of input (based
on perception), storage, retrieval, manipulation, and output of information. They view
abnormal behavior patterns as disturbances in the cycle. Disturbances might be caused by the
blocking or distortion of input or by faulty storage, retrieval, or manipulation of information.
Any of these can lead to lack of output or distorted output (e.g., bizarre behavior).
Schizophrenic individuals, for example, frequently jump from topic to topic in a
disorganized fashion, which information- processing theorists might explain as problems in
manipulation of information.
Other cognitive theorists (Albert Ellis, 1977, 1987, is one) view anxiety problems as
stemming from irrational beliefs and attitudes, such as perfectionism and overwhelming
desire for social approval. Aaron Beck attributes many cases of depression to “cognitive
errors,” such as self-devaluation, interpretation of events in a negative light, and general
pessimism (Beck et al., 1979). Some cognitive psychologists, as we shall see, attribute many
cases of depression to cognitions to the effect that one is helpless to change things for the
better.
Social-learning theorists such as Albert Bandura (1986) and Walter Mischel (1986) straddle
the border between the behavioral and the cognitive. As noted, they place primary
importance on encoding strategies, self-regulatory systems, and expectancies in explaining
and predicting behavior. For example, expectancies that we will not be able to carry out our
plans (low “self-efficacy expectations”) sap motivation and lead to feelings of hopelessness -
two aspects of depression (Bandura, 1982).
Many psychologists look to more than one model to explain and treat abnormal behavior.
They are considered eclectic. For example, many social-learning theorists believe that some
abnormal behavior patterns stem from biochemical factors or the interaction of biochemistry
and learning. They are open to combining behavior therapy with drugs to treat problems
such as schizophrenia and bipolar disorder. A psychoanalyst might also be eclectic. He or
she might believe that schizophrenic disorganization reflects control of the personality by the
id and argue that only long-term psychotherapy can help the ego achieve supremacy. But the
psychoanalyst might still be willing to use drugs to calm agitation on a temporary basis.

Now let us consider the major categories of abnormal behavior, as compiled in the third edition
(revised version) of the Diagnostic and Statistical Manual of the Mental Disorders (DSM –III-
R) by the American Psychiatric Association (1987). We shall refer to the DSM-III-R because
it is the most widely used classification system in the United States. However, psychologists
criticize the DSM-III-R on many grounds, such as adhering too strongly to the medical model.
So our use of it is intended as a convenience, not an endorsement. In future years psychologists
might publish their own system for classifying abnormal behavior patterns.

2.4 Section Summary

Abnormal behaviour is one of those concepts that is not easy to define. The line between
what is normal and what is abnormal is not always clear-cut and easy to specify. Nonetheless,
the following definition specifies several criteria that can help us think about what abnormal
behaviour is. Abnormal behaviour is behaviour that is deviant, maladaptive, or personally
distressful. There are three criteria in this definition of s of these criteria needs to be met for
the classification of abnormal behaviour, but two or three may be present.

So what can we say is abnormal or unacceptable behavior? If you behave abnormally then
this could be anything that is or could be viewed as being: irregular, non-standard,
uncharacteristic, unusual, strange, anomalous, odd or peculiar, intolerable, unsuitable,
unwelcome, unwarranted, unprovoked, or unjustified.

Unit 6 Review Questions

Choose the correct answer

Behavior may be judged abnormal by the following EXCEPT?
Statistical abnormality
 Violation of socially accepted standards
Theoretical
Lingual diversion
Subjective abnormality

Brain tumors, strokes etc help to define behavior abnormality in the category of
Subjective abnormality
Theoretical approach
Violation of standards
Biological injury
Brain maladaptivity

Criterion commonly referenced as maladaptivity

If a person is behaving in ways counter-productive to their own wellbeing
When a person does not follow the conventional social and moral rules of their society
When statistically rare behaviours are called abnormal
There is failure to function
Where all definitions of abnormality are used to determine whether an individual
behaviour is abnormal

Medical model of behaviour pioneers are people like?

Albert Ellis
Emil Kraeplein
Pope Innocent VIII
Albert Bandura
Walter Mischel

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HCH 100: BEHAVIOURAL SCIENCES - MODULE 3 BEHAVIOUR CHANGE

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY

HCH 100: BEHAVIOURAL SCIENCES

MODULE 3: BEHAVIOUR CHANGE

 FOR

BACHELOR OF MEDICINE AND SURGERY STUDENTS

WRITER:

DR. MUTHONI A. MATHAI, MBCHB, MMED (PSYCH), Ph.D.

Copyright

Copyright

Behavioural Sciences Course to Undergraduate Students in the College of Health Sciences

by Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

© University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced
in any form or by any means without permission in writing from the Publisher.

Writer: Dr. Muthoni A. Mathai

Reviewer:

Chief Editor: Joshua M Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

The University of Nairobi (UoN), College of Health Sciences wish to acknowledge the
contribution of the Department of Psychiatry and PRIME-K whose financial assistance made
the development of this e-learning course possible.

MODULE 3: BEHAVIOUR CHANGE

Welcome to this module on behaviour change. This module is a follow-up to module one and
two that cover, behavioural theories and personality theories. Knowledge acquired in the
previous module forms a good foundation for the current one. Disorders in health and
wellbeing are more often than not related to behaviour, either through negligence or through
acquired habits of unhealthy behaviour and life style. Although you are at the beginning of
your career as promoters of health and wellbeing, it is important that you start taking this role
actively, observing your surroundings from the perspective of the behavioural impact on
wellbeing. It is expected that during the practice of medicine you will continuously be trying
to change the behaviour of your individual patients or the community you are working in, in
order to prevent poor health and promote good health and wellbeing.

In this module we will be looking at psychosocial theories of behaviour as well as different

factors that influence it in a series of nine sections. The Module will start by addressing the
basis of human behaviour, which forms the foundation to understanding behavioural changes
which will be followed up with an appraisal of constitutional factors and behaviour including
genetic influence on behaviour with an additional section to address intelligence and
psychological disorders and gender differences in abnormal behaviour. We will move on to
more sociological aspects of behaviour to look at life events and their impact on behaviour,
social attitudes and their influence on behaviour and lastly iatrogenic disorders and behaviour.
It is hoped that having gone through this module your capacity to interact with colleagues and
patients and to make decisions relevant to the promotion of health will be positively influenced
by knowledge you have acquired.

3.2 Module objectives

At the end of this module, you should be able to:

1. <!--[if !supportLists]-->Discuss the Foundation of human behaviour

2. <!--[if !supportLists]-->Describe the Theories of behaviour change
3. <!--[if !supportLists]-->Evaluate the theories of Constitutional Factors and
Behaviour<!--[endif]-->
4. <!--[if !supportLists]-->Discuss genetic influence on behaviour<!--[endif]-->
5. <!--[if !supportLists]-->Describe genetic influence on Intelligence and psychological
disorders <!--[endif]-->
6. <!--[if !supportLists]-->Discuss Gender differences in Abnormal Behaviour <!--
[endif]-->
7. <!--[if !supportLists]-->Discuss Life Events and Abnormal behaviour<!--[endif]-->
8. <!--[if !supportLists]-->Discuss Social Attitudes and Behaviour<!--[endif]-->
9. Evaluate Iatrogenic Disorders and Behaviour

We shall now proceed to discuss the foundation of human behavior which makes the first
section of this module.

SECTION ONE: FOUNDATIONS OF HUMAN BEHAVIOUR

Welcome to this first section in this module on the theories of behavioural change and
behavioural models. From previous sections you will be familiar with some of the content in
this section. Psychology has been defined as the study of human behaviour and mental
processes. Behaviour is often implicated in health and wellbeing making behaviour change an
important vehicle in the prevention of ill health and promotion of wellbeing for health workers.
As future medical doctors and leaders in the promotion of health, this is priority area for your
intervention. This section is an overview on the scientific background of human behaviour, an
important preriquisite to unerstanding behaviour change We will look at a broad definition of
behaviour, describe the historical background in the study of human behaviour and review
some of the important theories in human behaviour from the perspective of history.

1.2 Section Objectives

At the end of the lecture you should be able to:

1. <!--[if !supportLists]-->Define and describe behaviour<!--[endif]-->

2. <!--[if !supportLists]-->Describe the Historical background in the study of human
behaviour,
3. Discuss the different theories of human behaviour

1.3 Behaviour

In this section we hve discussed:

 behavior of living things

 behavior of human beings
 1.3.1 Behaviour in Living Things
 The most basic form of behaviour is that seen in unicellular organisms, in higher
animals, behavior is controlled by the endocorine system and the nervous system.
 The complexity of the behavior of an organism is related to the complexity of its
nervous system. The capacity to learn new responses to environmental triggers and
adjust reaction to these, increases with the complexity of the nervous system as shown
in figure 1.


  Figure 1: Complexity of the Nervous System
 Source: Kolb & Whishaw, An Introduction to Brain and Behavior, 2nd Ed - Chapter 1
 1.3.2 Behaviour in Human Beings
 Human behaviour can be described as common, if it is a form of behaviour found the
majority of people in the community, it can also be said to be normal if within that
community it is within accepted norms. Other words such as usual or unusual,
acceptable, or unacceptable and abnormal are all used.

 In-Text Question 1.1



 What is abnormal behaviour?

 Abnormal behaviour is of interest to health workers and in particular to mental health
workers, and broadly refers to deviations from what is considered typical. Behaviour.
This deviation can be further be specified to qualitative abnormality- deviation from
culturally accepted standards or quantitive abnormal- behaviour that deviates from the
statistical average of a population.
 It must however be clear that normality is often relative and deviation may not be an
indication of a psychological disorder. However, because human beings are social
animals there are social norms that dictate behaviour and social control is used to
regulate behaviour.

 Activity 1.1
 In groups of two or four work on the following activity:
 Describe situations where abnomarlity in the form of deviation from social norms
cannot be termed psychological abnormality i.e. requiring intervention



 Figure 2: EEG evidence of brain activity
 What we see as behaviour are products of mental processes and Human behaviour
cannot be seen in isolation to the mental processes.

 Take Note 1.1

 Psychology is defined as the study of human behaviour and mental processes.

1.4 Historical background in the study of human behaviour,

We discuss:

 The Antic To Modern Times

  Nature vs Nurture
 1.4.1 The Antic To Modern Times
 An interest in human behaviour as far back as Plato and Aristotle in ancient greek.
While this consituted some of the important philosophical questions of ancient Greece,
in the middle ages around the 16th C. the questions of human behaviour had become
the preserve of church in Europe referred to as the study of the soul. The age of
enlightment around 19th C saw the return of free thinking and the question of human
behaviour returned back to the free thinking world of the then philosphical science.
Psychology became a scientific study of mental experiences and in the early 20th C-
Modern Psychology was born as the study of observable human behaviour.
 1.4.2 Nature vs Nurture
 One question has engaged the minds of philospohers and scientists through the ages
from ancient times to modern times and that is the the question as to whether human
behaviour is a product of biology as in inheritated or acquired through lifes experiences.
This has been referred to as the Nature vs Nurture or the role of the Biology (Hereditary)
vs Environment discourse.
 Aristotle-384-322 B.C. believed in sensory experience (what we perceive with our five
senses) as the source of knowledge that make us who we are- This has been referred as
empiricism. We are born without knowledge and life‘s experiences write on our ‚blank
slate‘.
 Plato (427-437 B.C.) on the other handbelieved that Human beings enter the world with
in-born knowledge of reality- referred to as Nativism/ Nature, he went on to add that
reasoning provided access to this knowledge.
 These have been called the two major schools of thought on the question of aetiology
of human behaviour-empiriscim and nativism. In other words those who believe that
human behaviour is a result of their experiences the empiricists – and who claimedlike
John Locke 1634-1704- Human mind is a‚tabula rasa‘ at birth- knowledge is acquired
through life experience, and those who believe that it is a result of biology or genetic
endowment. And in between are all the different grades of nature vs nurture in the sense
of- both are important but which one is more imprtoant than the other. An example of
this is Immanuel Kant (1724-1804) –who saw Nature and Nurture as sources of
knowledge and knowledge as a product of inborn faculties that interpret sensory input
from environment.

1.5 Different theories of human behaviour

In this section we have discussed:

 Modern Rationalism and the Behaviourism

 Freud and Psychoanalysis
 Humanistic Theories of Behaviour
 Social Learning- Social Influences
 Cognitive Behavioral Theories
 Instincts, Basic Drives and Motives
 Psychobiological Basis of Behaviour in the “Post Modern”
 1.5.1 Modern Rationalism and the Behaviourism
 By the 19th C and the evolvement of modern science the question was not so much
whether knowledge was inheritated or acquired but the question was projected more to
personality and bheavioural traits. In favour of biology were the rationalists and in
favour of environment were now referred to as as behaviourists
 In support of the Biological influence were advances in sciences which saw:
 - The study of nerve impulses by Herman von Helmholtz (1821-1894)
 - The desription of Brain function research by Broca (1824- 1880)
 And the earth shattering controversial evolutionary theory that stated that natural
selection accounted for development of human abilities. With the survival of those with
most highly developed abilities propagated and hotly defended by Darwin-( 1809-
1882) and his cousin Sir Francis Galton.
 The environmentalist were also on the march and ‚Nurture‘ can be said to have reached
its peak in the science of Behaviourism- study of observable behaviour. No statement
can express the conviction of the behaviourist as that made by J. B. Watson (1878-
1958) in 1946: „Give me a dozen healthy infants, well formed, and my own specified
world to bring them up and I‘ll gurantee to take any one at random and train him to
become any type of specialist I might select- doctor, lawyer, artist, merchant-chief and,
yes, even beggarman and thief, regardless of his talents, penchants, tendencies,
abilities, vocations, and race of his ancestors.“ (Watson, 1936)
 In other words Watson and his colleagues were convinced that it didnt really what
genetic material you were endowed with, you could under the right environment be
trained or molded to become anybody.
 Of particular interest in this movement was the learning theories developed by Ivan
Pavlov (1849- 1936), the classical conditioning and B.F. Skinner (1904-1990) the
operant conditioning.
1.5.1 Modern Rationalism and the Behaviourism

By the 19th C and the evolvement of modern science the question was not so much whether
knowledge was inheritated or acquired but the question was projected more to personality and
bheavioural traits. In favour of biology were the rationalists and in favour of environment were
now referred to as as behaviourists

In support of the Biological influence were advances in sciences which saw:

- The study of nerve impulses by Herman von Helmholtz (1821-1894)

- The desription of Brain function research by Broca (1824- 1880)

And the earth shattering controversial evolutionary theory that stated that natural selection
accounted for development of human abilities. With the survival of those with most highly
developed abilities propagated and hotly defended by Darwin-( 1809-1882) and his cousin Sir
Francis Galton.

The environmentalist were also on the march and ‚Nurture‘ can be said to have reached its peak
in the science of Behaviourism- study of observable behaviour. No statement can express the
conviction of the behaviourist as that made by J. B. Watson (1878-1958) in 1946: „Give me a
dozen healthy infants, well formed, and my own specified world to bring them up and I‘ll
gurantee to take any one at random and train him to become any type of specialist I might
select- doctor, lawyer, artist, merchant-chief and, yes, even beggarman and thief, regardless
of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors.“ (Watson,
1936)

In other words Watson and his colleagues were convinced that it didnt really what genetic
material you were endowed with, you could under the right environment be trained or molded
to become anybody.

Of particular interest in this movement was the learning theories developed by Ivan Pavlov
(1849- 1936), the classical conditioning and B.F. Skinner (1904-1990) the operant
conditioning.

1.5.2 Freud and Psychoanalysis

Sigmund Freud (1856- 1939) has a special place in mental health as the father of the modern
psychotherapy. Having started as a neurologist he moved on to become the founder of a new
discipline- psychoananlysis, with a heavy leaning towards environment as the basis of
psyhcological disorders or abnormal human behaviour.

According to the Psychoanalytical theory:

early childhood experiences play an important role in the developement of personality, and
experiences and conflicts during the first five year form the basis of psychosexual development.
Freud theorised that abnormal behaviour as in psychological disorders developed as a result of
unresolved childhood conflicts and trauma.

He also described the 3 instances of the psyche the id the ego and the super ego and the three
structure of the psyche -concious, subconcious and unconcious. Based on this theory he went
on to develop a therapy technique that aimed at resolving childhood conflicts.

In-Text Question 1.2

List the five stages of psychosexual development according to Freud.

Freud described the five stages of psychosexual development as the oral stage, the anal stage,
the phallic stage also referred to as the oedipal stage, the latent stage and the genital stage.
Another psychoanalyst- Erik Erikson went on to describe the 8 stages of Psychosocial
development.

1.5.3 Humanistic Theories of Behaviour

Humanistic perspective- Abraham Maslow (1908-1970), theorised that human behaviour was
geared towards satisfaction of needs. He described the hierarchy of needs, starting with the
most basic to the highest as: Physical needs, Safety needs, Love needs, Aesthetic needs.

Carl Rogers (1902- 1987) on the other hand postulated that human beings have through free
will the capacity to overcome the influences of unconcious motive and environmental
experiences. Human beings have a natural tendency for self-actualisation (the attainment of
one‘s potential).
1.5.4 Social Learning- Social Influences

The social learning theory postulates that as we grow and develop in our lives, we also
develop social attitudes which strongly influence our behavior. Children internalize the
values of their parents attitudes of the society and cultural expectations about how to behave-
socialisation.

As we grow away from childhood into adolescence and beyond, there is a tendency to adapt
behavior in order to fit in with a particular group and peer influence and pressure form an
important aspect of social influences .

1.5.5 Cognitive Behavioral Theories

In the Cognitive Perspective (Gardner 1985), the brain has an active role in organising
perceptions, in processing information, and in interpreting experiences.

Jean Piaget (1896-1980) described the cognitive development as an important basis of

behaviour.

The prevailing congitive theories postulate that thoughts shape emotions and behaviour and
that unwanted behaviour can be changed by changing the way we interpret our experiences
forming the basis of Cognitive behavioural therapy.

1.5.6 Instincts, Basic Drives and Motives

Earlier attempts to explain human behaviour on the basis of instincts as in other animals was
replaced by the drives theory and motivation. A Drive is described as a force originating from
a natural need, like thirst or hunger. Such a situation stimulates the organism to comply with
the need. This is complented by motivation corresponding to the state of an organism- to start
or to continue an act e.g. the type of food available or seen.

1.5.7 Psychobiological Basis of Behaviour in the “Post Modern”

The 21stcentury has seen major progress in the direction nature and hereditary factors,
sometimes being referred to as the age of the return to nature/ hereditary. This has been
influenced by rapid advances in the fields of: Behavioural genetics- based on increasing
knowledge on the human genom; Polygenic behaviour of human abilities and behaviour;
Identification of genes related to specific personality types and even disorders in psychiatry is
on the move.

It is now accepted that psycho-biology- the nervous system, allows us to perceive, to interpret
and to respond to events from the environment. Hormones for example regulate human
behaviour as in quantities of food eaten, though not in choice of foods.

Closely related to behaviour are the complex psychobiological states referred to as emotions.
Emotions includes a wide range of observable behaviors, expressed feelings, and changes in
the body state, regulated to a large extent by hormones and other neurobiological chemicals .

Understanding of behaviour is undergoing modifications based on new understanding of the

brain, What Eric Kandel- (In search of memory) has been termed the emergence of a new
science of the mind. This has been facilitated be the emergence of modern investigation
techniques like the Functional Magnetic Resonance Imaging (fMRI) and the Positron
Emission Tomography (PET).

Take Note 1.2

 <!--[if !supportLists]--><!--[endif]-->Functional magnetic resonance imaging (fMRI)

is a neuro-imaging that procedure that measures brain activity by detecting associated
changes in blood flow.
 Positron emission tomography (PET) is an imaging technique that produces a three-
dimensional image of brain activity.

1.6 Summary

We have now come to the end of this lecture. Interest in human behaviour goes back to the
Antic. The nature vs nurture discourse that has characterised historical discussions from time
immemorial has tried to argue either for biological factors/hereditary factors or the
environmental/socialisation factors to explain human behaviour.

Human behaviour is complex and cannot be explained on the basis of any single theory. Both
hereditary factors and environmental factors play an important role and it is not a question of
either or. Recent advances in sceince however, continue to shed more light on the process of
the brain making possible to have a closer knowledge of the biological factors.

1.7 Suggestions for further readings

 1.7 Suggestions for further readings

1. <!--[if !supportLists]--><!--[endif]-->Introduction to Psychology: Clifford Thomas

Morgan, Richard Austin King, et.al
2. <!--[if !supportLists]--><!--[endif]-->Atkinson & Hilgard's Introduction to
Psychology: Susan Nolen-Hoeksema, et.al
3. <!--[if !supportLists]-->Psychology: Lester M. Sdorow
4. <!--[if !supportLists]-->Human Adjustment J.A. Simons; S. Kalichman; J.W.
Santrock
5. <!--[if !supportLists]-->Social Psychology David G. Myers
6. Social Psychology Robert A. Baron & Donn Byrne

1.8 Review Questions

Review Questions
Abnormal human behaviour can be described using all the following except

Qualitative deviation from cultural norms

Quantitative deviations from society norms
Behaviour characterized by socio-occupation dysfunction
Behaviour based on different political opinion as the mainstream
eBehaviour characterized by personal distress

The historical discourse on Nature vs Nurture refers to:

The argument for or against science

The argument for hereditary factors vs environment to explain human behaviour
The argument for religion vs science
The argument for modern Tradition medicine vs modern medicine
The argument for ethnocentrism vs universalism

< !--[if !supportLists]--><!--[endif]-->Broca (1824-1880), the man who discovered the Broca
area in the brain was, with reference to the above discourse, a

Psychoanalyst
environmentalist
 a behavioralist
existentialist
rationalist

Sigmund Freud (1856-1939) theorised that abnormal behaviour and psychological disorders
developed as a result of unresolved childhood conflicts and founded a field of
psychology/psychotherapy referred to as

Humanism
Behaviouralism
Psychoanalysis
Existentialism
Rationalism

SECTION TWO: THEORIES OF BEHAVIOUR CHANGE

Welcome to this second section in this module on the theories of behavioral change and
behavioral models. In the first section you looked at the basis of human behavior, including
some of the historical background that has formed the basis of our understanding of behavioral
changes. Behaviour change is an important vehicle in the prevention of ill health and promotion
of wellbeing by health workers. As future medical doctors and leaders in the promotion of
health, this is a priority area for you. You will need to understand behaviour change in order
for you to be efficent in the promotion of health. In this section we will look at 4 of the theories-
Classical and operant conditioning; Social cognitive theory; Theory of self efficacy and the
Reasoned action theory and two models that have evolved through the history of psychosocial
sciences to explain behaviour change and to promote changes in behaviour that would improve
the wellbeing of humans and their capacity to adapt to a rapidly changing envirnoment.

2.2 Section Objectives

At the end of the lecture you should be able to:

1. <!--[if !supportLists]-->Describe behavioral change theories

2. <!--[if !supportLists]-->Discuss observed health related behavior from the
perspectives models of behavior change <!--[endif]-->
3. Describe relevant areas of Application of behavioural change models
2.3 Behavioral change theories

Behavioural change theories and models are attempts to explain the reasons behind
alterations in individuals' behavioural patterns.

Behavioural theories cite environmental, personal, and behavioural characteristics as the

major factors in determining behaviour and behaviour change.

There are several theories and models on behaviour change, Each theory or model focuses on
different factors in attempting to explain behavioural change. There are, however a lot of
common elements among the different theories and they all fall under a broad category of
learning and social cognitive theories

Examples of behaviour change theories that are of particular relevance to health include:

a. Classical and Operant conditioning

b. Social cognitive learning Theory

c. Theory of self-efficacy

d. Reasoned action theory

Some of these have already been covered more extensively in the module on theories of
personality development so will be covered only briefly here.

2.3.1 Classical and Operant Conditioning

These learning theories presume that complex behavior is learned gradually through the
modification of simpler behavior. Secondly that Individuals learn by imitating behavior they
observe in others and rewards (reinforcement) ensure the repetition of desirable behavior.
When we think learning theories two behavioural scientists come to mind- Ivan Pavlov and
B.F. Skinner.

Pavlov described what he called classical conditioning based on a series of experiements with
dogs. He was able to show that although dogs do not normally respond to a bell as stimulus to
salivate, they can be trained to do so by coupling the bell with natural salivation-causing
stimulus - food (in this case a bone).

Pavlovs classical conditioning (Figure 3) has been used as a component of learning in

different setting both in humans and animals over the decades.
Figure 3: A diagrammatical representation of Pavlov's experiment

Source: http://www.getting-in.com/guide/gcse-psychology-learning-introduction-to-studies-
and-terminology/

Operant conditioning - B F. Skinner (1904-1990) went further to describe how the

consequences of behaviour can be used to strengthen newly introduced or existing behaviour
or abolish unwanted behaviour in a series of experiements involving rats. He called this new
type of learning operant conditioning and the consequences of behaviour that influence
behaviour, reinforcement either positive or negative as shown in figure 4, where a rat is
rewarded when it push

es
a panel with food pellets. But may also be punished with electric shock.
Figure 4: A diagrammatical representation of Skinner's experiment on operant conditioning

Source: http://www.simplypsychology.org/operant-conditioning.html

Skinner showed that new behaviour could be enhanced through rewards- positive
reinforcement and unwanted behaviour though punishment- negative reinforcement. The
theory of Operant conditioning has had a major impact on education, child rearing, therapy
for disorders and correction.

Activity 2.1

In groups of two or four work on the following activities:

Describe behaviours that are learned through operant conditioning in a given socio-cultural
content.

2.3.2 Social Cognitive Theory

Bandura (1986) described the basic reciprocal interactions between environmental,

personaland behavioural elements as key determinants of behavioural change- depicted in
figure 5.
Figure 5: Basic reciprocal interactions as key determinants for behavioural change

Bandura went on to describe a more complex reciprocal interaction between thoughts,

behaviour, individual's characteristics and social environment.

Based on this theory there are three distinct components of interactions:

- An individual's thoughts affect their behaviour and an individual's characteristics elicit

certain responses from the social environment.

- Likewise, an individual's environment affects the development of personal characteristics as

well as the person's behaviour,

- Lastly an individual's behaviour may change their environment as well as the way the
individual thinks or feels.

These interactions have been further depicted in figure 6.

Figure 6: Complex reciprocal interactions as determinants for behavior change

Activity 2.2

Student Activities- in groups of upto 4 students-

1. Describe situations (as real as possible) in the Kenyan socio-cultural context in which:
2. <!--[if !supportLists]-->An individual’s thoughts affect their behaviour<!--[endif]-->
3. <!--[if !supportLists]-->An individual’s characteristics (personality traits) elicit
certain responses from the social environment. <!--[endif]-->
4. An individual’s characteristics (ethnic-lingual or racial) elicit certain responses from
the social environment
5. An individual’s environment affects the development of personal characteristics as
well as the person’s behaviour
6. An individual’s behaviour may change their environment as well as the way the
individual thinks or feels.An individual’s behaviour may change the way the
individual thinks or feels.

< !--[if !supportLists]--><!--[endif]-->

< !--[endif]-->

One of the key concepts inherent in the Social cognitive theory is the Self-efficacy where Self-
efficacy refers to one’s confidence in the ability to take action and persist in action.
This person is not likely to engage in healthy lifestyle by engaging in the 25 km marathon.

Self-efficacy determines other important elements of behaviour change like:

1. the choice of activities in which people engage

2. how much energy they will expend on such activities and
3. the degree of persistence they demonstrate in the face of failure and/or adversity

2.1.3 Theory of reasoned Action-(Ajzen 1985)

This theory has its basis in the humanistic theory of behaviour and starts off by making an
assumption that humans are rational and individuals consider the consequences of a
behaviour before performing the particular behaviour. As a result, intentionis an important
factor in determining behaviour and behavioural change.

Secondly that intentions develop from an individual's perception of a behaviour as positive or

negativetogether with the individual's impression of the way their society perceivesthe same
behaviour.

 Thus, personal attitude and social pressure shape intention, which is essential to
performance of a behaviour and consequently behavioural change
 2.4 Models of Behavior change
 Models of change borrow from one or more theories of change to develop a
model/structure that can predict likely behaviour in specific situations.
 2.4.1 Transtheoretic/Stages of Change Model
 The transtheoretic Model by Prochaska and DiClemente (1986)of change also called
the stages of change model is a model that has often been used to predict the changes
that one is expected to go through in recovery from an addiction.
 Behavioural change under this model is a described as a five-step process between
which Individuals may oscillate up and down before achieving complete change. In
addiction medicine there is the time during which the individual doesn't acknowledge
they have a problem, or is in denial, referred to as precontemplationstage. In the
Contemplation stage- develops a desire to change, in Preparation- shows intention
to change the behaviour, in Action stage- begins to exhibit new behaviour
consistently and in the Maintenance stage- exhibits the new behaviour consistently
for over six months.
 The Stages: are precontemplation, contemplation, preparation, action, and
maintenance.
 Figure 7: Stages of change spiral
 Source: The Behaviour Change spiral ("What do they want us to do now?") AFAO
1996
 It is however important to note that behaviour change can only take place in the
context of an enabling or supportive environment. The relevant features of such a
 context include social, cultural, ethical and spiritual, legal and political features and
resources










 

 Figure 8: Stages of change and environmental features
 Source: The Behaviour Change spiral ("What do they want us to do now?") AFAO
1996
 In this model behavioural change occurs in a cyclical process that involves both
progress and periodic relapse. In successful behavioural change, while relapses to
earlier stages may occur, individuals never remain within the earlier stage to which
they have regressed, but rather, spiral upwards, until eventually they reach a state
where most of their time is spent in the maintenance stage.

2.4.1 Transtheoretic/Stages of Change Model

Activity 2.3
Students activities- In agroup of upto 4 students- look at each of the features below and try to
describe how each of the features can apply to the recovery of an alcohol dependent student
going through the stages of change recovery
 o Social features
o Cultural features
o Ethical and spiritual features
o Legal features
o Political features
o Resources

2.4.2 The Health Belief Model

The Health Belief Model (HBM) attempts to explain health-behaviour in terms of individual
decision-making based on attitudes and beliefs of the individual. It proposes that the
likelihood of a person adopting a given health-related behaviour is a function of that
individual's perception of a threat to their personal health, and their belief that the
recommended behaviour will reduce this threat. Thus, a person would be more likely to adopt
a given behaviour if non-adoption of that behaviour is perceived as a health threat and
adoption is seen as reducing that threat.

The Key variables of HBM include

a. Perceived Threat: Consists of two parts- Perceived Susceptibility: One's subjective

perception of the risk of contracting a health condition and Perceived Severity:
Feelings concerning the seriousness of contracting an illness or of leaving it untreated.

While a youth may perceive getting rained on as a risk factor in catching a cold, the
seriousness of the illness may not be considered severe enough to keep him from playing
football in the rain.

b. Perceived Benefits: The believed effectiveness of strategies designed to reduce the

threat of illness.
c. Perceived Barriers: The potential negative consequences that may result from taking
particular health actions, including physical, psychological, and financial demands.
d. Cues to Action: Events, either bodily (e.g., physical symptoms of a health condition)
or environmental (e.g., media publicity)
e. Self efficacy: an individual's perceived ability to successfully carry out a "health"
strategy, such as using a condom consistently.

Activity 2.4

One of the most discussed form of behaviour change for prevention of HIV infection is the
use of the male codom.

In groups of upto 4 students- Discuss this from the perspective of the HBM

Taking into account

o Perceived Threat:
o Perceived Benefits:
 o Perceived Barriers:
o Cues to Action:
o Self efficacy:

2.5 Applications of behavioral change theories and models

While behaviour change models have been applied in many situations, three areas have
dominated:

a. Health
b. Education
c. Criminology

1. Health

Promoting healthy lifestyle development- in explaining health-related behaviours providing

insight into methods that would encourage individuals to develop and maintain healthy
lifestyles.

Specific health applications of behavioural change theories include the development of

programs promoting active lifestyles and programs reducing the spread of diseases like
HIV/AIDS.

2. Education

Behavioural change theories can be used as guides in developing effective teaching methods.

Since the goal of much education is behavioural change, the understanding of behaviour
afforded by behavioural change theories provides insight into the formulation of effective
teaching methods that tap into the mechanisms of behavioural change.

In an era when education programs strive to reach large audiences with varying
socioeconomic statuses, the designers of such programs increasingly strive to understand the
reasons behind behavioural change in order to understand universal characteristics that may
be crucial to program design.

3. Criminology and correction

Theories of behavioural change suggest possible explanations to criminal behaviour and

methods of correcting deviant behaviour. Since deviant behaviour correction entails
behavioural change, understanding of behavioural change can facilitate the adoption of
effective correctional methods in policy-making.

Take Note 2.1

 No single theory can explain complex human behaviour

  Most Health projects are based on more than one theory of behaviour change

2.6 Summary

We have now come to the end of this lecture. Behavioural change is an important component
of preventing ill health and promoting good health and wellbeing. Theories of behaviour are
psychosocial theories that help us not only to understand behaviour but also to understand
why people engage in certain behaviour, undertake a form of behaviour change, or even
sustain it. Theories of behaviour change help health workers to formulate and designs
programs to promote and maintain a positive change in the individual as well as the
community.

We hope you enjoyed the lecture. Before proceeding to the next lecture attempt the as self-
assessment test in section 1.8 to gauge how well you have understood the lecture.

2.7 Suggestions for further readings

2.7 Suggestions for further readings

1. <!--[if !supportLists]-->Introduction to Psychology: Clifford Thomas Morgan,

Richard Austin King, et.al<!--[endif]-->
2. <!--[if !supportLists]-->Atkinson & Hilgard's Introduction to Psychology: Susan
Nolen-Hoeksema, et.al
3. <!--[if !supportLists]-->Psychology: Lester M. Sdorow<!--[endif]-->
4. <!--[if !supportLists]-->4Human Adjustment J.A. Simons; S. Kalichman; J.W.
Santrock <!--[endif]-->
5. <!--[if !supportLists]-->Social Psychology David G. Myers <!--[endif]-->
6. Social Psychology Robert A. Baron & Donn Byrne

2.8 Review Questions

Pick the best answer

Which one of the following is true of classical conditioning in Pavlov’s experiment

Salivation to a bone only in the dog is a conditioned stimuli

A Bell is a an unconditioned reflex
A bell is an unconditioned stimuli
A bone is a conditioned reflex
A bone is a conditioned stimuli
Canning in schools is an education practice that is associated with

Classical conditioning
Health belief model
psychodynamic psychology
Permissive parenting
Operant conditioning

Which of the following is not associated with self-efficacy

Creativity
Persistence in an action
one’s confidence in the ability
Choice of activities
Amount of energy expended in an activity

Which one of these theories refers to the ancient Greek theory of Body types

Sheldon,s theory
Theory of Physiognomy
Kretchmer’ s theory
Somatotype theory
The Humoral theory

SECTION THREE: CONSTITUTIONAL FACTORS AND HUMAN BEHAVIOUR

Welcome to this third section in the module on bio-psychological basis of behavior.

Constitutional factors refer to the components of the individual make-up which includes
bodily build, sex and temperament. We will be taking time to reflect on whether the way you
look and your bodily constitution determine your personality and we will look at several
related theories some of which have been discredited but continue to have some influence in
the way behaviour is interpreted both in professional circles and and in every day life. We
will be looking at the antic humoral theory, the later theories of body and behaviour and the
more dicursive sociocultural theories of behaviour.

Objectives
At the end of the lecture you should be able to:

1. Describe the humoural theory of behavior

2. Discuss the theories of body and human behaviour
3. Discuss Body culture and media

Take note
Personality- refers to your unique, relatively consistent pattern of thinking, feeling, and
behaving

3.3 The humoural theory of behavior

The biological basis of personality and behaviour has been of interest since ancient times.
The Ancient Greeks- Hippocrates (460-377) B.C. And Galen (130-200 A.D.) hypothesized
that temperament, a person‘s predominant emotional state, reflects the relative level of body
fluids (called humours). The greeks described 4 type s of personalities based on the then
known body fluids

1. Blood- with cheerful, pleasure-seeking and sociable or sanguine temperament

2. Phlegm- with calm relaxed and quiet with phlegmatic temperament
3. Black bile- with a depressed, introverted and thoughtful, or melancholic
temperament
4. Yellow bile- with irritable, ambitious and leader-like choleric temperament

Modern research has not found a humoral basis for personality but recognises the four
personality types, and you will come across these descriptions of personality types repeatedly
both in literature and every day life, though less professionally.

In-Text Questions 3.1

Match each emoticon to one of the four personality types described above:
<!--[if !vml]--><!--[endif]-->

3.4 The theories of body and human behaviour

These include:

 Phrenology and Pysiognomy

 Physique Body build and personality: Kretchmer Body Types
 Sheldon’s Constitutional Theory of Personality
 3.4.1 Phrenology and Pysiognomy
 In the 18th century the study of phrenology and physiognomy gained dominance. New
psychological specilisation was born, with the so called Phrenologists claiming that a
study of the contours of the skull could indicate the personality of a person. The bumps
on the skull determined the relative sizes of certain brain areas related to particular
personality charactersitcs-like-assertiveness, continuity, firmness etc.
 The study of physiognomy on the other hand claimed that personality was revealed in
the features of the face (i.e. size of nose or ears, shape of chin). After enjoying a period
of popularity phrenology gave way to the study of physique as a basis for personality
 However, some of the phrases have been retained in everyday language in description
of character.

 Activity 3.1


 In groups of two or four work on the following activity:

 Discuss the credibility of phrenology and physiognomy. You can palpate each other’s
scalp and try to prove this theory. However this will only be possible if you dont have
much hair on the head.
 
 A phrenology chart


3.4.2 Physique Body build and personality: Kretchmer Body Types

Ernst Kretchmer a German Psychiatrist (1888-1964), described four constitutional types:

a. The Pyknic
b. The Asthenic
c. The Athletic
d. The Displastic

1. The Pyknic- was described as a robust, well rounded figure with a tendency towards
shortness and stoutness. The trunk and body cavities are large, chest and shoulder are
rounded. The neck and limbs are short and stocky. The face is full and shield shaped

People with pyknic bodies were described as being talkative, uninhibited individuals who
enjoy social contacts. The pyknic individuals approach to problems was said to tend towards
practicality and realisism. They were people who were likely to express their emotions freely
and warmly but at times tended to become unduly elated or depressed.

Kretchmer found a third of manic - depressive patients to have a pyknic build.

2. The Asthenics - These were described as individuals with flat delicate physiques, they are
slender individuals with long, lean limbs and flat narrow chest with an elongated and the
facial features are sharp, they were also described as being frail and rather weak. People with
this body type tended to be shy, sensitive people who avoided social contacts and spent much
of their time day - dreaming.

3. The Athletics- build as the name suggests was said to be characterized by good muscular
and skeletal development including broad shoulders, large hands and long sturdy limbs.

4. The Displastics- were described as having mal-proportioned and atypical physique, with
features of abnormalities associated with endocrine dysfunction.

Kretchmer based his theory on the measurements of the physiques of 100 of mentally ill
people. He associated physique not only with personality types but with psychopathology. He
however concluded that a person's physique has nothing to do with whether he becomes
psychotic or not. But the physique merely influences the type of mental illness he would
develop if he should become psychotic. This theory has not been found to be valid in modern
day psychiatry.

3.4.3 Sheldon’s Constitutional Theory of Personality

William Sheldon (American psychologist 1898-1977) working with thousands of

photographs of young men described 3 types of physiques which he called somatotypes

a. Endomorphy
b. Mesomorphy
c. Ectomorphy

After administering personality tests on his subjects he found that each somatoform was
associated to a particular temperament. Sheldon went on to describe 3 personality types
related to the body types as: Viscerotonia, cerebrotonia and somatotonia.

Reflection

In-Text Questions 3.3

Match each of the body types to a personality type.

In-Text Questions 3.3

Match each of the body types to a personality type.

1. Endomorph body type was described as - soft rounded, associated with relaxed, sociable,
easy going temperament he called viscerotonia. These types of personalities are
characterized by love of comfort and an interest in social gathering and food.

They express their feelings easily and are outgoing individuals.

2. Ectomorphs were described as thin frail physique- characterised by a shy restrained and
introspective temperament he called cerebrotonia. These personality types were found to be
very similar to the schizoid personality. Have inhibited feelings and favour solitude.

3. Mesomorphs were described as Muscular with strong physique- bold assertive and
energetic temperament he called somatotonia. These types are active, energetic and are self
assertive, aggressive and somewhat noisy. They are concerned with the affairs of the present
and are doers not thinkers.

Activity 3.2

In groups of two or four work on the following activity:

Discuss this excerpt from shakespeare and the implied physique and personality type.
Julius Caesar. Act 1 Scene 2

3.5 Body culture and media

Phrenology, Physiognomy and even Kretchmer‘s and Seldon's body type have faded more or
less from serious Psychology. Body types and the cultivation of certain body types in relation
to bheaviour and personality traits continues to be of great interest. This has become even
more prominent with the expansion of the media.

Activity 3.3

In groups of two or four work on the following activity:

Discuss the following.

1. How true is it that people of a certain body physique share some personality traits.
2. Is it true that tall people are more likely to be assertive and authoritative and small
people in leadership positions aggressive?
3. Are women with Sheldon,s endomorphic body types more likely to be more
motherly?

Use examples from historical or known personalities. You can also look at this portrayal of
body in the media

The cultivation of body type is closely related to culture. In the african traditional culture an
example can be found in the fattening of girls in west Africa to endomorph body types. While
this body type has seen a lot of favour among women in several african socieites, there is a
strong move influenced from the west and media to cultivate an ectomorph body type for
women and a mesomorph body type for men.

Activity 3.4

In groups of two or four work on the following activity:

Discuss the role of the media and the fashion industry in relation to the pictures below:

Reflection

In-Text Question 3.4

Normality, fashion or disorder?

<!--[if !vml]--> <!--[endif]-->

3.6 Summary and conclusion

We have now come to the end of this lecture:

The Ancients Greeks associated personality types with 4 body fluids referred to as humours:

 Blood- sanguine temperament

 Phlegm- phlegmatic temperament
 Black bile- melancholic temperament
 Yellow bile- choleric temperament

Kretchmer, and Sheldon maintained that there is a close relationship between physique and
temperament and between physique and psychosis- with ectomorphic component
predominating in certain types of schizophrenic patients and with the greater majority of
manic -depressive patients exhibiting a endomorphic traits

Sheldon's three body types correspond approximately with the pyknic, asthenic and athletic
types by Kretchmer,

According to sheldon and others- a persons somatotype might affect the persons sense of self
and their behaviour and the behaviour of others towards them.

While later research has not found an association between body types and mental illness

 The impact of body type and self awareness and environmental influence has been
observed.- Physically imposing people may be more self assured, assertive, more
confident and expected to lead.
 Gender and cultural expectations of different somatypes no doubt plays important
roles in this theory

3.7 Suggestions for further readings

3.7 Suggestions for further readings

1. Introduction to Psychology: Clifford Thomas Morgan, Richard Austin King, et.al

2. Atkinson & Hilgard's Introduction to Psychology: Susan Nolen-Hoeksema, et.al
3. Psychology: Lester M. Sdorow
4. Human Adjustment J.A. Simons; S. Kalichman; J.W. Santrock
5. Social Psychology David G. Myers
6. Social Psychology Robert A. Baron & Donn Byrne
7. American Psychiatric Association DSM IV Tr

3.8 Model Exam Questions

SCORM Quiz
Which one of these theories refers to the ancient Greek theory of Body types

Sheldon,s theory
Theory of Physiognomy
Kretchmer’ s theory
Somatotype theory
The Humoral theory

The sample group that Ernst Kretchmer used to develop his theory of physique Body build
and personality came from a population of

High school students

Mentally ill patients
Ford factory workers
Photographs of young men
Randomly sampled adults

Essay Questions

1. <!--[if !supportLists]-->Write a short essay discussing gender and the cultural

cultivation of body types
2. Write a short essay discussing the implications of modern cultivation of body types on
health and wellbeing

SECTION FOUR: GENETIC INFLUENCE AND BEHAVIOUR

Welcome to this fourth section in this module on bio-psychological basis of behavior. In this
section we will be looking at one of the most interesting areas of human behavior. We will be
looking at what determines some of our observable traits and whether these are
predetermined at conception. We will briefly look at hereditary factors in behaviour and the
study of behavioural genetics. We will review parentings outcomes, individual choices and
preferences in life from the perspective of genes and environment. The study of Genetics is
still-the new, to be explored, horizon.

4.2 Section Objectives

At the end of the section you should be able to:

1. <!--[if !supportLists]-->Describe the link between genes and behavior<!--[endif]-->

 2. Discuss Studies in behavioral genetics

4.3 Genes and Behaviour

Human variation in behaviourand susceptibility to mental illness, risk taking and

performance on intelligence tests, and other traits can partly be answered by behavioural
genetics. Studies seem to indicate a connection between genes and particular behaviours.
This link however does not mean there is a gene that makes some prefer football to cycling or
mathematics to languages or blue to green clothes the same way there are genes that explain
eye colour, height, skin colour.

A gene or even several genes cannot make you act in any particular way in day to day life
because behaviour is a manifestation of the play of genetics on the body's development and
physiology in response to the environment. We do inherit our genes, we do not inherit
behavior traits in any fixed sense. The effect of our inherited set of genes on our behavior is
entirely dependent upon the context of our life as it unfolds day to day.

The way genes relate to behavior is complex, indirect, and closely related to variable events
like internal environment and external environment

Figure 9: External and Internal Environment

Environment in genetic terms means all influences other than inherited factors.

The External environment encomapsses family and friends, home and workplace, and
specific experiences from everyday life.

The Internal environment comprises of factors belonging to the internal, biological world:
nutrients,hormones, viruses, bacteria, toxins, and other products that affect the body during
prenatal development and throughout life.

Behaviour is explained as the outcome of an interaction between inherited factors and

environmental factors: Gene/environment interaction is the complex exchange of
reciprocating influence that goes beyond nature vs nurture. The two act upon and with each
other. The same genotype (underlying genetic structure) in different environments may
lead to similar or different phenotypes (observable traits). The same environment operating
upon different genotypes may also lead to similar or different phenotypes.

It all depends upon interactions.

Take Note 4.1

Heritability is the proportion of phenotypic variation in a population that is due to genetic
variation.

Behavior is also shaped by gene/environment correlation. A gene/environment correlation

occurs when individuals endowed with certain hereditary traits live in environments that
support expression of the trait.

In-Text Questions 4.1

<!--[if !vml]--> <!--[endif]-->

Can gene-environment correlation be used to explain the picture above- discuss

4.4 Studies in behavioural genetics

For centuries behavioural scientists have tried to understand human behaviour in terms of
biological and hereditary factors-postulating that some aspects of complex human behaviour
in inherited first and foremost as a species but also from the closer ancestral lineage.

An interesting way to reflect on the role of behaviour and genetics is to look at our closest
„cousins" (if you believe in evolution that is):
 Figure 10: Similarities in Man and Chimpanzee

The similarities in man and chimpanzee is depicted in this figure

Activity 4.1

Discuss this in groups of 4 to 5.

What makes us different?

I hope you have had an interesting discussion and in case you have never heard of her, this is
a good time to also look at the work of Jane Goodall. Studies across species seem to indicate
that:

< !--[if !supportLists]--> Human beings are characterised by 99% genetic similarity<!--[endif]--
>

< !--[if !supportLists]--> Surprisingly Humans and chimpanzees share 98% genetic similarity<!-
-[endif]-->

Behavioural genetists are interested in the less than 1% of the human genome that varies.
Behavioural genetists look at behaviour from the perspective of hereditary factors, by
studying similarities in behaviour among people who share genetic material by virtue of
being biologically related to each other. Most of what is currently known about the role of
genes and behaviour is based on such studies.

4.4.1 Sibling Differences in Behaviour

Biological siblings are half alike genetically, on average, and twins are fully alike genetically
and yet still turn out differently in many ways. Children growing up together may have a
shared or non shared environment. The shared environment e.g parents socioeconomic status
may make them similar while the non shared environment-illnesses, friends, teachers etc.
may make them different.

The importance of environment is emphasised strongly in some organisms in which internal

environmental factors influence biological developement as in our very very distant relative
(if you believe in evolution that is) the bee.

Take Note 4.2

 An interesting but simplistic example of the impact of the environment on genetic

endowment can be seen in the social insects like the honey bee

 In any honeybee colony, there is only one queen. She is much larger than than the
worker and her function is to lay the eggs. The worker bee has clearly other functions.

All grow from the same eggs gentically fed on different diets.

4.4.2 Family studies in behavioural genetics

Behavioural genetics study specific traits and try to determine the roles of both the
environment and the genes.

In a family study there is the key subject- the proband who posses of the trait to be studied

The trait is sought in:

  First degree relatives- parents, siblings, and children
 Second-degree relatives- aunts, uncles, grandchildren, grandparents, and nephews or
nieces.

Figure 11: Sign of Twins in a Car

Some of the most important contributions in our understanding of behavioural genetics have
come from twin studies.

Twin studies can be done on identical/ monozygotic twins (MZ), fraternal /dizygotic twins
(DZ), twins reared apart or together. Twin studies rely on the fact that MZ twins have
essentially the same set of genes while DZ twins have, a half-identical set. A basic
assumption in these studies is that reared together MZ twins and DZ twins get the same share
of environmental influences- equal environmental opportunities. What makes identical twins
more alike compared to fraternal twins is their greater genetic similarity.

Concordance rates: If Data from many twin pairs are collected and the rates of similarity for
MZ and DZ pairs compared- for discrete traits (traits that are either present or absent, such as
a disease) we say that concordance rates are - the proportion of the twin pairs that both have
the trait under study.

Co-relation coefficient: If Data from many twin pairs are collected and the rates of similarity
for MZ and DZ pairs compared continous traits ( traits that are documented as a range like,
height, weight, intelligence etc), we do statisitcal calculations for co-relation coeffcient.

Genetic influence is indicated when the concordance rate or correlation coefficient for
identical twins exceeds that for fraternal twins.

Shared environmental influences are indicated when the similarity for both types of twins are
quite close and Non-shared environmental influences are indicated when identical twins are
dissimilar for a trait.

To further illustrate this I have taken an imaginary study on Polydactyl (a discrete trait)
depicted in Figure 12 and answer the In-text question 4.2
Figure 12: Polydactyl

4.4.2 Family studies in behavioural genetics

In-Text Question 4.2

Calculate the concordance rate for Polydactyl (Extra digits ED) in the following imaginary
study

Astudy sample of 100 MZ twins and 100 DZ twins

Findings-

 <!--[if !supportLists]--> In 80 pairs of MZ twins both have ED while in 20 pairs only

one has ED. <!--[endif]-->
 30 pairs of DZ twins both have ED while in 70 pairs only one twin has ED

< !--[if !supportLists]--><!--[endif]-->

1. <!--[if !supportLists]-->What is the concordance rate in MZ twins for trait ED- ??<!--
[endif]-->
2. <!--[if !supportLists]-->What is the concordance rate in DZ twins for trait ED -?<!--
[endif]-->
3. What does this tell us about the Genetic influence for trait ED?

4.4.3 Adoption Studies

Adoption creates an environment in which children are raised in families other than their
biological families. This give behavioural sceintists an opportunity to assess genetic vs
environemental influence. Adoption studies looks at biologically related people who have
been reared apart. In twin adoption studies, MZ twins separated at birth for adoption are
compared. It is assumed that the different environments shape them differently so that
similarities in traits can be attributed, at least in part, to genetic effects.

In child/parent adoption studies children adopted at birth are compared to both their
biological and adoptive parents. Evidence for partial genetic influence on a trait is indicated
when adoptees are more similar for the trait to their biological parents than to their adoptive
parents. Evidence for some environmental influence is found when the adoptee is more like
his or her adoptive parents than the biological parents.

Adopted children are also compared to other biological offsprings of adoptee parents,
similarity found is pressumed to be indicative of shared environment, while dissimilarity
would suggest genetic effects or non shared environement.

4.5 Summary

Behaviour is explained as the outcome of an interaction between inherited factors and

environmental factors. Studies seem to indicate a connection between genes and particular
behaviours.

Behaviour is a manifestation of the play of genetics on the body's development and

physiology in response to the environment.

The way genes relate to behavior is complex, indirect, and closely related to variable events
like internal environment and external environment

Behavioural genetics study specific traits and try to determine the roles of both the
environment and the genes. Family studies are apopular method used. In a family study the
key subject who posses of the trait to be studied is the proband while the first degree relatives
are parents, siblings, and children; and the second-degree relatives are aunts, uncles,
grandchildren, grandparents, and nepwhile hews or nieces.

Some of the most important contributions in our understanding of behavioural genetics have
come from twin studies

Conclusion: We do inherit our genes, we do not inherit behavior traits in any fixed sense.

4.6 Suggestions for further readings

Activity

1. Behavioral Genetics: An introduction to how genes and environments interact through

development to shape differences in mood, personality, and intelligence: Cat h e r i n
eBaker
2. Companion to psychiatric studies third edition- R. E: kendell and A. K. Zealey
3. DSM IV-TR
4. The personality Puzzle: David C. Funder. Published by W.W. Norton & company Inc.
New York. 5th edition. 2010
4.7 Review Questions

Choose the best answer

Environmental influence on Behaviour normally refers to influence from one of the
following:

Genetic endowment
Climatic conditions
Physiognomy
Life events
Hereditary factors

Which of the following statements is not true of behavioural genetics?

A proband is the person who has the traits you want to study
A first degree relative is the mother, the father and siblings
Monozygotic twins share the same genome
Study of dizygotic twins reared together is a good source of shared environment
Study of monozygotic twins reared apart is a good source of shared environment

SECTION FIVE: GENETIC INFLUENCE ON INTELLIGENCE AND PSYCHOLOGICAL

DISORDERS

Welcome to this fifth section in the module on bio-psychological basis of behaviour. In this
section we will be looking at some of the controversial areas in the study of genetics and
behaviour including the influence of genetics on intelligence and some of the psychological
disorders that are also categorized under psychiatric disorders. We will look at disorders
related to single gene defects as well as polygenic the aetiology of psychiatric disorders. We
will try to explain whether genetics can explain why some people score higher on IQ tests,
why some families seem to be predisposed to alcohol dependence syndrome and why some
psychiatric disorders run in families. Behavioural genetics is of particular interest in
psychiatry in as far as it contributes to an understanding of abnormal behaviour. The role of
Behavioral genetics in mental disease, personality, intelligence remain controversial.

5.2 Section Objectives

At the end of the section you should be able to:

1. Discuss intelligence and behavioral genetics

2. Defects in the human genome and behavior

5.3 Intelligence and behavioural genetics

Intelligence is a complex general capacity of the Brain- the ability to reason, to think
abstractly, to draw conclusions, to solve problems, to learn from experience, and to remember
what has been learned. It also has to do with how the mind makes use of sensory information
and how it takes cues from emotions (our own and others'). Intelligence very clearly
correlates with successes in school and work settings.

Intelligence theorists claim an underlying ability to learn that feeds into all cognitive
performance- general cognitive Ability (g).

A theory of multiple intelligences proposed (Howard Gardner in 1983) holds that humans
have eight forms of intelligence:

 Linguistic,
 Logical-Mathematical,
 Spatial,
 Kinesthetic,
 Musical,
 Intrapersonal,
 Interpersonal
 Naturalist

Take Note 5.1

 A great many quantitative studies have shown that IQ correlation increases as genetic
similarity increases.
 Quantitative studies also provide evidence of environmental influences on intelligence

Most quantitative studies of intelligence measuring modern Western populations have

produced heritability estimates ranging broadly around 0.50- suggesting that genetics and
environment are roughly equivalent in their influence on the variation in IQ.

This means that highly intelligent people have multiple superior genes for general cognitive
abilities. They may also have experienced favorable nutritional and nurturing conditions and
may have been raised in an intellectually stimulating environment.

5.4 Defects in the human genome and

One alteration in a gene is sufficient to produce some medical disorders, however the vast
majority of mental disorders are believed to be polygenic- arising out of multiple gene. And
multifactorial implying that environmental factors (internal or external) are involved.

The more recent method of research is studying the human genome for defects or
particularities in relation to specific traits. The discovery of epigenetic tags has made
important contributiions to the understanding of how internal environmental factors influence
genetics in the new science of Epigenetics.Differences in MZ twins with a shared
environment can now partly be explained through epigenetics.

Take Note 5.2

 The environment impacts on genetics through epigenetic process

 Epigenetic tags are chemical mechanisms that can express (suppress or activate)
genes to different degrees

5.4.1 Simple single gene defects

As mentioned above, even alteration in a single gene is sufficient to produce some medical
disorders. Such genes are relatively easy to find, compared to the genes that contribute to
complex disorders or behaviour. Listed here is a group of Single gene defect disorders with
added implications on mental well being.

1. Cystic fibrosis- Chromosome 7

2. Huntington's disease- Chromosome 4
3. PKU- phenylalanine hydroxylase Chromosome 12
4. Fragile X syndrome is an X- linked disorder that expressed in Boys with Autisim and
learning disability

Take Note 5.3

1. Cystic fibrosis is an autosomal recessive affecting lungs pancreas, intestine abnormal

mucous production and fibrosis and scarring
2. Hutington's disease- progressive degeneration of nerve cells in the brain resulting in
impairment of movement, cognitive abilities and psychiatric symptoms.
3. PKU- phenylalanine hydroxylase is an autosomal recessive metabolic disorder-
affecting the enzyme Phenlyallanine hydroxylase- learning disability and seizures

In-Text Question 5.2

 What is an autosomal recessive disorder?

 What is an autosomal dominant disorder?
5.4.2 Polygenic gene involvement and Psychiatric disorders

The vast majority of mental disorders are believed to be polygenic- multiple gene
involvement. Most mental disorders are also multifactorial- multiple environmental and
genetic factors are operating in an intricate fashion to distabilise the stable development and
functioning of cells of the CNS. A polygenic disorder results only when all of the pertinent
genetic and environmental factors are in place, and the extent of disorder depends on when
those factors occur and how they affect each other.

Examples of a polygenic disorders, related to impaired neurotransmitter production and

functions are schizophrenia and bipolar mood disorders

The 1st degree relatives of schizophrenia have 10 times greater risk of schizophrenia as the
general population.

In-Text Question 5.3

 X and Y are monozygotic twins. X is diagnosed with schizophrenia at the age of 16

years what are the chances that Y will also develop Schizophrenia?
 X and Y have a younger sister Z, what are the chances that she will develop
schizophrenia
 Who has the highest risk of getting schizophrenia Y or Z?

The concordance rate of schizophrenia are higher in MZ as in DZ twins.

The relative influence of environment to genetic influence is not clear- but indicated by the
the existence of substantial discordance in MZ twins (less than 50% concordance).

Important environmental factors thought to be intrauterine and perinatal infections

particularly viral infections.

Take Note 5.3

The genes implicated in the aetiology of schizophenia are not yet known studies are ongoing
and there are indications that these will be identified with the ongoing mapping of the human
genome making this statement invalid.

In Alcohol dependence syndrome it is estimated that 40-60% of the variance of risk of

alcohol dependence is explained by genetic influences. The risk of alochol dependence is 3 to
4 times higher in first degree relatives of alcohol depandants.

Impulsive disorders and novelty seeking is abehavioural feature found in several

psychiatric disorders like- Attention Deficit Hyperactive Disorder (ADHD), intermittent
explosive disorder (the loss of control over impulses toward aggression), kleptomania (the
impulse to steal unneeded objects), pyromania (the impulse to set objects on fire), and
antisocial personality disorder.

Associated to novelty seekers-people who thrive on new experiences and heightened

sensations, like skydiving, mountain climbing, travel to exotic locations etc. by genetic
behavioral researchers.

It is presummed that the similar groups of genes working through neurotransmitter pathways
are responsible for impulsive disorders and novelty seeking.

The expression of the genes into socially acceptable or unaccepatable behaviour depending
on environmental factors and context such as living in deprived urban neighbourhoods and
might be a deciding factor in future outcome- motor cross or pyromania.

Take Note 5.5

 In the past, research in behavioral genetics has been used to support- hateful
prejudices and violations of human rights as in eugenics.
 Eugenics is the movement/philosophy of improving the human population by
advocating the promotion of breeding the "desired traits" or out-breeding "undesired
traits".

5.5 Summary

Genes have an influence on human behaviour and of particular interest is genetic

involvement in intelligence and psychiatric disorders. However, based on your genes, no one
can say what kind of human being you will turn out to be or what you will do in life. Your
genetic endowment can be positively supplemented by internal and external environmental
factors. Human beings still have room to make choices.

„Genes cannot cause anybody to do anything, anymore than you can live in the blue print of
your house."Funder D. C. 2010. pg 335.

5.6 Suggestions for further readings

5.6 Suggestions for further readings

1. Behavioral Genetics: An introduction to how genes and environments interact through

development to shape differences in mood, personality, and intelligence: Cat h e r i n
eBaker
2. Companion to psychiatric studies third edition- R. E: kendell and A. K. Zealey
3. DSM IV-TR
4. The personality Puzzle: David C. Funder. Published by W.W. Norton & company Inc.
New York. 5th edition. 2010
5.7 Review Questions

Choose the best answer

The following are true about the aetiology of schizophrenia except

Schizophrenia is a polygenic disorders related to impaired neurotransmitter production

and functions
The 1st degree relatives of schizophrenia have 10 times greater risk of schizophrenia as
the general population
The concordance rate of schizophrenia is higher in MZ as in DZ twins
The concordance rate of schizophrenia is higher in DZ as in MZ twins
Intrauterine and perinatal viral infections are thought to be important environmental
factors

Which of the following is true of psychiatric disorders in childhood and adolescence?

The prevalence of psychological disorders is higher in girls as compared to boys

There is a higher prevalence of learning disabilities in girls
There is an excess of boys among children with emotional disorders
Girls are more likely to display truancy as compared to boys

SECTION SIX: SEX AND GENDER DIFFERENCES IN ABNORMAL BEHAVIOUR

Welcome to this sixth section in this unit on bio-psychological basis of behavior. In this section
we will be looking at the influence of gender on behaviour. As a preliminary to this we will
first define abnormal behaviour and then look at gender in relation to psychological disorders
and gender differences in common psychiatric disorders in adults and children.

6.2 Section Objectives

At the end of the section you should be able to:

1. Discuss Sex gender and behaviour

2. Describe Gender differences in Psychiatric disorders
6.3 Sex gender and behavior

In-Text Questions 6.1

What is gender?

While sex is a biological diagnosis Gender is defined as a social construction, that assigns
individuals roles and characteristics that are based on the presumed biological sex.
Consequently it also refers to an individual's self-conception as being male or female, as
distinguished from actual biological sex.

In-Text Question 6.2

Why do we say presumed sex?

Think about cases you may have read about where the biological sex of an individual was not
clear or was wrong

Figure 13: Different Colours Depending on Gender

In many parts of the world babies are dressed in different colours depending on gender as
depicted in figure 13.

Activity 6.1

In groups of two or four work on the following activity:

Look at the picture below and discuss the signficance of pink and blue colours

There are gender differences in normal behaviour, these include behaviour like mate
selection as in what women look for in a mate and what do men look for in a mate. Other
difference include, mating strategies as in commitment, variation in number of partners,
desire for monogamy. There are also gender differences in career choice

Activity 6.2

In groups of two or four work on the following activity:

Discuss the possible reasons for observed gender differences in:

 Mate selection
 Mating strategies
 Career choice
 Conflict resolution

Our focus here however is on abnormal behaviour. Behaviour can be said to be those
actions that are overt and directly observable- social interactions, speech, motor activity,
however private experiences and processes are often included in the psychological study of
behaviour.

Abnormal behaviour refers to deviations from what is considered typical behaviour and this
can be either:

 Qualitative abnormality- deviation from culturally accepted standards

 Quantitive abnormal- behaviour that deviates from the statistical average

Abnormal behaviour however is not always an indicator of psychological disorder,

people who achieve rare accomplishments may be abnormal (not typical) but not
psychological disordered. Even qualitatively abnormal behaviour- depends on context- if you
observe the aggresive Handwashing of a surgeon vs the hand washing in compulsive disorder
you arrive at different interpretation: Good surgeon vs obssessive compulsive disorder.

When psychological abnormality is determined by atypical behaviour alone then we have

abuse of psychiatry as has been observed in the past where Non conformists and political
dissidents who refuse to accept the status quo are are incacereted in Psychiatric hopsitals as
psychologically disordered-colonial policy or the communist policy in former USSR and
China.

Take Note 6.1

 It is not bad to be different

Evolution of species depends on individual differences- „For a species to remain viable it

must include diversity.“ Nettle 2006

In psychological disorders, Abnormality is only one of the 3 basic elements that comprises
psychological disorders. Abnormality here refers to -Pattern of moods, thoughts,
perception and behaviour. The other two criteria are- maladaptiveness and personal
distress.

Maldapativeness is behaviour that seriously disrupts your social occupational functioning.

Personal distress is a subjective feeling of anxiety, depression or other unpleasant
emotions.

The combination of abnormality, maladptiveness and personal distress to determine

psychological abnormality varies with different disorders.

6.4 Gender differences in Psychiatric disorders

Gender differences in several psychiatric disorders have been recorded. However, before we
discuss these, a quick look at the different psychiatric disorders is important see table 1.

Table 1: Major Psychiatric disorders: DSM IV Tr

 Anxiety disorders
 Somatoform disorders
 Disorders usually first diagnosed in  Factitious disorders
infancy, childhood, and adolescence  Dissociative disorders
 Delirium, dementia, and amnestic and  Sexual and gender identity disorders
other cognitive disorders  Eating disorders
 Mental disorders due to general  Sleep disorders
medical conditions  Impulse control disorders
 Substance-related disorders  Personality disorders
 Schizophrenia and other psychotic  Other conditions that may be a focus of
disorders clinical attention
 Mood disorders

The biopsychosocial model is an important key to understanding gender differences in

abnormal behaviour:

o Bio- Biological differences particularly hormonal

 o Psycho- Differences in psychological development
o Social-Gender differences due to environmental influences

While gender differences in psychiatric disorders are still under study, addressed here are 11
disorders in which gender differences in prevalence have been reported.

1. Disorders in children and Adolescence

Boys are often more disturbed than girls at a ration of 2:1 or even 2.5:1

Boys tend to display aggresive behaviour while girls tend to more emotionaldisorders.

There is a higher prevalence of developmental disorders (Mental retardation, learning

disabilities etc) in boys.

There is an excess of boys among children with conduct disorders that cannot be accounted
for solely by the higher frequency of developmental disorders in boys.

Take Note 6.2

Conduct disorders are disorders characterized by aggression to people and animals,

destruction of property, deceitfulness or theft, and serious violation of rule.

Apart from biological factors, male socialisation to aggression has been implicated in the
aetiology, Similarly Girls may tend to model the care givers who are predominantly women
whereas male role models are often remote at this age.

Figure 14: Aggression

Activity 6.3

In groups of two or four work on the following activity:

Discuss critically the role of socialisation in the aetiology of agression among boys in
different Kenyan communities.
1. Substance related disorders

Substance abuse is commoner in males than females

Misuse and dependence on sedatives and tranquilisers has been found to be commoner in
middle aged women

There has been an increase in prevalence of alcohol abuse in women as women enter and
work more in the male environment out of the family circles

Alcohol dependency in women develops faster and on lower quantities of alcohol

2. Anxiety disorders

Have been shown to be slightly more commoner in women than men this is particularly so
for Generalised Anxiety Disorders and phobias

3. Somatoform disorders

Among common somatoform disorders are: Somatization characterized by multiple physical

complaints and found more commonly in women and Conversion disorder, previously
referred to as "hysteria" which is 2-10 times more common in women than men

4. Affective disorders

The prevalence of depression is twice as high in women as in men-independent of cultur and

ethnie while The M:F ratio in Bipolar disorders (also referred to as Manic Depressive
Psychosis) is 1:1.

The rate of suicide in depressive illness which has been est. At 10- 15% is higher in males
than females. The rate of para-suicide on the other hand(attempted suicide) is higher in
females. Males tend to use more violent methods of suicide than females.

5. Schizophrenia

Schizophrenia which is one of the most devasatating psychiatric disorders affects about 1%
of general population globally in the the male:female ration of 1:1.

6. Eating disorders

Anorexia- and bulimia nervosa occur almost predominantly in young white women and
rarely in males.

7. Sleep disorders

Are Commoner in women and elderly going by the increased use of sedatives in women.

8. Sexual disorders
Gender difference in sexual disorders are related to the different anatomical and
physiological functions of bilogical males and females and are therefore predominantly
gender specific disorders.

While men complain predominantly of erectile failure and premature ejaculation women
complain more of arousal and orgasmic problems.

9. Impulse disorders Impulse control disorder.

Refer to is a group of psychiatric disorders characterized by impulsivity - failure to resist a

temptation, urge or impulse that may harm oneself or others.

a. Intermittent explosive disorder, characterized by recurrent, significant outbursts of

aggression is commoner in men than women
b. Kleptomania characterized by repetitive, uncontrollable stealing of items not needed
for personal use has been found to be commoner in women.
c. Pyromania characterized by repetitive purposeful fire setting and fascination with
fire, and pathological gambling repetitive by persistent and recurrent maladaptive
patterns of gambling behavior has been found to be commoner in men

10. Personality disorders

Gender differences in Personlity disorders are closely related to the specific types of
disorders.

Antisocial personality (previously referred to as Psychopathy) is commoner in men.

6.5 Summary

We have now come to the end of this lecture. While sex is determined by biology XX or XY,
Gender is a social construction that assigns individuals roles and characteristics and
consequently evolves into an individual's self-conception as being male or female. There are
gender differences in normal behaviour and abnormal behaviour. In abnormal behaviour we
refer here to abnormal patterns of moods, thoughts, perception and behaviour in addition to
maladaptiveness and personal distress, as opposed to socio-cultural deviations from the norm.

The biopsychosocial model looks at the aetiology of disorders from a biological, psychological
perspective and is an important key to understanding gender differences in abnormal
behaviour.

There are gender differences in psychiatric disorders in childhood, adolescence and

adulthood. Your biological sex XX or XY may have implications on your behaviour, this
however is not always based on biology but is also strongly influenced by the process of
gender specific socialisation.

6.5 Summary
We have now come to the end of this lecture. While sex is determined by biology XX or XY,
Gender is a social construction that assigns individuals roles and characteristics and
consequently evolves into an individual's self-conception as being male or female. There are
gender differences in normal behaviour and abnormal behaviour. In abnormal behaviour we
refer here to abnormal patterns of moods, thoughts, perception and behaviour in addition to
maladaptiveness and personal distress, as opposed to socio-cultural deviations from the norm.

The biopsychosocial model looks at the aetiology of disorders from a biological, psychological
perspective and is an important key to understanding gender differences in abnormal
behaviour.

There are gender differences in psychiatric disorders in childhood, adolescence and

adulthood. Your biological sex XX or XY may have implications on your behaviour, this
however is not always based on biology but is also strongly influenced by the process of
gender specific socialisation.

6.6 Suggestions for further readings

Activity

1. <!--[if !supportLists]--> Introduction to Psychology: Clifford Thomas Morgan,

Richard Austin King, et.al<!--[endif]-->
2. <!--[if !supportLists]-->Atkinson & Hilgard's Introduction to Psychology: Susan
Nolen-Hoeksema, et.al<!--[endif]-->
3. <!--[if !supportLists]-->Psychology: Lester M. Sdorow<!--[endif]-->
4. <!--[if !supportLists]-->Human Adjustment J.A. Simons; S. Kalichman; J.W.
Santrock <!--[endif]-->
5. <!--[if !supportLists]-->American Psychiatric Association DSM IV Tr <!--[endif]-->
6. <!--[if !supportLists]-->Social Psychology Robert A. Baron & Donn Byrne <!--
[endif]-->
7. <!--[if !supportLists]-->Understanding Human Sexuality Hyde DeLamater <!--
[endif]-->
8. <!--[if !supportLists]-->Human Sexuality: diversity in contemporary America B.
Strong; C. Devault; B. Sayad; W. Yerber <!--[endif]-->

6.7 Review Questions

Answer all questions

Which of the following is true of psychiatric disorders in childhood and adolescence?
 The prevalence of psychological disorders is higher in girls as compared to boys
There is a higher prevalence of learning disabilities in girls
There is an excess of boys among children with emotional disorders
Girls are more likely to display truancy as compared to boys

The following are factors that contribute significantly to gender differences in Psychiatric
disorders except

Differences in Socio-economic status

Differences in Physiognomy
Differences in psychological development
Biological differences particularly hormonal

Which of the following statements is true about gender variation in behaviour?

Boys are often more disturbed than girls at a ration of 5:1

Boys tend to display more withdrawn behaviour in early childhood as compared to
adolescence girls
Girls tend to display more emotional disorders than boys
Mental retardation and learning disabilities are commoner in girls in early childhood
Aggressive behaviour in girls is rare

SECTION SEVEN: SOCIAL ATTITUDES AND BEHAVIOUR

Welcome to this seventh section in this unit on bio-psychological basis of behavior. In this
section we will be looking at the interactions between attitudes and behavior. Attitudes and
behaviour are an important aspect of health care, particularly primary health care, where
Health Professionals try to change peoples behaviour- from unhealthy to healthy.

Assessing for (Knowledge, Attitude and Practice (KAP) or Knowledge, Attitude and
Behaviour (KAB) is an important excercise in public health and primary health care as it
generates baseline data in communities where there is a desire to initiate change. In this
section we will define the terms attitude and behavior. We will then address external factors
and how they influence personal attitudes, address the predictability of behavior based on
attitude, look at passive and active behavior, the influence of behavior on attitude and
conclude with the sociological theories of action on behavior.

7.2 Section Objectives

At the end of the section you should be able to:

1. Define Attitude and behavior

2. Describe passive and active attitude
3. Describe the sociological theories of behaviour to attitude

7.3 Attitude and Behavior

Attitude is defined as a predisposition to classify objects and events and to react to them
with some degree of evaluative consistency. Attitudes can also be said to be Beliefs and
feelings about others or about events and the inclination to act.

In-Text Question 7.1

When we perceive a scenario our brains quickly work out what/who/why/when/how etc.

< !--[if !supportLists]-->o With reference to the picture above note down your first
impression using the what/who/why/when/how questions?<!--[endif]-->

Now go back to your noted impressions and indicate what information you used to arrive at
your conclusions

Attitudes influence how we perceive and interpret events.

7.3.1 The influence of attitude on behavior

Attitudes inhabit the realms of our thoughts- in other words they are inferred either from
behavior or verbal communication. Ideally one would assume that attitudes particularly
verbally expressed are a predictor of behaviour. The highly advanced human brain is
however capable of many forms of deception even self-deception. Public Health workers
have realized that asking women what they feed their babies, they may receive answers
unrelated to what the women feed their babies depending on what the women have learned
from other health workers. Attitudes do not always determine behaviour and what we are
inside (our beliefs and feelings) may not always be related to who we are outside (what we do
or our public behaviour).

Activity 7.1

Do and a small survey in your class- sample size 20 to 50 using the following questions:
 1. Do you think it is wrong to cheat in an exam ?
2. Have you ever cheated in an exam ?
3. If you haven’t read for a exam would you accept a friend’s offer to sit next to him/her
and copy their answers ?

Evaluate your survey and answer the question:

Is a student‘s attitude towards cheating a good predictor of likelyhood to cheat in exams?

If you haven‘t prepared for an exam there is a high likelyhood you will fail. So What! If you
fail an important exam you might have to repeat a class. The consequences of this would be;
anger from parents, cost, separation from friends- these can be called external factors. And
then there are the internal factors- loss of face and shame. So even if you believe that
cheating in exams is wrong- this is weighed against the external and internal infleunces. If on
the other hand you decide to cheat- you risk getting caught and the consequences and if you
are lucky and dont get caught there might still be the uncomfortable feelings of guilt (internal
influence).

When all this is added and subtracted- Our expressed attitude may not always predict
behaviour because both our attitudes and our behaviour are subject to other internaland
external influences.

Whatever we say, whatever we do in public is being observed and interpreted according to

social rules of behaviour and the expectations of others

 We sometimes say what we think others want to hear

 We sometimes do what others expect us to do

A good reason for the secret ballot.

7.3.2 Predictability of behaviour from attitude

From the above it would seem like attitude is a not always a good predictor for behaviour.
This is particularly true if observation is over a short period of time. The effects of attitude on
behaviour becomes more reliable when one considers behaviour over a long period of time
Minimising on external influences will increase prediction of behaviour from attitude- that is
why the secret ballot is one of the most commonly used methods of voting globally and an
anonymous questionnaire more likely to produce desired results.
Attitude predicts behaviour when the attitude is more pertinent to behaviour- eg. A belief that
running is a good way to increase fittness has better predictability for jogging as opposed to
general concept of ‚healthy living‘ and eating plenty of fruits and vegetable better than eating
health food for an overweight person.
Attitude predicts behaviour when it is potent- present in the concious- ‚thought out‘.
However not all behaviour is thought out- Some behaviour is based on scripts- common daily
behaviour-If you are closing the road you don‘t have to think- „look left look right then look
left again“ like you learned in Kindergarten. In reponse to questions such as- how are you?,-
fine; how was school?-Ok Behaviour and verbal reponses that are repeated often becomes
automatized. In the abscence of a script behaviour is less automatic has to be thought out.
 Activity 7.2

In groups of two or four work on the following activity:

List some of the behaviour/ verbal responses that are based on scripts

Figure 15: Mercy of a Mob

Figure 15 depicts a man at the mercy of a mob, a not uncommon sight in Kenya.

Take Note 7.1

Self conciousness and self awareness is being in tune with your attitudes- people with little
self awareness are more likely to be influenced by mobs
“To thine own self be true““- Shakespeare”

Behaviour that is not thought out is driven by unconscious attitudes as in following a mob.
Our planet is characterised by diversity in life forms. Racial and ethnic diversity is a rich
characteristic of humans but also a cause of major conflicts- "us vs them"
Ethnic prejudice is one of the areas strongly governed by unconciously held attitudes.
Unconcious attitudes can also influence spontaneuos behaviour- walking thru‘ a dark alley.

7.3.3 Passive or active attitudes

Attitudes acquired through experience are more potent and more predictive of behaviour-
people who have been directly involved in a crisis are more likely to sign pettitions to change
things as opposed to those who know about the crisis theoretically. A student in Nairobi who
closes a busy road every day to get to college is more likely to sign a petition on the
construction of a flyover as compared to a student at Narok University.

Take Note 7.2

Behavior related to unconscious attitudes may have/have had a survival function in the social
evolution

While attitudes influence behaviour, taking into account internal and external influences, how
does behaviour influence attitude. This is particularly pertinent in consideration of
unconcious attitudes. The power of self persuasion is one of the explanations advanced to
explain how people explain behaviour based on unconcious attitudes by inventing a reason
for our behaviour which sounds reasonable.

In another scenarion acting into a role can be seen as behaviour that infleunces attitude, e.g.
the career you choose will affect not only what you do on the job but also your attitudes -
internalised roles

A third scenario is the power of the word or verbal affirmations to a cause- We believe what
we say and the more we say it the more we believe it- ‚Saying is believing‘

7.4 Passive and Active Attitudes

In-Text Question 7.2

We stand up for what we believe in but do we also believe in what we stand up for?

While attitudes influence behaviour, taking into account internal and external influences, how
does behaviour influence attitude. This is particularly pertinent in consideration of unconcious
attitudes. The power of self persuasion is one of the explanations advanced to explain how
people explain behaviour based on unconcious attitudes by inventing a reason for our
behaviour which sounds reasonable.

In another scenarion acting into a role can be seen as behaviour that infleunces attitude, e.g.
the career you choose will affect not only what you do on the job but also your attitudes –
internalised roles

A third scenario is the power of the word or verbal affirmations to a cause- We believe what
we say and the more we say it the more we believe it- ‚Saying is believing‘

7.4.1 A foot in the door phenomenon

There is a story of a camel on a cold night in the desert that asked his master if he could not
put just his nose into the tent for a bit of warmth------. The foot in the door phenomenon or
should we call it the nose in the door phnomenon is a strategy that influences behaviour by
introducing it step by step.

Small changes make way for bigger changes- immunising in small doses. When people
commit themselves voluntarily to social action they tend to believe in what they are doing.

This phenomenon is used actively to get people involved:

1. Time and participation

2. Sales and marketing
3. Petitions and fundraising
4. Dating

7.4.2 Influence of Immoral behaviour, acts of aggression and attitude

People tend not only to hurt those they believe are bad but alo to believe and say they hate
people they hurt, to justify acts of agression.

Nazi regime atrocities- were often explained by the perpetrators as being because they hated
jews even when they had never had prior contact. The more one commits attrocities the easier
it gets. Giving a drerogatory name to your victim makes it easier to commit attrocities to
them. The victims are seen as having traits that justify the action taken against them.

Take Note 7.3

Evil acts are not only a reflection of the self they shape the self.

The reverse can be said of moral acts- Moral action when chosen affects moral thinking.
Doing something good out of choice, having thought about, it has a longer lasting impact on
the way you behave than being threatened to do a good thing.

Activity 7.3

In groups of two or four work on the following activity:

 Discuss the ongoing debate on female genital cutting and critically discuss the
following question:

Should Kenya wait for attitudes to change- through public education or is it justified to force
behaviour through legislation that criminalises Female genital Cutting/mulitation to protect
children

Actions feed attitudes- even positive behaviour towards someone fosters liking for that person.
That Actions feed attitude can also be observed in social political movements- one step to
getting a person to support your team is to cloth them in the team colours. Political socialisation
and building patriotism is promoted through actions like raising flag, singing a national anthem,
party symbols.

Repeated verbal affirmations are a strong weapon in changing attitudes and consequently
behaviour- psychic equilibrium is achieved by believing what you are saying.

Take Note 7.4

Believing what you are made to say repeatedly is also called Brain washing or thought
control- as described in the literary classic „Brave New World“
"Alpha children wear grey. They work much harder than we do, because they are frightfully
clever. I’m really awfully glad I’m a beta, because I don’t work so hard. And then we are
much better than the Gammas and Deltas. Gammas are stupid. They are wear green and Delta
children wear Khaki. Oh no, I don’t want to play with Delta children and Epsilons are still
worse. They are too stupid to be able to read or write. Besides, they wear Black, which is
such a beastly colour. I am so glad I’m a Beta.”- Aldous Huxley. Brave New World (1931)

7.5 Action to Attitude theories

Social psychologists explain the effect of actions on attitude using 3 main theories:

1. Self presentation theories- assumes that we express attitudes that make us appear
consistent
2. Cognitive disonance theory assumes that to reduce discomfort we justify our
actions to ourselves
3. Self perception theory assumes that our actions are self revealing- we look at our
actions/ behaviour and explain our feelings and beliefs on this basis the same way we
do for other people

7.7 Summary

Social psychologists explain the effect of actions on attitude using 3 main theories:

1. Self presentation theories- assumes that we express attitudes that make us appear
consistent
2. Cognitive disonance theory assumes that to reduce discomfort we justify our
actions to ourselves
3. 3Self perception theory assumes that our actions are self revealing- we look at our
actions/ behaviour and explain our feelings and beliefs on this basis the same way we
do for other people

7.8 Suggestions for further readings

 7.7 Suggestions for further readings

1. David G. Myers- Social psychology- 4th edition, McGraw- Hill Inc 1983
2. Lester M. Sdorow- Psychology- 2nd edition, Brown and Benchmark 1993
3. Social Psychology Robert A. Baron & Donn Byrne

7.9 Review Questions

Anwer all questions

Assessment of knowledge attitudes and practice

Refers to anthropological studies in traditional communities

Is an academic exercise that has little relevance in practice
Has no relevance in modern health practices
Is can be good indicator of how communities are reacting to health messages
Can only have relevance in literate communities

Attitudes

Can never be used to predict behaviour

Are internalized before the age 2years
Can easily be measured through school performance
Influence how people perceive and interpret events
Are a good indicator of success in life

Predictability of behaviour from attitude

Can be increased by minimizing on external influences

Can be increased by increasing internal influences
Can be enhanced through a cross sectional survey
Corresponds to religious beliefs
Cannot be improved

Self presentation theories.

Assume that people justify their behaviour to reduce internal discomfort.

Assume that we express attitudes that make us appear consistent
 Assume that we look at our behaviour from outside ourselves
Assume that people justify their actions to continue doing them
Assume that people are strictly speaking not responsible for their actions

SECTION EIGHT: LIFE EVENTS AND ABNORMAL BEHAVIOUR

Welcome to this eighth section in this module on bio-psychological basis of behaviour. In

this section we will be looking at the impact of life events on behaviour and particularly
stress and other psychological disorders that are characterized by behavioural change. We
will start of by defining life events and outlining some of the common major life events. We
will then describe events in relation to life span starting with the early years and ending with
late adulthood. We will then look at bereavement an event that can occur through all the
cycles and end our journey with major traumatic life events.

8.2 Section Objectives

At the end of the lecture you should be able to:
Define life events
Describe major life events across the lifespan
Discuss losses across the lifespan
Discuss major traumatic life events

8.3 Life events

The life span of human beings is characterised by milestones also referred to as life events.
These are events that have a major impact on the individual. Life events are external
environmental influences that have an impact on Human beings and which may be
experienced as negative (divorce) or positive (marriage). Life events can function as stressors
and when many life events occur in a short period of time, the level of stress can rise to
impact on both Physical and mental health. Poorly adjusted individuals are more likely to
succumb to mental disorders after a major life event.

Activity 8.1
In a small group of four or five- spend five minutes each to outline some major life events in
your life.

Various definitions have been used to describe life events:

1. Events that cause physiological stress reactions.
2. Events that task the individuals coping resources triggering a stress response.
Stress may range from mild deviation from the norm like mild disturbance- like sleep
disturbance to major disturbance like psychosis or may provoke the onset of a psychiatric
disorder, or the relapse or deterioration of a previously diagnosed disorder. On the other
hand, psychiatric illness can also cause life events for example a schizophrenic breakdown
may lead to the loss of a job triggering a major life event. However individuals do not react to
similar events in the same way because aattitudes influence how we perceive and interpret
events.

In-Text Question 8.1

Describe two events in your life that caused you stress and compare them with the list of
events in 1.4.

Below is a list of some major life events as experienced by people worldwide? Reactions to
these and others may vary from one individual to another and from one community to the
other and may not follow the same sequence or priority:

a. Entry into school

b. Birth of a sibling

c. Exams

d. Moving house or migration

e. Adolescent crisis

f. Initiation*(in traditional societies)

g. Adolescent pregnancy

h. Divorce, separation or death of parent(s) or siblings and other significant relatives

i. Marriage

j. Birth of a child

k. Loss of job

l. Change of job

m. homelessness

n. Separation, Divorce, or loss of spouse

o. A significant change in health (self or spouse)

p. retirement

In-Text Question 8.2

Does your community practice a right of passage?
If yes what is the significance of this ritual?
If not give an example of such a ritual that you know about.
8.4 Major life events across the lifespan

These include:

 Early life events

 Life Events in adolescence and early adulthood
 Life events in Middle and late adulthood
 8.4.1 Early life events
 Early life events revolve around separation and loss and include separation from
mother/mothering person for reasons like - illness and admission to hospital of either
child or mother. The birth of a sibling may be perceived as loss of previous position
as mother‘s baby and expressed as sibling rivarly. The beginning of school may be
perceived both as separation from mothering person and familiar surrounding.
Moving house or migration is similarly experienced as loss of familiar environment
and friends.
The impact of early life events on child depends on the level of development and prior
attachment with poorly attached children having more problems with separation.
Symptoms may range from regression, depressive symptoms, withdrawal, aggression,
conduct disorders in older children and school refusal

 Activity 8.3
 What is attachment and why do you think poorly attached children have more
problems with separation? You may need to read the theories of attachment to answer
this question.


8.4.2 Life Events in adolescence and early adulthood

The Normal stressful changes of adolescence make adolescents particularly vulnerable to

negative life events. Stressful events include- school change and entry into boarding schools,
separation/abandonment,bereavement, rejection by contemporaries and failure at school,
loss of physical health that impair the adolescent from active participation in activities.

While all adolescents undergo biological or physical changes like the onset of menarche,
development of secondary sexual characteristics and rapid physical changes, not all are
prepared for these changes and some may be viewed negatively particularly if the occur
earlier or later relative to the peer group. One of the most important events in the life of an
adolescent is the initiation of sex. This may be complicated by unpreparedness, ignorance,
coercion, orientation confusion and socio-cultural and religious factors with associated guilt
and shame. Sexual initiation may also result in premature pregnancy and abortion, which
in our country may be unsafe with serious to severe medical implications.

Reactions to life events during adolescence include: depression, anxiety,

avoidancedisorders, obsessive - compulsive disorders and phobias, school refusal and
truancy. Conduct disorders are common in boys and manifest as delinquency (crimes of
violence, serious vandalism and criminality linked to drug abuse, truancy and vagrancy).
Substance use and abuse is a common reaction to stress in adolescence, but may also result
in major life events- like severe punishment, expulsion from school or home etc.

Eating disorders are more common in girls. Anorexia nervosa is still relatively rare in our
communities but a common disorder of young white females. Others in include bulimia
nervosa, adiposita (obesity) not so uncommon in modern Kenya. Sleep disorders are also
common.

The prevalence of suicide and attempted suicide also increases in adolescence. In school
systems where exams start early like in KCPE- the level of stress may become unbearable
leading to psychiatric symptoms- depression, somatisation, psychosomatic disorders, anxiety
disorders like- panic attacks, generalised anxiety disorders, conversion disorders.

Poor performance in exams may even lead to attempted suicide and suicide.

Events in early adulthoodrevolve around intimate relationships, leaving home, job marriage
and childbirth and not necessarily in that order. Among these childbirth is probably one of the
most significant for women so that most women are able to say that life is never the same
again.

While the birth of a child is often a joyous event for women, Pregnancy and childbirth can
however be associated with biological changes and psychosocial stressors that predispose to
psychiatric disorders.

Women who are unable cope with childbirth for various reasons may suffer maternal blues,
post-natal depression and post-partum psychosis.

Common Stress factors in child birth include:

 Lack of social support

 Young motherhood
 Unplanned pregnancy
 Single motherhood etc.
 Physiological changes
 Marital disharmony

Women with a genetic predisposition to Mental illness are more likely to succumb. As in:
Family history of depression or other mental illness.

While ideally marriage is a positive event, poorly adjusted people may have problems dealing
with the changed circumstances or even just the stress of organising a wedding.

Changes in employment life can also be a stressful event. These may range from new job,
loss or change of jobs, promotion and demotion and while these events may be negative or
positive as in promotion- some people may not be able to cope with the changes involved or
demands.

Stressors include:

 Adjusting to a new job, and new working colleagues

  Climbing up the ladder may come with new challenges, conflicts and group dynamics

Demotion is frustrating and demoralizing and may come with reduced income.

The loss of a job may happen as early as early adulthood but experienced more severely in
middle adulthood.

Reactions to major life events include: Depression, anxiety disorders, somatic disorders and
substance abuse, conduct disorders in children and relapses or worsening of previously
diagnosed mental disorders.

8.4.3 Life events in Middle and late adulthood

In-Text Question 8.4

From what age is middle adulthood?

Describe some of the characteristics of middle adulthood

Menopause and Midlife crisis constitue major changes in midlle adulthood. Menopause is
closely related to other major life events creating the midlife crisis. Events related to midlife
crisis include - loss of gainful employment through retirement, loss of own parents, loss of
children to the world (empty nest syndrome), diminishing physical health and physical
attractiveness.

Life change events have been found to be more important for the development of
psychological symptoms than the biological changes of menopause.

In-Text Question 8.5

What are the characteristics of menopause?

Although men don't have a clear cut biological change as in menopause, a change referred to
as andropause and a psychosocial crisis ‘midlife crisis' has been described in men.

Middle adulthood progresses to late adulthood and retirement which may be experienced as a
negative event to the individual because:

a) It represents major losses in income and in social status, purpose and role

b) It is a period characterized by monotony, boredom, and decline.

Retirement may be accompanied by depression and anxiety and even suicide

Late adulthood is a time of many losses-parents, friends, and spouse. It is also the time of
increasing physical disabilities and may even culminate in the loss of mobility. It is however
the loss of a long term spouse that has been found to be most striking.
8.5 Losses across the lifespan

Some life events know no age. The loss of a loved one is probably one of the most devastating
life events across the lifespan, death of a family member or death of a loved one is very painful
and a source of heightened stress for the bereaved.

Bereavement may provoke any of the psychiatric symptoms- particularly depression and
anxiety disorders. Abnormal reaction to death may warrant a special diagnosis of
„bereavement“ or „abnormal grief reaction“.

Several factors both individual and related to the kind of death determine how death is
experienced. Some breakdown and others come through the experience after normal mourning.

The following are factors that determine reaction to death include:

 Sudden death

 Traumatic death

 Strong attachment to a particular person

 Close relationship with the bereaved

 Multiple bereavements

 8.6 Major traumatic Life events

 In addition to life events related to the normal milestones of life, traumatic life events
are major unexpected life events, defined as an event that is experienced as life-
threatening or includes a danger of injury so severe that the person is horrified, feels
helpless, and experiences a psychophysiological alarm response during and shortly
after the experience. These include- severe road traffic accidents, personal violence,
wars and other conflicts, and natural catastophies.
 The reactions may be any form of psychiatric disorder- particularly major depressive
and anxiety disorders and substance use disorder, however reaction to trauma may
warrant a special diagnosis of „Acute stress disorder" or„Post Traumatic Stress
Disorder" - syndromes characterised by pathological reactions to a specific or
multiple traumatic experiences.

 Activity 8.2

In a small group compile a list of major disasters that have affected Kenyans in
different part of the country in the last 10 years.

 8.7 Summary and conclusion
  Most Life events are specific to the stage in the life span. Loss is a major theme in
most major negative life events and although th reactions may be developmental age
specific anxiety disorders and depression and the use of substances are common
reactions across board after childhood. Major life evenst however can triger the onset
or exercerbation of any mental disorder. Bereavement can result in abnormal grief
reaction and major traumatic life events are more likely to cause Post traumatic stress
disorders.
 Conclusion: Our journey through life is characterised by mile stones, without which
we would not be able to say we have lived. They influence our behaviour and shape
who we are. Similarly we experience life events and react to them and modify their
impact on us from a specific unique position- who we are.
 8.7 Summary and conclusion
 Most Life events are specific to the stage in the life span. Loss is a major theme in
most major negative life events and although th reactions may be developmental age
specific anxiety disorders and depression and the use of substances are common
reactions across board after childhood. Major life evenst however can triger the onset
or exercerbation of any mental disorder. Bereavement can result in abnormal grief
reaction and major traumatic life events are more likely to cause Post traumatic stress
disorders.
 Conclusion: Our journey through life is characterised by mile stones, without which
we would not be able to say we have lived. They influence our behaviour and shape
who we are. Similarly we experience life events and react to them and modify their
impact on us from a specific unique position- who we are.

8.8 Suggestions for further readings

8.9 Suggestions for further readings

1. David G. Myers- Social psychology- 4th edition, McGraw- Hill Inc 1983
2. Lester M. Sdorow- Psychology- 2nd edition, Brown and Benchmark 1993
3. Social Psychology Robert A. Baron & Donn Byrne

8.9 Review Questions

Answer all questions

Assessment of knowledge attitudes and practice

Refers to anthropological studies in traditional communities

Is an academic exercise that has little relevance in practice
Has no relevance in modern health practices
Is can be good indicator of how communities are reacting to health messages
Can only have relevance in literate communities
Attitudes

Can never be used to predict behaviour

Are internalized before the age 2years
Can easily be measured through school performance
Influence how people perceive and interpret events
Are a good indicator of success in life

Predictability of behaviour from attitude

Can be increased by minimizing on external influences

Can be increased by increasing internal influences
Can be enhanced through a cross sectional survey
Corresponds to religious beliefs
Cannot be improved

Self presentation theories.

Assume that people justify their behaviour to reduce internal discomfort.

Assume that we express attitudes that make us appear consistent
Assume that we look at our behaviour from outside ourselves
Assume that people justify their actions to continue doing them
Assume that people are strictly speaking not responsible for their actions

SECTION NINE: IATROGENIC DISORDERS AND BEHAVIOUR

Welcome to this eighth and last section in this unit on bio-psychological basis of behaviour.
In this section we will be looking at abnormal behaviour that is related to the interaction
between patients and health workers. Health workers and health systems are dedicated to
promotion of health and health care, however there are instances when they cause disease,
create disabilities or cause the health of those in their care to deteroriate. We will begin by
giving a broad definition of iatrogenic disorders, we will then look at the causes of such
diosorders and give examples of common ones. We will adress misdiagnosis, creation of
dependency on psychotropic drugs, reinforcement and medicalization of deviant behaviour
and end up with institutionalization.

I hope you have enjoyed this module and have learned enough to prepare you on your
journey as a health worker who will not only have to understand and interpret the behaviour
of your patients and treat them accordingly but will also be looked up to by society to provide
answers and direction when behaviour of members deviates from the norm.
 9.2 Section Objectives
At the end of the section you should be able to:
Define iatrogenic disorders
Describe the causes of iatrogenic disorders
Discuss the Creation of dependency to psychotropic drugs
Discuss the reinforcement and medicalization of deviant behaviour
Discuss institutionalization

9.3 Iatrogenic disorders

Iatrogenic disorders are disorders caused by doctors and other health workers or health care
system and are present in all branches of medicine.Iatrogenic disorders arise as the result
of the health worker:

1. Making Incorrect or incomplete clinical assessment (physical , behavioral,

psychosocial and psychological)
2. Making Inappropriate diagnostic and treatment interventions
3. Making False attribution to the etiology of the problems
4. Failing to recognize and reinforcing dysfunctional behavior
5. Failing to promote function and effective return to work

Activity 9.1
In a small group discuss and asnwer the following questions based on your life experience.
Are there cases that you know of where health workers have been responsible for causing
disease, created disabilities or caused the health of those in their care to deteroriate?

9.4 Causes of Iatrogenic disorders

As mentioned above, iatrogenic disorders can be said to arise by errors in diagnosis and
management of patients at different levels of patient/healthworker interaction.

9.4.1 Misdiagnosis in Psychiatry

Conversion disorders are often misdiagnosed as epilepsy and patients treated for years on
antiepileptics- sudden withdrawal of which causing seizures.

Patients with endocrine conditions like Hyperthyroidism or hyperthyroidism, cardiovascualr

disorders and other organic conditions may first present with psychological symptoms,
failure to diagnose these conditions may be life threatening, additionally they may often be
treated with antipsychotics exposing them to severe side effects.

Failure to recognise the side effects of drugs and either withdraw or reduce dosage of
medication. This is particulary common with Phenothiazines and Antidepressants. A
commonly hidden sde effect is sexual dysfunction which the patients may not report.
9.4.2 Misdiagnosis in Clinical Medicine/Surgery and related

Misdiagnosis in medicine of life threatening conditions may create psychiatric conditions

particularly Anxiety disorders and Depression. Common misdiagnosis include

 Misdiagnosis with cancer, or hiv/aids etc- may lead to stress depression and even
suicide
 Patients correctly diagnosed with life threatening conditions may develop adjustment
disorders due to poor counselling skills among clinicians

9.4.3 Medicalization of psychological disorders

Many Psychological disorders present with physical symptoms, failure of a clinician to take a
comprehensive history, examination and investigations may lead to medicalization-
Invocation of a medical diagnosis to explain physical discomfort that is not caused by organic
disease and application of a medical intervention to treat it as in:

 Manchausen‘s syndrome
 Anxiety disorders
 pain disorders
 Body dysmorphic syndrome
 Conversion disorders

9.5 Creating dependency on Psychotropic drugs

Figure 16: Sample of Drugs

It is not unusual to find patients with several prescription drugs as above particulary elderly
patients.
Figure 17: MJ Singing
Source:
The legendary Michael Jackson.

Activity 9.2
In a small group discuss Critically the events leading to the death of Michael Jackson.

A common problem among both psychiatric and medical health workers is the innapropriate
use of psychotropic drugs creating a problem of substance abuse and subsequent dependency.

Some of the most commonly prescribed and over the counter drugs are sedatives/tranquilisers
(benzodiazepines, barbiturates) and pain killers (opiates)

In many cases the use of these drugs is initiated by doctors

Patients continue using the drugs because they are poorly informed about the long term
addiction potentials or because they become addicted due to prolonged prescriptions

9.6 Reinforcing and medicalization of deviant behaviour

Reinforcing deviant behaviour- Certain forms of deviant behaviour which do not require
medical intervention are reinforced through misdiagnosis or clinicians conviction that they
should be treated using medication.

Deviation from the cultural norms of a society is not necessarily a medical or psychiatric
condition. Medicalization and labelling of deviant behaviour of political dissidents as metally
ill deserving treatment has a long history propagated by political systems in collussion with
doctors in various parts of the world.

9.6.1 Hypochondriasis and Autistic Spectrum disorders

Hypochondriasis is a well recognized condition in psychiatry, a condition in which the

patient believes they suffer from a major life threatening disorder and seek help from various
doctors. Failure to make a quick diagnosis and continuous investigation of such patients
reinforces the patients belief that they are suffering from a terminal illness.
Increased tendency to medicalise deviant behaviour and providing treatment- has particularly
affected children. Children who do not fit into the school system are quickly inappropiately
diagnosed and treated for disorders ranging from ADHD to autism. This has created a global
controversy particularly with highly gifted children. Some have argued that pharmaceutical
companies have a role in this trend.

In-Text Question 9.1

What is labeling?
Can labelling of deviant behaviour as mental illness- be seen as a cause of mental illness ?

9.6.2 Labelling

Labelling of deviant behaviour- assigning the behaviour a medical or psychiatric diagnosis is

a major cause of stigma worldwide. Psychosociological theories also claim that
people/society reacts differently to labelled people this may cause the labelled individual to
behave in the manner expected of his label. Children and people of lower intelligence are
particulary prone to adapt labels.
Sexual behaviour covers a wide range of behaviour determined by both by individual and
cultural factors. When deviation from the social norms is diagnosed as mental illness-
potential for the developement of other psychological disorders like depression, anxiety and
even suicidal behaviour- example homosexuality.

9.6.3 Controversial diagnosis in Psychiatry

Some disorders are so controversial in psychiatry that diagnosis and inclusion in diagnostic
criteria has often been labelled as creating iatrogenic disorders. Among these are the
dissociative disorders particularly- Multiple personality disorder, which is more commonly
found in fictional literature than in textbooks and Borderline personality disorder.

Activity 9.3
In groups of two or four work discuss critically the follwoing questions:
What is homosexuality?
Is homosexuality a psychiatric or medical disorder?

9.6 Institutionalisation

Prolonged admission of patients into psychiatric institutions creates a dependency on care

and institutions that makes it difficult for the patient to reintegrate into society. The situation
may be excerbated by a failure promote function and effective return to work. Patients
suffering from schizophrenia are particularly prone to this problem. Institutionalisation is
usually supported by the family and the community who wish to rid themselves of the
responsibilty of the care of the patient and abandonment is common.

9.7 Summary
Iatrogenic disorders are disorders caused by doctors and other health workers or health care
system and are present in all branches of medicine. These disorders are the result of
misdiagnosis, inappropriate use of psychotropic drugs, reinforcement and labelling of deviant
behaviour and institutionalization.

9.8 Suggestions for further readings

9.8 Suggestions for further readings

1. Introduction to Psychology: Clifford Thomas Morgan, Richard Austin King, et.al

2. Psychology: Lester M. Sdorow
3. American Psychiatric Association DSM IV Tr
4. Social Psychology Robert A. Baron & Donn Byrne
5. Understanding Human Sexuality Hyde DeLamater
6. Human Sexuality: diversity in contemporary America B. Strong; C. Devault; B.
Sayad; W. Yerber

9.9 Review Questions

Answer all questions

Iatrogenic disorders are

Disorders unique to Psychiatry

Are disorders which are found in urban settings
Are caused by health professionals
Are anxiety disorders
Are caused by neglectful relatives

Iatrogenic Substance use dependency is

Is a problem commonly associated with Antidepressants

Is related to prolonged prescriptions of benzodiazepines
Is associated with self diagnosis and treatment
Is associated with minor ailments
Is related to prolonged use of paracetamol

A patient is most likely to present to a medical doctor with a conviction of a terminal illness
if he/she has
 Generalised Anxiety disorder
Major depressive disorder
Schizophrenia
Hypochondriasis
Body dysmorphic disorder

An iatrogenic disorder can arise from all the following except

Living with a spouse who is mentally ill.

Being misdiagnosed with HIV
Being admitted for a long time in a psychiatric ward
Being misdiagnosed for cancer
Being given a two month prescription for Diazepam

HCH 100: BEHAVIOURAL SCIENCES - MODULE 4 - SOCIOLOGY

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE

HCH 100: BEHAVIOURAL SCIENCES

Copyright

Copyright
Behavioural Sciences Course to Undergraduate Students in the College of Health Sciences

by Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

©2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

©University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced
in any form or by any means without permission in writing from the Publisher.

Writer: Dr. Anne Obondo

Reviewer:

Chief Editor: Joshua M Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

MODULE 4: SOCIOLOGY

Module Introduction

Welcome to this module on sociology. Sociology is the systematic study of human societies,
human behaviour, the patterns of interaction and relationships in a social context. The
teaching in sociology will help you to grasp the sociological concepts as medical students and
in your practice as doctors you will begin to realize that a psychiatric patient cannot be
treated in isolation of their environment. In addition, learning sociology will provide you with
knowledge about social institutions and their functions in society which will become
important in your clinical years when dealing with patients who may require good social
support systems to rehabilitate. Learning sociology will also make you aware of how social
relationships/interactions influence the development and behavior of the individual. In this
module you will also be equipped with knowledge on sociological theories which are
important because they provide guiding principles in social investigations and intervention
with patients. Learning sociology will also make you aware of your actions and the
happenings in your environments therefore, enabling you to influence your environments and
your own future. Learning about research methods in sociology will help you in your
sociological enquiry and generally in assessment of individuals. Further knowledge of the
cultural differences will help you in your clinical years in assessment and rehabilitation of the
patients and their families (I wish to refer you to module 6 section...which deals with the
influence of culture).

This module is divided into 4 units as follows:

Unit 1: Fundamentals of sociology

Unit 2: The components of society and their functions

Unit 3:Crime, deviance and health implications

Unit 4: Methods of social investigations.

Let's now look at the module objectives as stated below:

Module Objectives

the end of this module you should be able to:

1. Describe the fundamentals of sociology.

2. Describe the components of society and their functions
3. Explain Crime, Deviance and Health Implications
4. Describe sociological methods of investigations.

Let's now proceed to look at the various units beginning with Unit 1.

UNIT 1: FUNDAMENTALS OF SOCIOLOGY

Unit Introduction

Welcome to this unit on fundamentals of sociology. In this unit you will be introduced to
sociology, the sociological perspectives and environmental, socio-cultural and traumatic
influences on behavior. The theoretical basis and the social causes of mental illnesses will help
you understand the nature of human interaction and relationships and their influence on
behavior. You will begin to realize that environment plays an important role in human
behavior.

To achieve the objectives of this unit, it is divided into 3 sections as follows:

Section 1:Introduction to sociology

Section 2:Sociological perspectives

Section 3: Social causes of mental illness

We wish you luck in this unit.

Before we proceed to discuss each section in turn, we will look at the unit objectives as listed.

Objectives

By the end of this unit, you should be able to:

1. <!--[if !supportLists]-->Define sociology and describe sociological concepts<!--

[endif]-->
2. <!--[if !supportLists]-->Describe the sociological perspectives<!--[endif]-->
3. Describe the social cause of mental illness
We will now proceed to discuss the various sections in details.

SECTION 1: INTRODUCTION

Welcome to this section. Today in this section we are going to introduce you to sociology
which is one of the behavioral sciences course modules. Under the introduction of sociology
we shall cover the definition of sociology, the nature and scope of sociology, what
sociologists do, sociological theories, the branches of sociology and sociology in relation to
other disciplines and then we shall give a summary of the section. Enjoy the lecture.

We now look at the section objectives as listed below.

1.2 Section Objectives

By the end of this section you should be able to:

1. Define the term sociology.

2. Explain the nature and scope of sociology.
3. Explain the role of sociologists.
4. Describe the branches of sociology.
5. Describe the sociological theories.
6. Describe the relationship between sociology and other related disciplines.

1.3 Definition of sociology

Sociology has been defined by a number of sociologists and some of them are as follows:

(i). Auguste Comte coined the word sociology in 1798 when he combined the Latin word
for society (socio) and Greek word for science (logy). He defined sociology as the study of
the interaction between human institutions such as family, school, and religion and how these
institutions contribute to the development and transformation of societies which influences
behaviour.

(ii) Emile Durkheim definedsociology as the study of social facts such as the state of
economy or the influence of religion. He was interested in social integration and social
regulation which he believed prevented people from committing suicide. He believed suicide
was as a result of lack of regulatory norms (anomie) in society.

(iii) Herbert Spencer definedsociology as the study of social control, politics, religion, the
family, the individual, the communities and social stratification. Like Auguste Comte he was
interested in the social institutions within society and how these institutions influenced
behaviour.

(iv) Max Weber defined sociology as the study of social actions and social relationships. He
was interested in patterns of interaction and relationships in society.
All four founders agreed that sociology is an attempt to understand human society as one
whole by examining the relationships among its various parts.

Take Note 1.1

Sociology is therefore simply the systematic study of human societies, human institutions,
human behaviour, the patterns of interaction and relationships in a social context.

1.4 Nature and scope of sociology

Sociology is a science and every science discipline must have:

1. A distinct and recognized field of study i.e. subject matter.

2. A developed methodology i.e. techniques and procedures of scientific enquiry.
3. Relatively specialized language (concepts) to facilitate precision of communication
among its practitioners.
4. Theories and laws about the universe. When tested against this criterion sociology
qualifies as a science because it satisfies all the requirements of a science which
include a subject matter, methodologies for scientific enquiry, sociological concepts
and sociological theories.

From the works of Auguste Comte, Welser and Parsons we can identify the subject matter of
sociology to be scientific study of:

1. Social interaction, human relations, companionship

2. Institutions e.g. the family, religion, polity, economy, law, education etc.
3. Society e.g. the clan, community, tribe, nation, the world and
4. Social change and development

Sociological conclusions do not therefore depend on myths, tales or folklores, but on

carefully concluded social research which is based on observations and the recording of facts,
as they truly are and not as we may wish them to be. This makes sociology a science.

Sociology is the social science that probes deeper than any other social science into the
underlying and hidden factors in society which will otherwise be completely hidden.

Sociology is also committed to solving social problems such as poverty and anomie or
normlessness arising from industrial revolution.

Like all the social sciences which study man in society such as psychology, social
psychology and anthropology, sociology is a behavioural science which adopts a particular
approach that is peculiar to it. For instance, while other sciences go for pure evidence
(empiricism) sociological perspectives delves into hidden meaning behind what is observed.
For instance, in Africa political leaders have been accused of being corrupt, autocratic and
tribalistic, the sociological perspective will go beyond that mere observation and try to locate
these vices in their cultural and social milieu. The sociologists will strive to discover what is
behind the mask of corruption, nepotism and autocracy. For this sociology has been dubbed
"the painful elaboration of the obvious".
 Take Note 1.2
The sociological perspective therefore does not focus on the individual as isolated entity, for
example, Freudian psychologist do - taking man's behavior purely as a naked response "to
internal or external physical stimuli" Instead focuses on the individual and his environment.

1.5 The role of sociologists

Sociologists study society, social institutions and social relationships. In their study of
society, they make enquiry into the internal structures of the society e.g. the internal problems
the society faces, the components of the society i.e. the various institutions within the society,
functions of the various institutions within the society and the consequences of combining the
various institutions

The sociologists also study institutions such as the family, the church, the schools and
welfare institutions which involve studying the features all the institutions have in common,
for example, provision of services. Also study the differences between the institutions and the
different functions the institutions perform. The functions of the institutions will be covered
more in detail in the section on social institutions.

Finally, sociologists study social relationships which involve the study of relationships within
the family, for example, relationships between man and woman, parent and child, brother and
sister and grandparent and grandchild. It also involves studying relationships at the work
place. These are studied in terms of the quality of the relationships which will be covered
under relational problems (in unit 3 section 4).

1.6 Branches of sociology

There are many branches of sociology which are mentioned below. All these branches are
relevant in relation to the understanding of human behavior however; the most relevant one
here is the medical sociology but we will consider all of them as follows:

1. Medical Sociology: Medical sociology focuses on social interaction between people

e.g. the patient and the doctor. Examines the relationship between culture, values,
norms and how cultures shape our personalities. Also examines the distribution and
consumption of medical services.
2. Rural Sociology: Strives to understand rural social problems such as rural
unemployment, crime, alcoholism, landlessness, poverty, and health problems
3. Political Sociology: Studies the interaction between societal institutions and politics
(governance) i.e. the distribution of power and its uses and abuses in society and
mechanism for conflict resolution.
4. Sociology of religion: This is the study of origin of religion both from a sociological
and anthropological perspective, the functions of religion, it relationship with other
institutions (politics, economics, education etc.)
5. Law and society: Examines the social foundation of law, the interaction between
social change and changes in the law
6. Sociology of science: Looks at the social origins of scientific ideas and their impact
on social life.
 7. Sociology of philosophy: Critically examines the sociological factors that arise from
some known schools of philosophy and some given philosophical systems e.g.
religion.

Take Note
All these branches are important because they make significant contribution to sociological
inquiry thereby helping in solving sociological problems.

1.7 Sociological theories

A number of theoretical approaches have been employed in sociological enquiry. These

theories are covered more in details in section two.

1.8 Sociology and related disciplines

Sociology has link with most social sciences particularly philosophy from which it originally
branched. It has close link with psychology, anthropology and history as well as psychiatry.
Sociology is related to social sciences because most social sciences are concerned with the
study of man's social behaviour in society. In addition, the social sciences make scientific
contribution to sociological inquiry which helps in solving sociological problems.

Since social sciences have very close links with psychiatry and other sciences like physical
and biological sciences, sociology as one of the social sciences is also linked to psychiatry
and this makes it important for you to learn sociology which you will be able to link to
psychiatry.

1.9 Suggested further readings

1. The African TextBook of Clinical Psychiatry and Mental Health. EDS. Professor Ndetei
and Colleagues. AMREF. 2006.

2. Sociology. "An Introductory African Text". By Odetola T. O. and Ademola A. Macmillan

Education Ltd. 1985.

We will now proceed to the second section of this unit.

SECTION 2: SOCIOLOGICAL THEORIES

Welcome to our second section on the sociological theories. This section is tied to the
previous section which was on the introduction to sociology. It is important to understand
theories behind every subject and this section will shed light on the theories behind
sociology. In this section we are going to look at the deviant theory, theories of culture and
poverty- social exchange theory, equilibrium theory, social conflict theory,

structural-functionalism and systems theory, and evolutionary theory. All these theories are
important because they will contribute to the understanding of sociology as a subject. The
subsequent sections will also be explained or based on these sociological theories. You will
understand why sociology is an important social science in medicine and hence the reason for
learning sociology as one of the behavioral sciences.

Objectives

By the end of this section you should be able to:

1. Define a theory.
2. Describe the various types of sociological theories and appreciate theoretical basis of
sociology.

2.3 A theory

Intext Question 1.1

What is a theory?

Theory is a general statement of fact, about how the society is structured, works and changes.
According to Adetola and Ademola (1985), theory is a set of ideas useful in explaining social
phenomena and actions.

In short, theory is the basic tool by which sociology explains social phenomena and social
processes.

Having defined a theory it is now important to proceed to describe the various types of
sociological theories.

2.4 Types of sociological theories

The types of sociological theories include the deviance theory, theories of culture and
poverty, social exchange theory, equilibrium theory, social conflict theory, structural
functionalism and systems theory and evolutionary theory.

Basically, the Sociological theorists believe that environmental circumstances such as rapid
socio-cultural changes, economic changes and lack of regulatory norms in society predispose
people to moral acts such as alcohol and drug abuse and other psychological problems.

We will now proceed to discuss these theories in turn starting with the deviance theory.

2.4.1 Deviance Theory

This theory was advanced by Durkheim in 1952. Durkheim used the concept of anomie (or
normlessness) to explain deviant behavior e.g. suicide or attempted suicide. He focused on
conditions that ultimately produce breakdown in regulatory norms such as rapid social
change, economic crisis and economic prosperity which led to downward mobility and hence
an experience of deregulation and loss of moral certainty (anomie). As a result of these
conditions is normlessness which leaves the whole society and individuals without moral
guidance resulting in all sorts of problems and social ills.

Although he used deviance to explain different kinds of suicide in society, deviance is also
used to explain other types of individual and societal malfunctions such as drug abuse and
alcoholism. For example, an alcoholic is deviant when his drinking takes the form which
deviates from socially controlled traditions and customs or regulatory norms. In a society
where there are no regulatory norms, such a person would not be considered a deviant.

Take Note
This theory suggests that moral guidance is necessary for the well-being of individuals and
that the state of normlessness may result in social problems and other social ills and hence
become devastating to individuals their families and society at large

2.4.2 Theories of Culture and Poverty

This theory was advanced by Merton in 1970. The theorists believe that there exist certain
subsections of society who are subjected to lack of opportunity and subjugation by the
existing political and economic structures. People who belong to such subsections are more
likely to be unemployed, poor and condemned to life of apathy and helplessness. According
to the theorists such people commit acts including alcohol abuse which the society abhors.
These acts are committed both as deviance against society and as an escape mechanism in
response to oppression and exploitation of the less fortunate.

2.4.3 Social Exchange Theory

This theory was advanced by George Homans and Peter Blau in 1961 and 1964
respectively. This is a utilitarian which assumes that people always behave or relate to other
men in society to maximize gain.

The theorists believe that behaviour or social interaction is two -way- traffic where every
actor aims at gaining something out of it - meaning that people always behave and relate to
others to maximize gain. For example, person or people will help you hoping that they will
also receive help in return in future when in need.

Take Note
Reciprocity is the most important aspect of this theory. Goods exchanged are not always
material things but also non-material things like gestures and praise are exchanged.

2.4.4 Equilibrium Theory

This theory was advanced by Talcott Parson. The concept of homeostasis (i.e. the balance or
stable equilibrium) is important in this theory. He believes that where there is disequilibrium,
certain corrective measures have to be taken. For example, intensive work with families to
strengthen them and teach them new ways of coping is paramount. By introducing new ways
of coping the equilibrium would have been restored. When the family equilibrium is not
restored then the family becomes dysfunctional which is may be psychologically damaging to
the members of the family.

2.4.5 Social Conflict Theory

This theory was advanced by Lewis Coser (1964), Ralf Dahrondorf (1959), Cartwright
and Zanders (1968), Johan Galfung, and Fredrich Engels. The social conflict theorists
believe that conflict relations are normal and can be functional.

For example, Coser argued that conflict helps sharpen appetite for action because people
begin to think quite sharply in response to conflict or threat in order to find way out of it. It is
also believed that conflict bring people together when exposed to external threats or danger.

This theory helps us explain better group relations than structural - functionalism theory. For
example conflicts between the masses and elite groups and even among the elite themselves
is very important. Such conflicts ended up in revolutionary reconstruction of society at large
which is a positive thing.

Conflict between the oppressor and oppressed also leads in every historical epoch to bitter
struggle between the two classes eventually leading to the overthrow of the oppressors and
changes in the a) economic base (emergence of new relations of production), b) promulgation
of new superstructures.

Relationships are not harmonious all the time but often relationships are in conflict. For
instance, for most societies it is wrong to covet another man's wife but when a man and a
woman are seriously attracted to each other the norm of avoiding entering into any illicit
relationship may not operate all the time. If the husband finds out then the conflict arises.
Hence at the level of real human action conflict is endemic therefore, while conflict is normal
and can be seen not to disintegrate society, society is hardly ever in equilibrium.

2.4.6 Structural-Functionalism and Systems Theory

This theory was advanced by Brownislaw Malinowski in 1926, Radcliffe Brown in 1952,
Talcott Parson 1972, and Framo J., in 1976.

The theorists believe that unit within a structure function to maintain that structure. For
example, functions of the various parts of the body like the heart and the kidney function to
maintain the body. Also in the family, the father and the mother perform roles of providing
education, food, shelter for their children who in turn have to pay respect to their parents in a
system of authority.

The family as a social structure is maintained by continuous role interaction among the
various units such as, the parental subsystem, sibling subsystem, a male subsystem, functions
to maintain the family as a structure.

Talcott Parsons (1972) believed that the main functions of any social systems are structural
(Table 1). He referred to them as the AGIL function. Where:
A - stands for Adaptation

G - stands for Goal attainment

I - stands for Integration and

L - stands for Latency or tension management.

These functions are important for the individual's well-being in the society and in the absence
of these functions the individual's well-being in society may be jeopardized. For example, in
the case of adaptation - an individual has to adjust to his environment to be able to function
normally. Goal attainment - there are certain goals that people set to achieve and failure to
achieve them may lead to problems of low self-esteem and feelings of worthlessness.
Integration - It is important for people to be integrated into their communities because
isolation may results in problems such as alcoholism, drug dependence and other
psychological problems. Latency and tension management - This function is measured by
the various institutions in the community and the functions they perform e.g. the family, the
school and the health institutions which play important roles in the individual's life in the
society and may act as a buffer against psychological problems.

Table 1: Structures and Functions

Structure Function It Performs

Community Integration: Maintains relationships among components and provide social
control
Culture Pattern maintenance: Socialization of people to fit into the system and manage
tension
Politics Goal attainment: Set goals, establishes priorities and uses resources to achieve
the goals
Economy Adaptation: Seeks resources from the environment, converts them to useable
forms and distributes them to the rest of the system.

2.4.7 The System Theory

The theorist believes that the problems existing in the family result from relationships with
extended family system. For example, Framo believed that children's problems are related to
marital relationships which have their roots in families of origin. Families therefore, need
help to disengage from "ego mass" and function independently. Ego mass refers to family of
origin.

In dealing with family problems it is necessary to establish the source of the problem which
may be rooted in the family of origin.

Take Note 1.6

The major problems and weakness of structural functionalism and systems theory is their
instability in accounting for social change and the fact that the conflict is regarded as always
dysfunctional. This led to the formulation of a counteracting theory of social conflict
2.4.8 Evolutionary Theory

Advanced by August Comte (1798 -1857), Herbert Spencer (1820 - 1902), Ferdinand
Tonnies (1855 - 1936), Emil Durkheim (1858 -1917) and Robert Redfield (1947).

Evolutionary theory is important and popular in sociology, social sciences and biological
sciences. Evolutionary theory of sociology stems from Darwin's evolution theory of biology
which is considered to have been more complex. The theorists believe that society evolved
from simple forms to higher levels of complexity and perfection. Each society passes through
a number of stages in a given sequence- from savagery, through barbarism to civilization.
They argued that each era resisted the birth of the new era and concluded that the next step in
social evolution could be attained only by violent revolution.

As mentioned above the following were the proponents of evolutionary theory of sociology.

Let's now look at them in more details.

1. August Comte (1798 - 1857)

He saw society as evolving through 3 stages of evolution as follows:

a. Theological stage

This stage exhibits features of religiosity where everything that happens in life is explained as
the works of supernatural powers such as gods and goddesses among the ancient Greeks and
Romans. There was the belief in divine intervention by the god and goddesses.

He viewed magic, exorcism witchcraft and ancestor worship as the dominant cultural
behavior of those in this stage of human development. He also believed that the structure of
the society was based on militarism and slavery and therefore a change was necessary.

b. Metaphysical stage

He believed this is the stage where men began to doubt the idea of human affairs being a
product of divine intervention. Effects are made to establish causal relationships with abstract
forces in the universe and questions are asked and answers speculated about the nature of
man and the purpose of his existence. There was a lot of uncertainty in this era that needed
explanations.

This stage according to him was based on conquest and production. Men began to realize that
they could solve their own problems through conquest and production and not through divine
interventions

c. Scientific stage

He believed the scientific stage was to be the apex of human development. This is the stage
where men began to think scientifically and interpret reality in scientific terms. Positivism
was the highest level of intellectual development.

This stage he based on industrialism where there would be peace, plenty and understanding.
2. Herbert Spencer (1820 - 1902)

He believed that social institutions evolve like biological organism where those which cannot
adapt die out and only those which can adapt the environmental changes survive and persist.

Like Emil Durkheim, Spencer viewed society as evolving from state of homogeneity to that
of heterogeneity. Unlike Comte who viewed society as evolving through 3 stages, Spencer
presented a dichotomous (division into two) view of development i.e. militant vs industrial
society. He viewed militant society as possessing autonomous and self-sufficient units and
industrial society as peaceful, politically decentralized, and existed for the benefit of all
citizens. He seems to have concurred with Auguste Comte in his view about industrial
society.

3. Ferdinand Tonnie (1865 -1935)

He was also a dichotomous theorist. He believed society passed from the stage of
gemeinschaft (community) to gesellschaft (society) relationship. He believed that the
relationship in the community is intimate and face to face and the relationship in society is
contractual and exhibited individualism. This means that community is homogeneous and
autonomous whereas the society is heterogeneous and individualized like it is in
industrialized societies.

4. Emil Durkheim (1958 -1917)

According to Emil Durkheim, traditional societies were held together by similarities, norms,
morals and culture. These social bonds that held members together he called mechanical
solidarity. In modern societies the bonds are based on what he termed functional
dissimilarity which he called organic solidarity. The organic solidarity to him was the
impact of technological advances in knowledge which led to a form of social differentiation
and mutual interdependence in society. Therefore, organic solidarity is similar to the
interdependence of parts in the case of biological organism. He believed that the third world
countries are traditional and western countries modern. His concepts are a reverse of Tonnies
although the ideas are the same.

Take Note 1.7

The evolutionary theorists argued that each era resisted the birth of a new era and concluded
that the next step in social evolution could be attained only by violent revolution. They
believed that the third world countries are traditional and western countries of Europe and
North America are modern.

2.5 Section Summary

In this section we defined theory as general statement of fact, about how the society is
structured, works and evolves. We also described the various sociological theories which
include the deviant theory, theory of culture and poverty, social exchange theory, social
conflict theory, structural functionalism theory, systems theory and evolutionary theory. We
learned that the sociological theories explain phenomena in the social context and provide
guidelines in sociological analysis and that the theorists believe that environmental
circumstances such as rapid socio-cultural changes and lack of regulatory norms in society
result in moral acts such as alcohol/drug abuse and psychological problems. Therefore it is
necessary to take drastic action to curb the problems.

2.6 Suggested further reading

1. The African TextBook of Clinical Psychiatry and Mental Health. EDS. Professor
Ndetei and Colleagues. AMREF.2006.
2. Sociology. "An Introductory African Text". By Odetola T. O. and Ademola A.
Macmillan Education Ltd. 1985.
3. Internet

SECTION 3: SOCIAL CAUSES OF MENTAL ILLNESS

Welcome to this section on the social causes of mental illnesses. This section is related to the
previous section on the sociological theories on which this section and other subsequent units
and sections will be based. This section will look at the factors within the family, the school
and the community that contributes to abnormal behaviour in the individual. The psychiatric
problems or disorders do not strike at random but are related to environmental factors,
biological factors, socio-cultural factors, life events, traumatic events and relational factors.
These factors cause and perpetuate psychiatric disorders in both child and adult psychiatric
disorders.

For example, a child may develop severe behavioural difficulties as a result of earlier
experiences of deprivation but the problem may be perpetuated by family handling. Also a
panic disorder may be precipitated by the death of a parent from a sudden myocardial
infarction but then may persist as a result of the patient failing to be reassured that his/her
own heart is healthy. In this section we are going to look at the environmental factors
influencing psychosocial development of children, socio - cultural factors and traumatic
events. For life events (I refer you to module 3 which is on foundations of human behaviour
and covers this topic in details.).

Before we proceed to describe these factors, let us now look at the objectives of the section
below:

Objectives

By the end of this section you should be able to:

1. Describe environmental factors influencing psychosocial development of children.

2. Describe the role of socio - cultural factors in the development of mental illnesses.
3. Describe the role of traumatic events in the development of mental illnesses.

3.3 Environmental factors influencing psychosocial development of children

These are environmental factors which include; interfamilial factors, school factors and
socio-cultural factors.
Let's now proceed to discuss them in turn.

3.3.1 Environmental Factors

Under this we are going to discuss interfamilial, school and socio-cultural factors.

1. Interfamilial factors

The family is an important institution for an individual's well - being because the family is
supposed to provide emotional bonds and relationships, a secure base, models of behavior
and attitudes, life experiences, nurturance, guidance and control. The family therefore in
whatever form is fundamental to every member as is food to life.

Let's now look at these interfamilial factors in turn

a. Emotional bonds and relationships

Children develop specific bonds with significant people in their lives. When the bonding
process is disrupted, adverse or unsatisfactory due to separation or social disadvantage, the
child's ability to make satisfactory relationship in later life and his subsequent personality
may be impaired. Some children may develop antisocial behaviours.

A healthy mother child-relationship involves reciprocal gratification of the mother and child.
The mother certainly satisfies her own need to be motherly, be protecting, to be nurturing and
be comforting when she relates to her baby. Figure 1 illustrates how the bonding process
starts immediately after the birth of the child.

Figure 1: Emotional Bonding

Figure 2 shows how attachment becomes important in a child's normal growth. It also
illustrates that maintenance of close proximity with a significant person in their lives, assures
the infant/child of safe haven and a secure base to return to after going out to explore and
hence normal development. When there is disruption in the bonding process e.g. when there
is separation then the child will become distressed and when the child is distressed, he/she
may regress in development by reverting to earlier behaviours such as bedwetting or thumb
sucking or both. Some children may become too clinging as a result of fear.

The relationship between the mother and the child becomes pathogenic when the mother
does not recognize the needs of the child and satisfy them.

Figure 2: Secure Base and Safe Haven

b. Parental deprivation

Lack of parental care or interaction with the parents or substitutes during formative years can
have adverse effects on the child's personality and intellect. For example, lack of parental
care during formative years:

1. May result in fixation at the oral stage of psycho-sexual development (Freud)

2. May interfere with the development of basic trust (Erickson)
3. May retard the attainment of needed skills because of lack of available reinforcements
(Skinner)
4. The child's development capacity may be stunted (Sullivan)

For example, maternal deprivation according to Bowlby (1951), leads to:

 Acute distress which is probably due to disruption of the bonding process

 Developmental delay and intellectual impairment which are consequences of lack of
perceptual and linguistic stimulation.
 Enuresis which is a reaction to early stress.
 Failure to thrive syndrome which is as result of poor nutrition
  Delinquency due to family discord and inability to form emotional relationships

c. Parental rejection

Parental rejection is closely related to parental deprivation and may be shown in the
following ways:

 Distorted or inadequate care of children. In this the parents devote little time to their
children or neglect their children
 Denial of love and affection
 Lack of interest in the child's activities and achievements
 Cruel and abusive treatments.

The consequences of parental rejection include:

 Overt aggression and impulsive behaviours.

 Failure to form meaningful relationships
 Diminished intellectual functioning
 Excessive fears
 Running away from home.

d.Cycles of deprivation and abuse

Deprivation and abuse can be transmitted from one generation to the next. For instance,
children who are deprived of love and affection, those who are rejected and those who are
abused, may not be able to form emotional bonds and relationships.

Studies have shown that parents who had experienced rejection in childhood had serious
difficulties giving and receiving affection. In other words parents who reject their children
have been victims of parental rejection. The child may also reject the parents in the process.
Rejected children are adversely affected as discussed under rejection above.

e. Maladaptive family communication

Maladaptive communication such as double bind communication or ambiguous and

superficial communication interferes with normal development of children. For example,
double bind communication which Involves giving conflicting messages or contradicting
demands. For example, when a mother responds coldly to a child's affection and then
complaints that the child does not love her when as a result of the initial response the child
holds back his love. This kind of behaviour may result in serious impairment of the child's
identity because the child becomes confused. The child can only become whole self if he
breaks away and the strategy of breaking away involve the adoption of schizophrenia
responses. The other is ambiguous and superficial parental communication which is the
failure to provide each other with emotional support and there is scape-goating device
whereby one member is labelled a deviant in order to relieve family tension. Such labelling
interferes with the normal development of the child

f. Child-rearing practices
The way we as parents or care givers bring up their children is very important for their
emotional development and will determine their behaviours in later life.

(a) Overprotection - Sometimes we tend to overprotect our children by watching over them
by constantly protecting them from the slightest risk, over clothing them, medicating them,
and making up their minds for them at every opportunity. In essence parents smother the
child's growth. Such children become emotionally disturbed, they have poor peer
relationship and difficulty adjusting to new situations. Maternal overprotection has also
been found to create anxiety and excessive fear in children. Such children reach adolescence
and young adulthood feeling inadequate and threatened by a dangerous world. When the
time comes for them to be on their own they usually find themselves unprepared for the
challenges - which leads to physical and emotional trauma in such children.

(b) Restrictiveness- Enforcing restrictive rules and standards and not allowing a child to gain
freedom of autonomy may affect the child. Restrictiveness may foster well-controlled
socialized behaviour but can also nurture fear, dependency, submission and repressed
hostility. Adolescents who experience extreme restriction may rebel.

(c) Severe discipline or harsh discipline - Severe discipline like corporal punishment is
likely to lead to increased aggressive behaviour, fear, lack of initiative and spontaneity
resulting in a serious repressed child, who lacks spontaneity and warmth. Such children may
in return develop hatred of the disciplining person. It may also lead to rebellion and social
deviant behaviour.

(d) Inconsistent discipline - Inconsistent discipline confuses a child. For example, a child
who is punished one time and ignored or rewarded the next time for the same behaviour is at
a loss to what behaviour is appropriate. Inconsistent discipline is associated with
delinquencyand criminal behaviours. Therefore, children who are severely and
inconsistently disciplined, develop serious psychological problems in their lives and in later
life. For example, a child who is constantly being punished will learn that canning or beating
is the only way to resolve issues. That child will become aggressive. He will fight with his
friends, neighbours etc. because this is what he has leant from his/her parents. Hitler was an
authoritarian leader because he came from authoritarian home. Also children who are
punished for a wrong doing one minute and the next minute he makes the same mistake he is
not punished, such a child will be confuse as what is right and wrong.

(e) Authoritative discipline - Is associated with development youngsters of general

competent. In authoritative discipline the parents reason with the children and reach an
agreement.

Take Note 1.8

There is therefore an advocate for authoritative discipline as opposed to authoritarian and
inconsistent discipline.

3.3.1 Environmental Factors

(f) Unrealistic demands - Some parental demands are unrealistic that the children are unable
to live upto them. For example, a child may be expected to excel in school and other
activities but if the child does not have the capacity then the child may be frustrated and
devalued. Unrealistic demands and expectations (too high, too low or distorted or rigid) can
lead to faulty development and maladjustment. Parents also tend to push their children to
achieve or do what they have no capacity for. Such children may become very frustrated and
develop aggression or become depressed. For example, a parent may want his/her child to
become a doctor and the child may not have the capacity to do medicine. In such instances,
when the child realizes that he is unable to manage, he will consider himself a failure and
may even end up committing suicide or getting into heavy drinking or drug abuse.

(g) Undesirable parental models - Children learn good and bad behaviours from their
parents when they observe and imitate them. Parents become undesirable models when they
depend excessively on defence mechanisms in coping with problems e.g. blaming others for
their own mistakes or when they lie or cheat. Undesirable parental behaviour contributes to
emotional problems in children such as delinquency, crime and other forms of maladaptive
behaviours

g. Parental disturbance

Parental psychological problems such as anxiety, depression, schizophrenia, alcoholism or

drug abuse etc. have a bearing in psychological problems in children. For example, a mother
who is depressed will not be able to care for the child the way she should. The child may be
emotionally abused and abused children tend to have relationship problems. They also suffer
from low self esteem and may also suffer from depression. Studies have shown that children
of alcoholics go on to develop alcoholism (Goodwin 1976, 1978 and 1979).

h. Role problems

Children are sometimes given too many responsibilities in the family that they are unable to
cope with. For example, one of the special roles that children play is that of the "Parent
child". In this case the child is given too many responsibilities that he/she may not be able to
cope with resulting in the development of psychological symptoms. In extreme cases there is
the "role reversal". In this case the child takes up all the responsibilities including taking
care of the parents. These may be cases in which the parents have debilitating physical or
mental illness or there has been death of the parents most likely due to HIV/AIDS hence
child headed families.

i. Abnormal emotional expression in the family

Overprotection and criticism (High E.E) may result in abnormal behaviour in children. A
child, who is always criticized by the members of the family, feels he does not belong and
may look for solace in drugs or alcohol. Also a child who is overprotected may feel very
inadequate and develop low self-esteem. In adults, Vauhn and Leff, (1976), found that high
expressed emotions in schizophrenic families resulted in relapse of the schizophrenic patient.

j. A secure base
A child requires the security of a stable home or relationships. Children like to go out and
explore the world and sometimes as they go out to explore, they are threatened and they
become fearfully and anxious and therefore run back to the mother for reassurance and
comfort to help mitigate the fear/anxiety. Figure 3 illustrates the circle.

Figure 3: Secure Base

Figure 4: Circle of Security Necessary for a Growing Child

Figure 4 further illustrates the circle of security necessary for a growing child. A child needs
the caregiver/parent to support his/her exploration by watching over him/her, helping him/her
and enjoying with him or her. When the child has explored the child needs to go back to a
secure base or safe haven where he or she is protected, comforted, and appreciated.

3.3.2 Pathogenic family structures

The following family structures are associated with abnormal behavior in children and in
their later life:

(a) Discordant family - Discordant family is one in which there is poor interpersonal
relationship between the parents. For example, one or both the parents are not gaining
satisfaction from the relationship and expresses feelings of frustration by belittling the other
partner. Such conflict has a negative effect on the children.

(b) Disturbed family - Disturbed family is one in which the home is in constant turmoil due
to parents' abnormal behaviour. There is marital schism and skew. Marital schism is when
there is open conflict between the couple whereas marital skew, there is submerged conflict
between the couple. In such families children receive no love or guidance. Children from
such families suffer from emotional problems including aggression and antisocial behaviour

(c) Disrupted family - Disrupted family is an incomplete family due to divorce, death or
separation. These aspects are traumatic to the child and may result in psychopathology. For
example, delinquency and other maladaptive behaviours are common and frequent.

(d) Inadequate family - Inadequate families are families that are characterized by inability to
cope with the ordinary problems of family living. They lack the necessary physical or
psychological resources for satisfactory coping. They rely heavily on outside assistance and
support. Such families are unable to provide children with feelings of safety and security they
need and they also fail to provide guidance for competent development.

(e) Antisocial family - Antisocial family is one in which the parents overtly or covertly
engage in antisocial behaviours making them chronically in conflict with the law. Such
parents provide undesirable models for the child. Children from such families may become
dishonest, deceitful and develop other undesirable behaviour patterns.

3.3.3 Factors in the school

School just like the family is supposed to provide a good environment for competent and
normal development of the child. However, in certain instances this is not the case.

(a) Teacher - child relationship

The teacher child relationship may not sometimes be good. For example, a child may
complain of being picked on by the teacher or being punished wrongly. In such cases the
child may develop anxiety and refuse to go to school for fear of being punished by the
teacher.

(b) Academic progress

Poor performance in school may contribute to psychopathology in the child. Such children
may drop out of school or develop low self-esteem. Some children may become aggressive
which may result in them being hated by their peers and teachers in school and hence truancy
or school phobia.

(c) Peer group interaction/relationship

Some children may not have poor relationship with their peers in school due to the fact that
they are being teased, beaten or bulled. Such children may develop anxiety. They may fear
going to school because of being beaten and bullied by others. May play truancy or develop
school phobia.

3.4 Socio-cultural factors

Under socio-cultural factors we will discuss social disadvantages and cultural factors. Let’s
proceed to discuss these in turn.

3.4.1 Social Disadvantages

1. Poverty, unemployment and lack of property

Poverty is the number one factor that is associated with psychiatric disorders in children and
adults. Poverty is associated with poor housing and poor environmental circumstances.
Individuals who are unable to cope financially become frustrated and as a result develop
depression or take to heavy drinking or drug abuse as an escape from frustrations. Such
conditions have been shown to be associated with schizophrenia. For example, a study on
admission rates to specialist psychiatric hospitals in the U.K for people with schizophrenia
was higher among those residents in deprived areas (Palmer et al, 2004). Another study in
Scotland, showed twice as many suicides occur among people, from deprived areas (Blamey,
et al, 2002).

Work and employment are important for the well-being of individuals because the
individuals feel they are active members of the society which gives them satisfaction in life.
Barrier to work and unemployment is linked to stigma, prejudice, and discrimination

2. Stigma, discrimination and prejudice

Stigma and discrimination are sources of stress which may lead to mental illness fin the
individual. They are based on ethnicity, minority communities', race, gender etc. However,
people with mental illnesses have to deal with discrimination on a day-day basis. A study
found that 84% of people with mental illness have felt isolated compared to the general
population (Mind, 2004). In the same survey nearly 60% of people with mental illness felt
that isolation was linked to discrimination on the grounds of mental health.

Discrimination can occur in the school, the work place, in access to services, (including
housing and health) and in the community.

3. Mental and physical disability

A severe mental or physical illness represents a crisis in an Individuals social life and
psychological equilibrium which may result in anxiety, fear and other unpleasant emotions.
The way people respond to physical deformity with expression of disgust, revulsion can be
extremely devastating to the patients' self-esteem/concept. People's view about certain
disabilities can create a lot of anxiety in the parent.

The problems the disabled people have in common are not so much their physical capacities,
which are often very different but limitations of their life styles which becomes very
frustrating.

4. Lack of vocational skills

This means lack of qualification and skills in anything. These can be very stressful for an
individual because without any qualifications or skills possibilities of getting a well paying
job are nil. Such an individual feels hopeless and frustrated resulting in depression and /or
drug and alcohol abuse.

5. Financial problems

This is tied with poverty and social classes which are associated with psychological illness
and physical illness. For example, people from low socio-economic background are much
more likely to develop psychological problems than those from high socio-economic
background. This is because people from low socio-economic background undergo a lot of
stress as a result of their social disadvantages which make them more vulnerable than those
from high class.

Financial problems in the home lead to marital problems, poor housing or homelessness or
lack of property which are sources of stress resulting in psychological problems like
depression, anxiety and drug abuse.

6. Lack of social support

Social support by family members, friends, organization, school and community are very
important to the well-being of individuals. Lack of social support therefore, can lead to the
development of various psychopathologies and relapse.

Take Note 1.9

The experience of poverty and social disadvantage creates feelings of hopelessness, anxiety
and powerlessness which may impact not only on mental health and well-being, but also
physical health.

7. Adverse personal problems

Adverse personal reactions such as lack of confidence, poor self esteem, low motivation, and
feelings of inadequacy are individual limitations which result in frustration

Loneliness and isolation also result to frustrations in an individual. Friends are a source of
support and in the absence of friends one becomes very lonely and the only way to be with
people is to indulge in alcohol and drug abuse

8. Interpersonal problems

a) Strained family relationships and Marital disharmony - Family tension and strained
relationships results in emotional difficulties such as anxiety fear and other unpleasant
emotions leading to psychological problems in adults. Marital disharmony can lead to divorce
or separations which are sources of stress for the spouse and children.

b) Conflicts with the neighbours- Strained relationship with neighbours can cause anxiety
in some people resulting in psychological problems.

9. Work problems
Loss of skills that are necessary for effective participation in productive work is a source of
stress which may results in frustration and depression or drug and alcohol abuse.

Poor interpersonal relationships and poor working conditions within the work place are
aspects that lead to psychiatric disorders in the individual. It is important that an organization
provides a conducive environment for her employees to work in

Job loss - due to retrenchment or redundancy - Job loss is a source of stress which may result
in depressive illness

Major change of responsibility at work or job changes such as demotion, promotion or

transfer are sources of depression and alcohol abuse in the individual

3.4.2 Cultural Factors

For cultural factors, I refer youto Module 6 on anthropology which has dealt with cultural
factors extensively.

3.5 Traumatic Events

Traumatic events are traumatic experiences of which violence is an example. Others include
bereavement, road traffic accidents, surgery (e.g. amputation), natural and manmade disasters
etc. In this subsection we will look at the role of violence, natural and manmade disaster, civil
conflicts, wars and atrocities, tribal clashes and bereavement.

Let's now proceed to look at these events in turn starting with violence.

3.5.1 Violence

Violence in families such as domestic violence, (battered wife syndrome), battered child
syndrome or sexual abuse or rape, attempted murder or murder may result in behaviour
problems in children, depression and post-traumatic stress disorder in the victims of violence
or survivors of violence. These problems are found to be common in alcoholic families. For
example, Bwibo 1971 and 1972 respectively reported battered child syndrome to be prevalent
in alcoholic families.

We now proceed to discuss these violent acts in turn beginning with domestic violence now
referred to intimate partner violence (IPV).

1. Intimate partner violence (domestic violence)

Intext-Question 1.2
What is intimate partner violence or domestic violence?

Intimate partner violence (IPV) refers to any behaviour within an intimate relationship that
causes physical, psychological or sexual harm to those in the relationship. Examples of types
of behaviour include; Acts of physical violence such as slapping, hitting, kicking and beating.
Sexual violence, including forced sexual intercourse and other forms of sexual coercion.
Emotional (psychological) abuse, such as insults, belittling, constant humiliation,
intimidation (e.g. destroying things), threats of harm, threats to take away children.
Controlling behaviours, including isolating a person from family and friends; monitoring
their movements; and restricting access to financial resources, employment, education or
medical care (Rennison, C.M., 2003).

We now proceed to look at the occurrences of intimate partner violence.

a. Incidences of IPV

This is a common phenomenon in our set up and occurs mainly in homes with women as the
victims. Wives are often battered by their husbands or partners. This is also common
occurrence in the western world. More than one in three women and more than one in four
men in the United States have experienced rape, physical violence and/or stalking by an
intimate partner in their lifetime. Seventy four (74%) of all murder-suicides involved an
intimate partner (spouse, common-law spouse, ex-spouse or boyfriend/girlfriend). Of these,
96 percent were women killed by their intimate partners. One in five female high school
students reports being physically and/or sexually abused by a dating partner. Interpersonal
violence is the leading cause of female homicides and injury-related deaths during pregnancy.
The percentage of women who consider their mental health to be poor is almost three times
higher among women with a history of violence than among those without. Women with
disabilities have a 40 percent greater risk of intimate partner violence, especially severe
violence, than women without disabilities. Nearly half of all women in the United States have
experienced at least one form of psychological aggression by an intimate partner. On average,
more than three women are murdered by their husbands or boyfriends every day. One out of
three women around the world has been beaten, coerced into sex or otherwise abused during
her lifetime. Intimate Partner Violence occurs across age, ethnic, gender and economic lines,
among persons with disabilities, and among both heterosexual and same-sex couples. US
Violence Policy Center (2006), (Rennison, C.M., 2003), Powers, L.E., Hughes, R. B.,&
Lund, E.M. (2006

b. Expression of Aggression

Aggression can be expressed in the following ways:

i. Expressive aggression

This when the intimate partner has called the other partner names (e.g. fat, ugly, crazy,
stupid), insulted, humiliated or made fun of the partner or called her or him a loser, a failure,
or not good enough. These expressions are common in our relationships and people do not
realize that they are a form of violence towards a partner.

ii. Coercive control

This is when the intimate partner has tried to keep his or her partner from seeing or talking to
family or friends, made decisions for the partner, monitoring the partners movements, making
threats of physical harm, committing suicide because was upset with the partner, threatening
to hurt someone the partner loves e.g. parents, children etc., or threatening to take away the
children, looking the partner in the house, not providing financial support and destroying
something very valuable to the partner
 Take Note 1.10
Violence of any form is a criminal offence and the perpetrators are liable to punishment
depending on the gravity of the offence.

Let's now look at some physical violence offences meted on intimate partners.

c. Illustrative images of the victim before and after violence

Figure 5: Victim before violence

Figure 6: Victim after violence

(Courtesy:http://www.dailymail.co.uk/tvshowbiz/article-1150824/Pictured-Rihannas-horrific-
injuries-alleged-bust-Chris-Brown.html#ixzz3KLGyAj6w)

Figure 5 and 6 above shows how the victim was before and after violence. In these figures
the victim had visible injuries on the head face and mouth. However, in some instances
violence can result in death.

Intext-Question 1.3

What are risk factors in intimate partner violence?

Listed are risk factors in intimate partner violence.

d. Risk factors in intimate partner violence

1. Poverty -Environmental circumstances like poor living conditions, lack of proper nutrition
due to financial problems, are factors that contribute to stress in an individual and hence
aggression.

2. Lack of education - Individual who are uneducated lack skills required to survive in
society. This is therefore a stress factor that may result in aggression

3. Being Female - Females are the weaker sex and therefore prone to being abused.

4. Living in a high-poverty neighborhood - This is related to poverty above. It is as a result

of poverty that people live in high poverty neighborhoods such as the slums which have poor
drainage systems, poor sanitation hence poor conditions of living. These are recipes for
violence and other criminal offences.

5. Aggressive behavior as a youth - Children who are brought up by parents who believe in
authoritarian style of discipline, grow up knowing that severe punishment is the only way
out.

6. Heavy alcohol and drug use - People who drink heavily and use drugs tend to get violent
under the influence of drugs and alcohol. Studies have shown that violence is common in
alcoholic families.

7. Mental disorder - People with mental illnesses become intolerant and other base their
attack on their symptoms e.g. schizophrenics would attack due to auditory hallucinations.

8. Anger and hostility - People who have uncontrollable anger and hostility are very likely
to attack others in their environment or around them

9. Isolation- Being lonely is a reason for one to get angry with others and hence attack

10. Emotional dependence and insecurity - Those who are dependent on their spouses for
financial and other support feel very insecure and frustrated and hence aggression meted to
others

11. Being a victim of child physical or psychological abuse - Here we talk of cycles of
abuse. People who were abuse as children tend to be abusive either to their children or to
others.

3.5.1 Violence

Consequences of intimate partner violence (Fig 7)

Intimate partner violence may results in the following:

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Poor physical health

Emotional detachment
Sleep disturbance
 Risky behavior (substance abuse)
Low self - esteem
Posttraumatic stress disorder
Suicidal thoughts/behavior
Anxiety
&nbsp;

Isolation
Fear of intimacy
Inability to trust others
Depression
INTIMATE PARTNER VIOLENCE

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Figure 7: Consequences of Intimate Partner Violence

All these factors render an individual dysfunctional and therefore, it is important to intervene
to help resolve the issues contributing to these problems. This now takes us to the question of
how can we help?

We now proceed to look at what we can do to help.

f. What one can do to help?

In cases of intimate partner violence, it would be necessary for the partner to be connected
with supportive and caring people, not those who might blame her/him for the abuse. It
would also be necessary to secure a restraining or protective order if necessary, because this
will prohibit the partner from harassing, threatening, approaching, accosting, or even
contacting the victim. The partner has to always keep the order with her/him. Of at most
importance is seeking help from a psychologist or other licensed mental health provider; the
partner should contact his/her doctor or other primary health care provider; and also engage
the services at centers or shelters for battered women, which in our setup the most prominent
is the Nairobi women's hospital

After looking at the possible interventions lets proceed and examine safety plans.

g. Safety Planning

It is necessary for one to identify the partner's use and level of force so that one can tell when
they are in danger before it occurs. Also identify safe areas of the house where there are no
weapons (e.g. not the kitchen) and ways to escape. If arguments begin, try to move to one of
the safe areas. If violence occurs, make yourself a small target - dive into a corner and curl up
into a ball, with your face protected and arms around each side of your head, fingers
entwined. If possible, have a phone handy at all times and know what numbers to call for
help. Don't be afraid to call the police. Let trusted friends and neighbors know of the situation
you are in, and develop a plan and visual signal for when help is needed. In case of
anticipated danger pack a bag (include money, an extra set of keys, copies of important
documents, extra clothes and medicines) and leave it in a safe place or with someone you
trust. Teach your children how to get help. Instruct them not to get involved in the violence
between you and your partner. Plan a code word to signal to them that they should get help or
leave the house. Practice with your children how to get out safely. If available, call a
domestic violence hotline periodically to assess your options and get support and
understanding.

Having looked at the possible safety measures in the house, we now look at available
organizations involved in domestic or intimate partner violence from which help can be
sought.

h. Resources

National Coalition against Domestic Violence works to educate the public on how to
recognize domestic violence and what to do about it; teen dating violence; the impact of
family violence on children; and domestic violence against individuals with disabilities, older
adults, and other marginalized populations.

The National Online Resources Center on Violence against Women

Provides a comprehensive and easily accessible collection of full-text, searchable electronic
materials and resources on domestic violence, sexual violence, and related issues.

We now proceed to our next subtopic under violence which is child abuse specifically
physical and sexual abuse which are considered to be the most traumatizing forms of child
abuse.

3.5.2 Child Physical and Sexual Abuse

Intext-Question 1.4
What is child physical abuse?
Child physical abuse is defined as non-accidental trauma or physical injury or fractures caused
by punching, beating, kicking, biting, burning or inappropriate or excessive physical discipline
(Jaudes, P., & Mitchel, L., 1992). Physical abuse is the most visible form of child maltreatment

The physical signs of child abuse used to be called battered child syndrome. This syndrome
referred to many fractures that occurred at different times in children too young to have
received them from an accident.

After defining child physical abuse we now proceed to look at the various possible causes as
discussed below:

b) Causes of child physical Abuse

Physical abuse tends to occur at moments of great stress. Many people who commit physical
abuse were abused themselves as children. As a result, they often do not realize that abuse is
not appropriate discipline.

Often people who commit physical abuse also have poor impulse control. This prevents them
from thinking about what happens as a result of their actions.

Other factors that can contribute to child abuse include parents’immaturity, lack of parenting
skills, poor childhood experiences and social isolation, as well as frequent crisis situations,
poor social support, characteristics of the child, drug or alcohol problems and domestic
violence. In most instances child physical and sexual abuses occur together. Most children
are sexually abused, battered and/or killed

The major risk factors for child abuse include:

c).Risk Factors in Child Physical Abuse

The following are risk factors in child physical abuse:

1. Alcoholism - This is associated with child physical as concluded by Bwibo (1971/72).

He reported that battered child syndrome was common in alcoholic families.
2. Domestic violence - When there is violence in the family, children in most cases also
become victims particularly of domestic violence.
3. Drug abuse - Drugs are equally intoxicating just like alcohol so in the same way will
contribute to abuse.
4. Being a single parent - The frustrations associated with being alone and also lonely.
In some instances the single parent may be financially unstable leading to frustrations
which may result in an attack.
5. Lack of education - This is associated with lack of skills which is a hindrance to
gainful employment and with no employment there is financial problems and poverty.
These factors result in frustrations which studies have shown to result in aggression.

Take Note 1.11

It is important to note that cases of child abuse are found in every racial or ethnic back
ground and social class. It is impossible to tell abusers from non-abusers by looking at their
appearance or background.
3.5.2 Child Physical and Sexual Abuse

d). Signs and Symptoms of Physical Abuse

Signs may include the following:

1. Physical abuse should be suspected if the explanations do not fit the injury or if a
pattern of frequency is apparent.
2. The presence of many injuries in various stages of healing makes it obvious that the
injuries did not all occur as a result of one accident.
3. If both the parents or one of the parents has:

 Alcohol or drug problems

 A history of abuse or was abused as a child
 Has emotional problems or mental illness
 Has high stress factors, including poverty
 Does not look after the child's hygiene or care.
 Does not seem to love or have concern for the child.

Physical indicators include the following:

 Black eyes
 Broken bones that are unusual and unexplained
 Bruise marks shaped like hands, fingers, or objects (such as a belt)
 Bruises in areas where normal childhood activities would not usually result in
bruising
 Bulging fontanelle (soft spot) or separated sutures in an infant's skull
 Burn (scalding) marks, usually seen on the child's hands, arms, or buttocks
 Choke marks around the neck
 Cigarette burns on exposed areas or on the genitals
 Circular marks around the wrists or ankles (signs of twisting or tying up)
 Human bite marks
 Lash marks
 Unexplained unconsciousness in an infant (National Child abuse and Neglect Data
Systems, 2005)

Take Note 1.12

The visible physical marks are normally symmetrical in nature.

3.5.2 Child Physical and Sexual Abuse

Figure 8: Bruises of a baby who has been physically abused

Figure 9: A 10 year old Child physically and sexually abused

e). What should one do?

1. Discipline effectively: Remember that kids will be kids. Children can be loud, unruly and
destructive. They will break things, interrupt telephone conversations, track mud through the
house, not pick up their toys or clean their rooms, struggle over eating their vegetables or
pester routinely. Children will inevitably do things that may make their parents feel irritated,
frustrated, disappointed and angry. Changing a child's behavior is not easy. However,
children should not be disciplined through violence.

It is better to deny children privileges when they do something unacceptable, as well as

reward them when they do something good. This teaches children that there are consequences
for their actions.
2. Regain control: Child abuse is a symptom of having difficulty coping with stressful
situations. If one feels overwhelmed and are losing control, they should ask someone to
relieve them for a few minutes

3. Get help: Support is available for families at risk of abuse through local child protection
services agencies, community centers, churches, physicians, mental health facilities and
schools.

4. Report, report, report: If one suspects that a child is being abused, it would be necessary
to report it to the local child protective services agency e.g. the children's Department or other
child care agencies or in addition, in our setup the "nyumba kumi initiative".

Having looked at what child abuse is the risk factors, causes, signs and symptoms and what
can be done, it is necessary to now proceed and examine the possible prevention factors.

f. Prevention

Counseling or parenting classes may prevent abuse when any of the factors discussed above
are present. Watchful guidance and support from the extended family, friends, clergy, or
other supportive persons may prevent abuse or allow early intervention in cases of abuse.

Having looked at child physical abuse, we now proceed to look at child sexual abuse.

2. Child Sexual Abuse

a. Definition of child sexual abuse

Sexual abuse describes any incident in which an adult engages a minor in a sexual act, or
exposes the minor to inappropriate sexual behaviour or material. Sexual abuse also describes
any incident in which a child is coerced into sexual activity by another child. A person may
sexually abuse a child using threats and physical force, but sexual abuse often involves subtle
forms of manipulation, in which the child is coerced into believing that the activity is an
expression of love, or that the child brought the abuse upon themself. Sexual abuse involves
contact and non-contact offences.

b. Incidences of child sexual abuse

In this country child sexual abuse is a common occurrence particularly in schools. Media
reports suggest frequent occurrences of child sexual abuse. Published and unpublished
studies have indicated high prevalence of sexual abuse. The same trend is also seen in other
parts of the world as indicated by the following reports. Approximately one third of women
surveyed in Australia have reported sexual abuse in childhood (Flemming, 1997; Glaser,
1997; Mazza, Dennerstein et al., 2001). Approximately 10% of Australian men report sexual
abuse in childhood (Goldman and Goldman, 1988).

c. Child most likely to be sexually abused

Whilst all children are vulnerable to sexual abuse, girls are more likely to be sexually abused
than boys. Disabled children are up to seven times more likely to be abused than their non-
disabled peers (Briggs 2006).
d. Sexual abuse reporting to the authorities

In one study of Australian women, only 10% of child sexual abuse experiences were ever
reported to the police, a doctor, or a health agency (Flemming, 1997). In Kenya, abused
children are taken to gender based recovery centres e.g. Kenyatta National Hospital and
Nairobi Women's Hospital.

e. Who sexually abuses children?

Across all community-based studies, most abusers are male and related to the child
(Flemming 1997). Most adults who sexually abuse children are not mentally ill and do not
meet the diagnostic criteria for "paedophilia". Children are often sexually abused by people
known to them. The perpetrators include fathers, mothers, uncles, cousins and even brothers.
Others in positions of authority such as the teachers are likely to abuse the pupils.

f. Physical Warning Signs

Physical signs of sexual abuse are rare; however, if you see these signs, take your child to a
doctor. Your doctor can help you understand what may be happening and test for sexually
transmitted diseases. Pain, discoloration, bleeding or discharges in genitals, anus or mouth ,
persistent or recurring pain during urination and bowel movements, wetting and soiling
accidents unrelated to toilet training.

g. Behavioural Signs in Childhood

Sexually abused children exhibit a range of behaviours, including:

 Withdrawn, unhappy and suicidal behaviour

 Self-harm and suicidality
 Aggressive and violent behaviour
 Bedwetting, sleep problems, nightmares
 Eating problems e.g. anorexia nervosa and bulimia nervosa
 Mood swings
 Detachment
 Pains for no medical reason
 Sexual behaviour, language, or knowledge too advanced for their age

h. Signs in adulthood

Adults sexually abused as children have poorer mental health than other adults. They are
more likely to have a history of eating disorders, depression, substance abuse, and suicide
attempts. Sexual abuse is also associated with financial problems in adulthood, and a
decreased likelihood to graduate from high school or undertake further education (Silverman,
Reinherz et al. 1996).

i. A case illustration of consequences of child sexual abuse

A 58 year old male, a Jamaican wept uncontrollably when he disclosed in therapy that as a
boy he was forced to repeatedly have intercourse and perform other sexual acts with his older
female relative. He was narrating his ordeal for the first time to someone. He felt angry,
ashamed, guilty and had feelings of helplessness and powerlessness because he did not
express his pain as a child. He said he started acting out and soon was kicked out of school as
a 'rude boy'. He was always in the wrong side of the law as a child and as an adult because of
wrong doings including illicit drug use. He managed to 'migrate' to the United States but also
lived there on the wrong side of the law and was deported back to Jamaica after a long time
in prison, unskilled and unable to fully function as a good citizen. This is not really an
unusual case. Many children grow into adulthood suffering with the scars of abuse.

Take Note 1.13

According to the world report on Violence and Health, female and male victims of sexual
abuse suffer a range of psychological and social consequences in the short and long term.
Many sexually abused children do not receive adequate counseling and therapy, if any at all.

3.5.2 Child Physical and Sexual Abuse

j. Prevention

The following are prevention measures:

 Identification of families at high risk - This is important because one will have to
intervene before the abuse occurs.
 Education of the family to recognize when they are neglectful or abusive - When the
family is aware of their aggression, and that they are neglectful, then they may be able
to adjust accordingly.
 Separation of parent and child should be prevented -
 Prevent placement of children into institutions.
 Telephone hot line for parents who feel they are in danger of losing control and
abusing their children
 Parenting classes that discourage physical punishment
 Supportive phone calls.
 Improve economic status of the poor.

k. Factors that may contribute to the success of intervention

 Self-help group (parents anonymous) - peer support for abusive parents

 Giving practical help
 Providing day care nurseries - play grounds
 Social support - friends, relatives etc.
 Family therapy

l. Prognosis

Studies have shown high rates of re-abuse of children at risk. For example, Cohen (1976), in
his review of 11 abused children in the USA, found that 56% had re-incidences of severe
abuse. It can be assumed that recidivism rates are even higher in abusive families that do not
receive treatment or support.
3.5.3 Murder/attempted murder and survivors of violence crimes

Murder, attempted murder and manslaughter are some of the most serious offences you can
be charged with. Those who suffer as a result are the victims of attempted murder, the
relatives of the bereaved, and survivors of violent crimes.

1. What is murder?

Murder is defined in law as, when a person of sound mind unlawfully kills another person,
with the intention to kill or cause grievous bodily harm. The crime of murder carries a
mandatory life sentence, if convicted as shown in figure 10.

Figure 10: A Convicted Murderer

2. What is attempted murder?

Attempted Murder is defined in law as, when a person has the intention to kill and has done
something more than merely preparatory to commit the killing.

The attempt has to be serious enough that death could have resulted from it. The main
difference between attempted murder and other serious offences against the person, such as
grievous bodily harm, is the intent to kill.

3. Manslaughter

Manslaughter is a less serious offence than murder. Although the result is the same in that the
person has died, the main difference is in the intent of the attacker.

Manslaughter is when a person kills another, but only intended to hurt them, or to exert some
force on them. It can also be manslaughter if the attacker was negligent or reckless as to
whether some harm would be caused to the victim. With murder, the intention has to be to
kill the person or to commit serious harm (Lee, 2014).

3.5.4 Natural/Manmade Disasters

1. Manmade Disasters

The manmade disaster include; plane crash (Fig 11), automobile accidents, explosions and
fires, which are aspects of life that are very traumatic to the individual because they involve
loss of lives, loss of property, displacement, migration and even loss of limbs. These kinds of
losses leaves the individual devastated resulting in depression, PTSD, and other
psychopathology.
Figure 11: Manmade Disaster of a Plane Crash

A plane crash can be very devastating to the individual because it can result in loss of
property, lives which become very traumatic and may result in posttraumatic stress disorder
and depression.

2. Natural Disasters

Natural disasters include a tornado, tsunami; earthquake, etc which involves loss of lives,
property, home etc. These aspects can be very traumatic to the individual leading to
depression and PTSD. Figure 12 shows a natural disaster - a tornado.
Figure 12: Natural Disaster of a Tornado

3.5.5 Civil Conflicts

Civil conflicts are conflicts which are intrastate as opposed to interstate and are in the form of
rioting, stone throwing, burning of houses and displacement of people. The conflicts result in
loss of lives, devastation of communities and displacement of millions of people. The
following are some forms of conflicts, wars and atrocities

War is the worst form of conflict whether intrastate of interstate. War, the most violent form
of conflict, refers to organized armed violence aimed at a social group in pursuit of an
objective. Whether war is just or unjust, defensive or offensive, it involves the most
horrendous atrocities known to humankind.

Let's now look at the global trends in violent conflicts between 1945 and 2005 as shown in
figure 13.
Figure 13: Global Trends in Violent Conflict

1. Causes of War

The following are some of the causes of war:

 Conflict over Land and Other Natural Resources: Disputes due to scarcity of land
and other natural resources by different groups.
 Conflict over Values and Ideologies: World War II was largely a war over
democracy versus fascism. Cold War largely involved conflict over capitalism versus
communism. Wars over differing religious beliefs have lea.d to some of the worst
episodes of bloodshed in history.
 Racial and Ethnic Hostilities: Hatred between different racial groups and different
ethnic groups.
 Defense against Hostile Attacks: Interstate wars occur when one state defends its
citizens from external attacks.
 Terrorism: Premeditated use, or threatened use, of violence to gain a political or
social objective. Transnational terrorism occurs when a terrorist act in one country
involves victims, targets, institutions, governments, or citizens of another country.
Domestic terrorism is exemplified by the 1995 truck bombing of a nine-story federal
office building in Oklahoma City, resulting in 168 deaths and the injury of more than
200 people.

2. Causes of Terrorism

The following are some causes of terrorism:

 A failed or weak state, which is unable to control terrorist operations.

  Rapid modernization, when, for example, a country's sudden wealth leads to rapid
social change.
 Extreme ideologies - religious or secular.
 A history of political violence, civil wars, and revolutions.
 Repression by a foreign occupation (i.e., invaders to the inhabitants).
 Large-scale racial or ethnic discrimination.
 The presence of a charismatic leader.

3. Consequences of Civil Wars

These include:

a. Social problems: Millions of people are displaced and forced to migrate to other countries
or places as refugees. The refugees are faced with a lot of problems particularly women and
children who are vulnerable to sexual abuse and exploitation. There is loss of property, lives
and homes.

Figure 14: Global Refugee Populations

(Courtesy: http://www.unhcr.ch,
http://www.iom.int/http://www.state.gov/www/global/prm/index.html)
Figure 15: Refugee Camp in Tanzania

The 1994 genocide in Rwanda triggered a massive exodus into neighboring Zaire and
Tanzania where huge refugee camps such as the one established in the Ngara area of
Tanzania sprung up as shown in the above figure (UNHCR/25192/1995/C. Sattlberger).

b. Psychological problems:Victims of violence experience trauma which results in

Posttraumatic stress disorder (PTSD) whose symptoms include recurring nightmares,
flashback, and poor concentration. Estimate 30% of male veterans of the Vietnam War have
experienced PTSD, and about 15% continue to experience it.

c. Genocide: Civil war can result in genocide (The deliberate, systematic, annihilation of an
entire nation, people, or ethnic group). For example, the 1994 genocide in Rwanda that
resulted in killings of Hutus by the Tutsis.

d. Environmental degradation:Wars where biological and chemical weapons result in

degradation of the environment.

e.Tribal clashes

Tribal clashes in Kenya have led to loss of lives, loss of property and migration to safer
places. For example, in Tana River in the coast region 116 people died (Fig 16). There was
fear that this was instigated by politicians and Somalis. The clashes have been between
hundreds of fighters from the Pokomo and Orma tribes, armed with guns, spears and bows
and arrows with which they attacked each other's villages, burning homes and killing people.
These resulted in people fleeing from their homes as shown in figure 17.

Although Kenya has experienced sporadic ethnic violence since the 1990s, these have never
translated into civil wars or lasted long. To a large extent, ethnic clashes have been localized
in limited geographical areas and have not affected life in other parts of the country.
Furthermore, the clashes have not involved rebel groups fighting to dislodge the government
and therefore did not result in casualties on the government side. By all measures then, Kenya
has not had a civil war during the post independence era.

Figure 16: Houses burnt during the Tana River Delta Tribal Clashes

Figure 17: Family fleeing from their home as a result of the clashes

4. Causes of Ethnic Violence in Kenya

There are three main factors that have been associated with ethnic violence in Kenya. These
are as follows:

a. Deep ethnic cleavages:The country is ethnically diverse, with at least 42 distinct tribal
groups, and it has been established that ethnic identification in Africa is very strong
(Kimenyi, 1997). Violence has been organized along ethnic lines; the inference is that ethnic
clashes in Kenya have been purely the result of "ethnic hatred." But this ethnic hatred is
linked to electoral politics and competition among new arrivals in a region, groups with large
land ownership, and native groups who feel threatened by the others.

b. Conflict over land distribution: Conflict over land rights is often seen as being at the
center of ethnic conflict in Kenya. In fact, violence was directed at members of minority
ethnic groups in the rift valley whose houses were burnt down and evicted from their farm
land. This resulted in retaliatory attacks. The clashes only stopped after the attackers achieved
their objective of forcing the minority tribe out of their region.

c. Politically instigated:In Rift Valley politicians exploited the land disputes that existed to
wage were against non-Kalenjin for political reasons. It was not only in the Rift Valley that
there was ethnic conflict as a result of politics but also in other parts of the country where
opposition existed. There were political differences between Sabaots who were in KANU and
Bukusu who supported FORD. The Sabaot attacked Kikuyus, Teso, and Bukusu tribes by
burning down houses for political reasons. Bukusu supported KANU while Sabaots
supported FORD-Kenya. There was calm after Sabaot attackers succeeded to force the
Bukusu out of the farm. The Sabaot were better organized, trained, and armed than Bukusu.

Take Note 1.14

Kenya possesses many of the risk factors that can lead to civil war but those involved in the
clashes have had neither a well defined group identity nor well-defined long-term goals. If
this had happened, the ethnic conflict would have been more persistent and would have
spread to other areas of the country.

Intext-Question 1.15
What is bereavement?
Bereavement refers to loss through death of a close relative such as death of a spouse or just
death in general. There are other losses which may not be referred to as bereavement such as
loss of a limb, loss of property, loss through divorce, loss of a job, and death of a pet. These
other losses just like bereavement which is loss through death can result in grief reaction (a
stage of mourning).

3.5.5 Civil Conflicts

Death is experienced as timely or untimely. Timely death is death that is expected for
example, death due to old age or terminal illness. Untimely death is one which is not
expected. For example premature death of a young person, sudden death or catastrophic death
associated with violence or accident. Death has also been described as intentional (suicide),
unintentional (trauma or disease) and sub intentional (substance abuse, alcoholism, cigarette
smoking).

Death is an inevitable experience therefore, dying people and relatives with the help of the
doctor, should understand the situation and decide on what should be done.

Today because medical procedures extend people's lives, death is often seen as an event that
can be deferred indefinitely. However, death is an intrinsic part of life and talking about the
likely outcomes of illness including death and dying is an important part of health care.
1. Forms of Bereavement

The different forms of grief reaction include:

a. Normal grief reaction

i. Brief grief - This occurs when there is immediate expression of feelings e.g. outbursts of
anger and crying. This type is not prolonged. There can also be a feeling of numbness and
talking about the dead which lasts for a few hours to a few days. There is disbelief that it has
really happened and for many people it is the funeral service that brings home the reality of
what has happened. Physical symptoms are also likely to develop. Some people may feel ill
and shivery and remain in bed for a couple of days.

ii. Anticipatory grief- In this case there is awareness of loss and the bereaved prepares for
the loss e.g. like in the case of terminal illness.

b. Abnormal grief reaction:

i. chronic grief - This is prolonged reaction to bereavement. For example some people may
mourn the dead for years and years.

ii. Delayed grief - This is when people do not grieve, they behave as if nothing has happened
but weeks and months later, develop psychiatric symptoms.

2. Causes of death or dying

The causes of death or dying are multiple including sudden death due to accidents, or
massive heart attack or murder. Death may also be due to terminal illnesses such as cancer,
AIDS, diabetes etc. Terminal illness means an incurable illness or illness with bad prognosis
but death is not immediate. Other causes of death or dying may include witchcraft or voodoo
which occurs when a person who is thought to have the power to cause death physically puts
a curse on someone who believes in this person's power. Unless a folk healer removes the
curse, a person under such a spell may die. One would therefore, conclude that death is due to
physical and social - cultural factors. Psychological factors may also play a role in the causes
of death.

3. Reactions to death or dying

According to Elizabeth Kubler - Ross a psychiatrist and thanatologist, there are five stages
through which dying people undergo.

a. Stage 1 - Shock and denial

When one is told that he/she is dying, the initial reaction is that of shock. The patient refuses
to accept the diagnosis or deny that anything is wrong. Most patients react by saying "no not
me". When a cancer patient was asked about his view regarding his illness during an
interview, the response was that he could not live as he had with the dreadful disease as
cancer. This denial caused him comfort which was temporary but relieving.
Isolation or loneliness does set in at times. This may come about because the patient due to
his illness has cut off his social contacts and withdrawn into his own shell. In such cases, the
doctor must communicate to the patient and patient's family, in a respectful and direct way,
giving them information about the illness, its prognosis and the options for treatment.

b. Stage 2 - Anger

Anger comes when one realizes that it is not a mistake but it is true that he is really dying. A
common response is, "why me?" They may become angry at God, a friend, or a family
member, they may even blame themselves. The anger may be blamed on to a member of staff
and the doctor and the family, who are blamed for the illness because they are the immediate
environments.

Management of angry patients involves the understanding that the anger being expressed
cannot be taken personally. The doctor should also recognize that anger may represent the
patient's desire for greater control in a situation in which he or she feels completely out of
control.

c. Stage 3 - Bargaining

The patient may attempts to negotiate with the physicians, friends or even God by attending
church regularly or giving charity. Another aspect of bargaining is that patients believe that
by their being good the doctor will make them better.

The family can also try this in their own way like offering rituals depending on different
religions and beliefs. This may have an association with guilt feelings, irrational fears or
repressed hostility. Also the patient may decide to sponsor a research centre or a special ward
in the hospital for the care of other patients with the same illness. Unconsciously it is meant
to benefit the patient that more therapies may be known and he may be cured.

The management of such patients involves making it clear that they will be taken care of to
the best of the doctor's abilities and that everything that can be done are done regardless of
any action or behaviour on their part. The patient must be encouraged to participate as a
partner in the case and to understand that being a good patient means being as honest and
straight forward as possible.

d. Stage 4 - Depression

The patient shows clinical signs of depression such as withdrawal, psychomotor retardation;
sleep disturbances, hopelessness and possibly suicidal ideation. The depression is typical
reaction to the effects of the illness on his or her life (e.g. loss of job, loss of limb, economic
hardship, helplessness, hopelessness, isolation from friends and family) or it may be in
anticipation of the actual loss of life that will eventually occur.

Major depression with vegetative signs and suicidal ideation should be treated with
antidepressant medication and electroconvulsive therapy may be indicated. A person who
suffers from major depression may be unable to sustain hope. Hope may alter longevity and
is likely to enhance the dignity and the quality of the patient's life.

e. Stage 5 - Acceptance/Hope
The patient realizes that death is inevitable and accepts the universality of the experience.
This may be the ultimate goal, and often it is void of feelings probably with long suffering.
Feelings may range from a mood that is neutral to one that is euphoric. This leads to better
and open communication and meaningful support. Under ideal circumstances, the patient
resolves his or her feelings about the inevitability of impending death and is able to talk about
death in the face of the unknown "It must be noted that not all patients reach this stage".

Hope exists at all the other stages, one looks forward to a life without an illness since there
are new drugs and research or hope for a miracle or spiritual therapy. As patients and
relatives bargain - these are all indications of hope. Hope may cause one to do a lot of things
- like travel to far away shrines/temples/churches and from one doctor to another. But
terminally ill patients should not be given unrealistic hope by staff of the hospital and the
family. Kubler Ross said, "When terminally ill patient stops experiencing hope it is a sign of
imminent death"

These feelings and emotions are not only experienced by the patient himself but also by the
patient family and the professional care - giver, such as the physicians, the nurses, the social
workers and other caregivers, involved with particular patients.

1. Helping the bereaved

The following intervention tools are used to help the bereaved cope with loss:

a. Counseling

This may be on a one to one basis or in a group.

i. Individual counseling:

The bereaved is helped to ventilate and reassurance is given whenever necessary. The
therapist also provides empathetic listening. A person who has experienced major
bereavement can also this kind of support because the person really understands what the
other person is going through and know that bereavement is not the end.

Reassuring the bereaved that they are not alone in the world help reduce feelings of
insecurity. For example, it may also be important for instance to reassure a distressed woman
that feelings of anger and guilt and hallucinations of her dead husband are normal reaction to
loss and the physical symptoms resembling those suffered by her husband do not mean that
she is dying of the same disease. She may need to be reminded that she is not a bad mother if
she finds it hard to cope with the demands of her children and to assure her that it is fight for
her to call upon the support of others.

Many people are surprised and frightened by the sheer intensity of their emotions after
bereavement. Reassurance that they are not going mad, that such feelings are perfectly
natural and that crying does not mean a nervous breakdown is very useful for the bereaved.

Acceptance of the bereaved with all the problems and weaknesses gives the bereaved a sense
of belonging and helps them to move on.
For the bereaved as well as those experiencing abnormal grief it is important that they should
be engaged in talking about loss (sadness, guilt, anger etc.). Those experiencing abnormal
grief should be encouraged to accept loss as real by working through the stages of grief
during counseling sessions

ii. Counseling Bereaved children

Children needs to know about the death and needs of children vary with age. Most children
over the age of five are able to understand if it explained in simple language, that mummy or
daddy is going to heaven or is leaving the earth. The task of the therapist is to let the children
know.

In counseling, the therapist needs to reassure them that he/she will be there for them. Parents
should also be involved in helping their children go through grief by telling them about the
loss or by going through the photographs of the dead person. This will help children come to
terms with the loss.

iii. Group counseling

A group of bereaved individuals will go along way in helping the members cope. In such
groups members share experiences and people learn that they are not alone. This gives them
encouragement in life.

Group therapy helps people with a sense of loneliness, guilt, and helplessness, to gain
strength through supportive relationships.

iv. Marital and Family therapy

Traumatized people may have problems with their relationship e.g. violence and child abuse
may be the outcome of such relationships.

Marital counseling should therefore be directed towards the improvement of sexual

functioning because in some families sexual intercourse may be non-existent.

a. Social support

The bereaved needs support to come to terms with the bereavement and also with the new
roles in the family and their position as widows and widowers. At times older children
provide support for their parents to go through grief.

Friends, workmates, and relatives must be involved when trying to help a particular
individual since care of the bereaved is a community responsibility.

b. Practical support

The bereaved requires a lot of practical help. They need help from friends and relatives e.g. to
the final visit to the hospital, the notification of the relatives, looking after the bereaved,
registration death and funeral arrangements. To prevent abnormal grief it is important that the
bereaved is involved in the burial rituals and ceremony (e.g. viewing of the body, putting
away the deceased belongings, receiving visiting mourners and talking to them). In case of
stillborn, it is important to name the stillborn and give him/her a proper burial

The bereaved may also require financial support particularly if the dead were the
breadwinners of the family. Relatives may have to provide this kind of support.

2. Crisis intervention in bereavement

The main concern is to restore emotional arousal to near normal level since over - arousal
interferes with problem solving. This is achieved by providing reassurance and opportunities
for the client to express his emotional feelings. It is important to encourage the client to be
involved in efforts to ameliorate the situation that precipitated the crisis. It is also important
to employ problem solving counseling. Problem solving counseling involves encouraging the
client to assess his problems against the assets he may have, leading the client to suggest
alternative solutions and making the necessary choices. The counselor encourages, prompts
and asks clarifying questions. He /she avoids formulating the problems or suggesting
solutions directly. The therapist helps the client to do so himself/herself.

When the client succeeds, it is important for him/her to realize that he/she has learned a better
way of solving a problem that can be employed in the future. The following are steps that can
be followed:

 Identify and list problems

 Consider what can be done
 Select one problem and carry out action most likely to ameliorate the problem
 Review result and either choose another solution or another problem if the first
problem has been effectively dealt with.

3. Cultural dimensions

There has been cultural variation in response to bereavement in terms of funeral

arrangements and coping.

In African culture there are funeral rites, which are ceremonial and are intended to express
grief at the loss of the member of the community and to express awe and concern in the
presence of death itself.

Recovery from bereavement was faster in many African communities because of the practical
ways, which symbolically assisted individuals in recovery. For example, in the Luo and the
luhya communities of Kenya, widows were expected to wear their husband's clothes
especially during "tero buru" and mourning usually wailing was encouraged and gossip was
directed against a close kin who did not wait. The end of mourning period was prescribed and
the end of which was marked by a ritual passage. These helped the bereaved go through
bereavement.

These, among others, have a psychological and social function in coping with or recovering
from bereavement.

In many cultures, death is thought to be caused by unforeseeable and unavoidable intrusion

into society of external and superhuman power. This is beyond human comprehension but
nonetheless the living must somehow control it and when it comes find ways of coping with
it lest they become overwhelmed by it.

3.6 Section Summary

We have come to the end of this lecture. In this lecture we learned about factors that
influence psychiatric illness. It is apparent that psychiatric illnesses are caused by multiplicity
of factors including environmental factors, socio - cultural factors, adverse personal reactions
and traumatic events. It is therefore important that a multidisciplinary approach to
management is employed. In the next section we proceed to discuss the relational problems
and how they influence psychiatric disorders.

3.7 Suggested further readings

Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB,
Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;
2007: chap 36.

Berkowitz CD, Stewart ST. Child maltreatment. In: Marx JA, Hockberger RS, Walls RM, et
al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia,
Pa: Mosby Elsevier; 2009: chap 63

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horrific-injuries-alleged-bust-Chris-Brown.html#ixzz3KLGyAj6w

SECTION 4: RELATIONAL PROBLEMS

Welcome to section four on relational problems. This lecture is linked to the previous one
which was on factors associated with psychiatric illnesses because this lecture will further
look at the relationship between psychiatric disorders and patterns of
relationships/interactions. Relational problems are patterns of interaction between or among
members of the relational unit e.g. marital/family relational problems, parent child relational
problems, sibling rivalry, mother child relational problems, pupil-teacher relational problems,
patient-therapist relational problems, and employer-employee relational problems, neighbor
relational problems and racial/ethnic differences. These relational units are associated with
symptoms of clinical impairment among one or more members of the relational unit or
impairment in the functioning of the relational unit. These relational problems today are due
to the western influence because western values do not conform to our values. For example,
divorce was rear but now it is rampant due to conflicts within the families who fight for
equality, against infidelity and against nagging.

The objectives of this section are as follows:

4.2 Objectives

By the end of this section, you should be able to:

1. Define relational problems.

2. Describe the causes, consequences and intervention strategies.
 3. Describe the intervention strategies.

4.3 Definition relational problems

Intext-Question 1.6
What is a relational problem? What are the possible causes of these problems?

Relational problems are patterns of interaction between or among members of the relational
unit and they include: marital/family relational problems, parent child relational problems,
sibling rivalry, mother child relational problems, pupil –teacher relational problems, patient-
therapist relational problems, and employer – employee relational problems, neighbor
relational problems and racial/ethnic difference. Let’s look at these problems in succession

Having looked at what relational problems are, we now proceed to discuss them in details in
terms of description, causes, consequences and intervention

4.4 Description of causes, consequences and intervention strategies of relational problems.

a) Marital/family problems

(i) Description:Family/marital problems include conflicts, squabbles, tension or disharmony

and separation or divorce between the couple or in the family.

(ii) Causes:The possible causes of the conflicts include, cultural differences, when family
roles are not well defined, financial difficulties, pathological jealousy, looking after a
handicapped child, alcoholism and personality problems, misuse of family resources, uneven
distribution of family resources or favourism of one member.

(iii) Consequences: The consequences of these conflicts are depression in the husband or
both the spouses, neglect and lack of affection for children, divorce, psychological problems
in children e.g. anxiety, depression and antisocial behavior

Intervention:

Intext-Question 1.7
How best do you think such people can be helped?
People who develop problems due to relational problems are helped by the use of family
therapy or couple therapy. Some may require medication for various disorders. Practical help
may be necessary e.g. in the case of violence or high expressed emotions manipulation of the
environment may be necessary or some may require legal arbitration where they may be
helped to get one since they may not afford the services of a lawyer on their own.

4.5 Intervention strategies

a) Parent- child relational problems

  Description: This is poor interaction between the parent and the child. This has
negative consequences for both the child and the parent.
 Causes: The possible causes of parent-child relational problem are absence of father
from home due to alcoholism or polygamy, unreasonable punishment, child rejection,
psychiatric disturbance in parents and lack of attention
 Consequences: This is likely to result in identity problem, aggressive destructive
behavior, antisocial behavior and attempted suicide
 Intervention: This problem can be managed through psycho-education - that is
educating the family about the consequences of such relationship. In some instances it
would be necessary to remove the child to a place of safety and provide
psychotherapy to both the child and the parent.

b) Sibling Rivalry

 Description: Sibling rivalry occurs between or among siblings. This is seen when
siblings have differences or when there is hatred between the siblings
 Causes: May be due jealousy because one child is favoured over the others or due to
the birth of another child in the family which results in shifting of attention to the new
born or having an only child for a long time or when the family size is large with little
space between birth of individual children hence overcrowding.
 Consequences: Sibling rivalry may result in aggression in such children. Anew born
baby who may be considered as taking the play or receiving all the attention from
other children may be mishandled and injured. Some children may regress in their
behavior. For example, they may start bedwetting or talking babyishly or crawling or
crying or wanting to take the bottle again. It may also interfere with the successful
resolution of Oedipus complex

 Intervention: Parents should be educated about the effects of favouring a child over
the others. They should also be made aware of the fact that children need to be
prepared before the birth of another child so that they learn to accept the new born
and to cope. When the new born arrives attention should be divided equally among
the children without ignoring the others. Parents should also be made aware of the
fact that spacing of children is important.

c) Mother- child relational problems

 Description: This is evident when there is poor relationship between the mother and
the child.
 Causes: This poor relationship between the mother and the child may be due to
maternal overprotection. The child may feel smothered by the mother and hence
develop hatred for her. Domineering and passive mothers may also have problems
with children. In the case of mothers who are domineering, the child may feel that the
mother is running their lives for them and this is likely to cause a lot of conflict
between the mother and the child. In the case of a mother who is passive, the child
may be isolated and feel that the mother is not responsive and this may result in
hatred for the mother. Also children, who are deprived of the mothers love and
affection, have poor relationship with the mother most likely hatred for the mother.
 Consequences: Include dependent mature personality in the part of the child. Some
children may also become submissive, timid and withdrawn. Failure to thrive
 syndrome, developmental delay and intellectual impairment are likely to be the
outcome (Bowlby 1951)
 Intervention: The mother needs to know about the reasons behind the poor
relationship so that they adjust accordingly or change and adopt new strategies of
handling the child/children

d) Pupil- Teacher relational problems

 Description: This is evident when there is poor or strained relationship between the
pupil-and teacher in school.
 Causes: The main reasons for this kind of relationship may be due to the pupil's bad
behavior in school, poor academic performance, negative peer relationship and
parental interference or parental uninvolvement in school activities.
 Consequences: This kind of problem between the pupil and the teacher may result in
school phobia and conduct disorder.
 Intervention: It would be necessary to establish the reasons for the poor relationship
and intervene accordingly. For example, if it is due to the child's bad behavior the
teacher need to understand why the child is behaving the way he/she is behaving and
help the child accordingly. If it is because of parental interference, the teacher and the
parents need to resolve their differences for the well-being of the child.

e) Patient- therapist relational problems

 Description: Patient - therapist relational problems evident when there is a conflict

between the therapist and the patient.
 Causes: Transference and counter transference or when there is delay in the treatment
of the patient or when the patient is not treated with respect.
 Consequences: This kind of relationship may result in rejection of the therapist or
death of the patient and in some instances, may result in legal tussles between patient
and therapist.
 Intervention: Good patient - therapist relationship will depend upon:

i). Trust based on confidentiality

ii). Effective communication about the following:

 Nature of the illness

 Diagnosis
 Prognosis
 Possible management strategies

iii) Acceptance and social support

The therapist therefore, should be aware of these factors.

f) Employer - employee relational problems

 Description: This is evident when there is conflict at the workplace i.e. between the
employer and employee or between or among employees. Conflicts in organizations
or at the workplace are universal.
  Cause: The conflicts may be due to personal problems or the poor working conditions
or due to poor remuneration, poor communication skills by employers or high
handedness or dictatorship by employers.
 Consequences: Conflicts within the organization may lead to inefficiency in the
organization, resignation and dismissal may result into strike by the employee and
psychological problems in the individuals.
 Intervention: It would be necessary to resolve the conflict by intervening at the
workplace. It would also be necessary to help in the improvement of the working
conditions by working closely with the employers.

g) Neighbour relational problems

 Description: Good neighbourliness is the key to mental well-being. Poor neighbour

relationship is a recipe for mental illness. The levels of conflicts include inter
individuals, Interfamilial, Intercommunity, Interstate and Intercontinental
 Causes: The causes for the conflict between neighbors are e.g. land disputes,
territorial violation, land clashes, terrorism etc.
 Consequences: The neighbor relational problems may result in poverty, wars and
atrocities, loss of lives and property, psychological problems both in adults and
children and homelessness

 Intervention: When there is conflict in relationship with neighbors, the conflict

should be resolved. Conflict resolution can be done through negotiations (i.e. if it is
interstate or intercontinental) between states. It can also be done through mediation.

h) Racial/ethnic differences

 Description: This is evident when there racial/ethnic hatred. The apartheid in South
Africa was a good example of racial hatred. Also the hatred between the whites and
blacks in America and other European countries are also good examples. Ethinic
hatred in Kenya is evident

 Causes: The causes of racial/ethnic hatred include personal attitude and values, poor
social interaction among groups, economic factors, unequal distribution of resources
and land problems.
 Consequences: The racial and ethnic differences may affect the individuals' social
and economic status, prejudice and discrimination and psychological problems in the
individual.
 Intervention: It would be necessary to root out racism, ethnicity and also create
equality and unity among human population and decrease skirmishes such as war and
exploitation of the minority.
 4.6 Section Summary
 We have now come to the end of this section on relational problems. In this section
we learned about what relational problems means. We have also looked at the causes
of conflicts in social relationships and also the consequences of the conflicts. We have
also discussed the possible interventions in conflict problems. We realized that these
problems are negative because they can retard development; result in poverty and
psychological psychopathology in individuals. Proper intervention is therefore,
imperative to resolve the conflicts which will result in normal functioning.
  We have now come to the end of unit one and will now proceed to unit 2 which is
going to focus on the components of society. But before we discuss the sections under
this unit, I would like you to look at some of the practice questions provided to test
your knowledge on this unit. Also in groups of four, I would like you to work on the
activity provided.

 Activity 1.1
 In your group, Please discuss the following
 1. Discuss how best a child should be raised by the parents or caregivers in a given
community.
 2. Discuss the importance of the theory of anomie (normlessness) according Emil
Durkheim.
 Discuss selection of a marriage partner in the context of traditional and western
societies.


4.7 Suggested readings

1. The African Textbook of clinical psychiatry and Mental Health. EDS. Professor Ndetei
and colleagues. AMREF.2006
2. Sociology. An Introductory African Textbook. By Odetola T.O. and Ademola A.,
Macmillan Education Ltd. 1985
3. Unit 1 Review Questions
4.

6. Self Assesment Questions

7. < !--[if !supportLists]-->Which of the following theory is associated with anomie?
8.
The Deviant theory
Theories of culture and poverty
< !--[if !supportLists]-->

Functionalism and systems theory

Evolutionary theory.
9.
10. < !--[if !supportLists]-->Which of the following was the proponent of deviant theory?
11. < !--[if !supportLists]-->

12.
<!--[endif]-->Emil Durkheim
< !--[if !supportLists]-->
<!--[endif]-->Talcott Parsons
< !--[if !supportLists]-->
<!--[endif]-->Ferdinand Tonnies
< !--[if !supportLists]-->
 Herbert Spencer
<!--[endif]-->Radcliffe Brown
13.
14. <!--[endif]-->Which one of the following coined the word sociology?
15.

16.
Emil Durkheim
August Comte
< !--[if !supportLists]-->
<!--[endif]-->Herbert Spencer
< !--[if !supportLists]-->

< !--[if !supportLists]-->

Max Weber
17.
18. The following are societal institutions, except:
19.

The school
The church
The hospital
The state
The family
20.
21. Which one of the following branches of sociology is associated with social interaction
between people?
22.
Criminology
Medical sociology
Political sociology
Sociology of religion
Rural sociology
23.
24. The following are sociological theories, except:
25.
Deviant theory
Theory of culture and poverty
Structural – functionalism theory
Social conflict theory
Psychodynamic theory
26.
27. The following disciplines are closely linked to sociology, except:
28.
Anthropology
Psychology
Philosophy
Social sciences
Mathematics
29.
30. Sociology is important to medical students in the following ways except:
31.
Provide knowledge about the various classes in society and their influence on behavior
< !--[if !supportLists]-->
Sociological theories provide guiding principles in research evaluation and intervention
with patients

Provide knowledge about cultural differences which are important in assessment and
rehabilitation of individual and families

Provide knowledge on lack of relationship between other social sciences.

Provides knowledge on the importance of psychodynamic evaluation and intervention

with individuals and families
32.

34. Unit 1 Review Questions

35.

37. Self Assesment Questions

38. < !--[if !supportLists]-->Which of the following theory is associated with anomie?
39.
The Deviant theory
Theories of culture and poverty
< !--[if !supportLists]-->

Functionalism and systems theory

Evolutionary theory.
40.
41. < !--[if !supportLists]-->Which of the following was the proponent of deviant theory?
42. < !--[if !supportLists]-->

43.
<!--[endif]-->Emil Durkheim
 < !--[if !supportLists]-->
<!--[endif]-->Talcott Parsons
< !--[if !supportLists]-->
<!--[endif]-->Ferdinand Tonnies
< !--[if !supportLists]-->
Herbert Spencer
<!--[endif]-->Radcliffe Brown
44.
45. <!--[endif]-->Which one of the following coined the word sociology?
46.

47.
Emil Durkheim
August Comte
< !--[if !supportLists]-->
<!--[endif]-->Herbert Spencer
< !--[if !supportLists]-->

< !--[if !supportLists]-->

Max Weber
48.
49. The following are societal institutions, except:
50.

The school
The church
The hospital
The state
The family
51.
52. Which one of the following branches of sociology is associated with social interaction
between people?
53.
Criminology
Medical sociology
Political sociology
Sociology of religion
Rural sociology
54.
55. The following are sociological theories, except:
56.
Deviant theory
 Theory of culture and poverty
Structural – functionalism theory
Social conflict theory
Psychodynamic theory
57.
58. The following disciplines are closely linked to sociology, except:
59.
Anthropology
Psychology
Philosophy
Social sciences
Mathematics
60.
61. Sociology is important to medical students in the following ways except:
62.
Provide knowledge about the various classes in society and their influence on behavior
< !--[if !supportLists]-->
Sociological theories provide guiding principles in research evaluation and intervention
with patients

Provide knowledge about cultural differences which are important in assessment and
rehabilitation of individual and families

Provide knowledge on lack of relationship between other social sciences.

Provides knowledge on the importance of psychodynamic evaluation and intervention

with individuals and families
63.

SECTION 1: THE INSTITUTION OF MARRIAGE

Welcome to the first section of unit 2 on the institution of marriage. This lecture will form the
first part of social relationship after the introduction and theories of sociology and social causes
of mental illnesses. In this section you will be introduced to the institution of marriage which
is defined as the union between two people. A successful marriage forms the basis of stable
relationships which contributes to the well-being of the couple and the individual in the society.
We will also learn about factors contributing to the success of a marriage, strains of a marriage,
separation and divorce, consequences of a divorce and resolution of conflicts. I hope this
section will be stimulating. Enjoy!

Before we proceed to discuss the section, let’s look at the objectives which will help you
understand the section.
 Section Objectives

By the end of this section, the you should be able to:

1. <!--[if !supportLists]--><!--[endif]-->Define the institution of marriage

2. <!--[if !supportLists]--><!--[endif]-->List the types of marriages
3. <!--[if !supportLists]--><!--[endif]-->Describe the purpose of a marriage
4. <!--[if !supportLists]-->Describe selection of a marriage
5. <!--[if !supportLists]--><!--[endif]-->List marriage restrictions
6. <!--[if !supportLists]--><!--[endif]-->Describe benefits and strains of a marriage
7. <!--[if !supportLists]--><!--[endif]-->List characteristics of a marriage and making a
marriage work
8. <!--[if !supportLists]--><!--[endif]-->Describe marital resolution and contemporary
view about marriage
9. Describe the consequences of a marriage.

1.3 Define the institution of marriage

In-text Question 1.8

What is a marriage in your own view?

Marriage is a legal union between man and woman for the purposes of living together and
procreating lawful offspring. Traditionally, marriage was an institution and an arrangement for
and between kin groups designed to effect rights and obligations between two people and
groups of kin (Onyango and Kayongo Male, 1984).

1.4 List the types of marriages

The types of marriages include:

1. Arranged marriages: In this type of marriages the partner is identified by the family. The
decision is between the two families i.e. the bride's family and the bridegroom's family.

2. Love marriages: These are marriages that are based on love. The two meet and fall in love
and decide to get married.

3. Alternatives to marriage: Cohabitation (where a couple live together in a sexual

relationship without getting married) and Gay and Lesbian partnership (where you have
homosexual men and women living together in stable relationships as couples).

1.5 Describe the purposes of a marriage

The purposes of marriage include the following:

1. Child bearing and continuity of lineage

Reproduction is the most important aspect of a marriage. For example, in some communities,
if a woman dies prematurely her family replaces her with her sister and if a man dies his wife
is inherited by-in-laws who bear children for the bereaved. Childlessness resulted in a woman
being sent back or another woman brought to take her place for purposes of childbearing

In matrilineal set up divorce is usually rampant because in this system the women reproduce
for her own family group.

2. Companionship

Having a confidante is very important for the well-being of an individual. It is a buffer

against depression.

3. Condition to regular sex experience

Sex outside or before marriage are considered illegal. So marriage gives one a ticket to
regular sex.

4. The basis of economic activity

Having children means expanded labour force. High economic productivity is based on the
big size of the family.

In-text Question 1.9

Who is likely to be a partner in marriage?

1.6 Describe selection of a partner

Marriage can occur within: that's in one's social group (endogamy) e.g. people marrying
within their own caste or tribe. Outside one's own social group (exogamy) - e.g. cross cousin
marriages. Marriage may also take place between people of similar socio-economic,
religious, racial, educational and ethnic backgrounds. In addition, partners/spouses tend to be
of same ages, with similar levels of intelligence and physical attractiveness. Also some
marriages may be based on romantic love or Widow - inheritance or can be child marriages

1.7 List marriage restrictions

Some of the marriage restrictions include:

(i). Age: - Child marriages are prohibited in most societies. However, child marriages still
occur in some societies e.g. rural sub Saharan Africa and South Asia

(ii). Race, ethnicity, tribe, caste and social class: - There are laws prohibiting certain
marriages e.g. marriages outside particular group.

(iii). Gender: - Restriction of same sex marriages

(iv). Consanguinity: - Restrictions of marriage to relatives

(v). Number of spouses in a marriage: Restrictions against polygamy.

1.8 Describe benefits and strain of marriage

1.8.1 Benefits of a Marriage

Sharing healthy relationship between the couple is necessary for emotional and social growth.
This is because the partners support each other both emotionally and socially. Marriage is
also beneficial because important decisions are made together by the couples. There is also
the fulfillment of social needs like sex and provision of companionship. The isle of White study
done in Britain among women from a low socio-economic residence in Camberbell showed
that women who were married had lower risk of developing depression. Therefore, marriage
prevents the development of depression because social support acts as a buffer to
development of depression and other psychological problems. In a marriage, the couple share
many tasks of marriage i.e. division of labour – important especially when both partners are
employed. Marriage provides opportunity to acquire skills in the art of compromise – able to
compromise when there are differences. The hustles of a marriage can also be a source of
increasing maturity and personal development.

1.8.2 Strains of a Marriage

1. Role confusion- when roles played by the couple are not well defined, this can create
confusion because one partner may take over most responsibility or one partner taking the
responsibility of another partner. In this case who should do what in the family is not clearly
stated.

2. Increased entrance of women within the labour force -has resulted in women spending
most of their time outside the home neglecting the home and children.

3. Arrival of children especially when one or two children are pre-schoolers - this affects the
marital relationship because normal life is disrupted – disagreements on how to handle child
caring practices also occur, the husband also becomes jealous when too much attention is
given to children.

1.9 List characteristics of a successful marriage and making a marriage work

1.9.1 Characteristics of a successful marriage

This is based on the following factors:

1. Each partner getting what they want from the relationship

2. Both partners should fill productive in their own way.
3. Have freedom to share tasks and trials with each other.
4. They should have the ability to adapt to changes and circumstances affecting them.
A successful marriage also hinges upon the following factors akin to the husband

1. His own parental marriage (whether the parent’s marriage was stable or unstable)
2. His level of education
3. His socio-economic status and the stability of his personality.
1.9.2 Making a marriage work

Have an equal – partner marriage in which there is:

1. Lack of privacy for each individual

2. Frank and honest communication – open communication can increase the partners
sense of trust in one another
3. Flexibility of roles
4. Commitment to individual and couples growth e.g. encouraging one to further their
education or to venture into business
5. The couple should have the ability to use conflicts constructively – creative use of
conflicts
6. They should have the ability to give and receive affection in unconditionally way.
7. The couple should have the ability to appreciate common interests and differences.
8. They should accept the fact that each individual is unique and see the other as having
equal status in the relationship. All these make an ideal marriage.

In-text Question 1.10

What are other factors that you think will make a marriage work other than the ones
already mentioned?

1.10 Describe marital resolution and contemporary view about marriage

1.10.1 Marital Conflict Resolution

Effective means of resolving marital conflict include:-

<!--[if !supportLists]-->1. <!--[endif]-->Forgetting about winning – meaning that one cannot

always have it his way without considering the feelings of the other person
< !--[if !supportLists]-->2. <!--[endif]-->Compromise– reach a mutual agreement
< !--[if !supportLists]-->3. <!--[endif]-->Always deal with problems as they come up – should
not issues pending may be harmful to the person.
< !--[if !supportLists]-->4. <!--[endif]-->Listening and trying to understand what the other is
attempting to communicate and explicitly saying what you feel.
Conflict is an essential ingredient in a healthy intimate relationship – when a couple really
listens to each other. However, maintaining a hostile and bitter marriage for the sake of
children may inflict more damage on the children than clear break up in the relationship.

1.10.2 Contemporary View About Marriages

Divorce Rate – there is high divorce rate. Marriage and sexual violence (marital rape)– marital
rape has become common in marriages. Adultery – Infidelity has also become common

Interracial and interfaith marriages occur. All these are as a result of the rapid socio-economic
changes that have taken place.

1.11 Describe the consequences of divorce

Juvenile delinquency is associated with broken homes as studies have shown. It has also been
reported that boys of divorced parents show a higher rate of behavioural disorders and problems
with interpersonal relationships

Divorce also leads to two families in distress instead of one – and this becomes very devastating
to children and spouse. Also children of parents with conflicts between them have lower self-
esteem. They are characterized by psychosomatic illness, delinquent behaviour and parent-
child adjustment problems. In adolescents there is usually adjustment problems and hence
rebellion. Children of divorced parents also lack the interpersonal skills of bargaining and
negotiation, problem solving and conflict resolution. Divorce may also lead to alcoholism or
depression in one of the spouses or both.

It can also lead to suicide

1.12 Summary

We have come to the end of this section. Hope you have enjoyed the section. In this section
we defined the institution of marriage and described types, purpose, benefits, restrictions,
how to make a marriage work, conflict resolutions and consequences of divorce. Marriage
has numerous benefits but has equally numerous ups and downs resulting in conflicts and
eventual break down of the marriages. Children from broken homes developed insecurity
problems than children raised under stable circumstances. It is would be unwise to remain in
a hostile and bitter marriage for the sake of children because this may inflict more damage on
children than divorce.

1.13 Suggested further readings

1. <!--[if !supportLists]-->Green B. (1998). “The Institution of Woman-Marriage in

Africa: A Cross-Cultural Analysis” Vol. 37, No. 4 (Autumn, 1998), pp. 395-412,
Published by: University of Pittsburgh- Of the Commonwealth System of Higher
Education
2. African Textbook of clinical psychiatry and Mental Health. EDS. Professor Ndetei
and colleagues. AMREF. 2006

Let’s now move to the next section under this unit which is the family
SECTION 2: THE FAMILY

Welcome to this section on the family. This section is linked to the previous one on the
institution of marriage. Without a marriage one cannot be sure that a family exists. Just like
the institution of marriage, family is an important institution in every society whether
industrialized or developing and is associated with the well - being of its members
particularly if the family is supportive. The family is considered to be supportive when the
family fulfills certain functions which include sexual, reproduction, socialization, economic,
emotional and assignment of roles. The family is also supportive when roles are well defined
and there is no role confusion as well as division of labour. The family also fulfils emotional
and physical needs of individuals for economic and social development and provides safety
net for the children i.e. shelter, food, clothes, education and love. The family supports and
protects its members and it is in the family where socialization takes place. The family should
also be free of conflicts and provide love and affection to its members. It is therefore,
important for you to learn about the family and its functions.

To understand the family and its functions of the family, let's look at the objectives outlined
below.

2.2 Section Objectives

By the end of this section, the you should be able to:

< !--[if !supportLists]-->1. <!--[endif]-->Define the family.

< !--[if !supportLists]-->2. <!--[endif]-->Explain the various forms of family.
< !--[if !supportLists]-->3. <!--[endif]-->Describe the family roles.
< !--[if !supportLists]-->4. <!--[endif]-->Describe the functions of the family.
< !--[if !supportLists]-->5. <!--[endif]-->Describe changes occurring in the family due to the
rapid socio-economic changes.
Describe ways in which the family could be helped to resolve problems.

2.3 Introduction to the family

In-text Question 1.11

What is your view of the family?

Basically, the family is the social unit for bringing children into the world and all societies-
primitive, developing and industrialized have some form of family. Historically, the family
was a sacred and important institution in society because:

(i) The family was the source of happiness and well-being

(ii) The family was the source of socialization and reproduction of the labour force

(iii) The man was the breadwinner and the woman the homemaker and
(iv) Children helped in duties according to ages and sexes.

Today the traditional family unit has become outmoded due to the rapid socio-economic
changes; the structure of the family has changed, for example, the extended family has
disintegrated and the size of the family has also declined

2.4 Definition of the family

Generally, the family is defined as comprising of an adult of both sexes with at least one child
living under the same roof and sharing the same facilities. They have to be related by blood,
adoption or by marriage. The following sociologists have attempted to define the family:

Murdock G.P., (1949)defines the family as: “a social group characterized by common
residence, economic, cooperation and reproduction. According to him the family should consist
of adults of both sexes who maintain a socially approved relationship, with one or more
children of their own or adopted. Murdock’s definition is based on the nuclear family. He
considered the nuclear family as the ideal type of family to which people should aspire.

Goode (1987)also defined the family as a social unit consisting of at least two adult persons of
the opposite sex residing together and engage in division of labour. They share many things in
common such as food, sex, residence and social activities. Parents have authority over their
children and a duty to protect and nurture their children.

Onyango and Kayongo Male (1984)defined the family as consisting of a husband, a wife and
their offspring. They considered the nuclear family.

Take Note 1.13

It is important to note that family is universal and a dynamic entity in societies because
members take different roles and go through life cycle and Society is not static but keeps on
changing.

2.5 Forms of family

2.5.1 Nuclear family: is a domestic unit composed of a man and woman in a stable marital
relationship with their dependants. Before industrial revolution the societies were based on
extended kinship systems. After industrial revolution nuclear family become dominant.
Nuclear family can be extended horizontally and vertically. Horizontally, when polygamy
exists and the unit includes the children of all the spouses and vertically, when members of
different generations share a common residence.

2.5.2 Extended family: is a form of family where more than one generation of husbands and
wives cohabit with their offspring. Extended can also include other relatives who are not
nuclear members such as cousins, uncles etc. A Joint family is an example of a form of
extended family

2.5.3 Single parent family: This is a family with only one parent and one or more children.
Children may be natural children of the parent or fostered or adopted. The parents may be
separated, divorced, widowed or unmarried.
2.5.4 Child headed family: Child headed family is one in which a child takes up the
responsibility of the siblings.

2.6 Family Sex Roles

Male and female roles have always been different. Traditionally, the woman was the home
maker and the man the bread winner. Child bearing and nursing was purely a woman’s role
and children helped according to their sexes and ages.

Colonial times, the roles changed due to the introduction of forced labour and cash economy.
Women and children fulfilled the role of fathers. Children engaged in exploitative work and
parental authority over children declined

Today the woman is still responsible for the home and children. In rural areas the women are
subsistence farmers and in the urban areas the woman is over burdened because the man is
supposed to be the provider but does not provide fully. Children on the other hand spend more
time in school and therefore not involved in tasks at home.

2.7 Functions of the family

The basic functions of the family according to functionalist are:

< !--[if !supportLists]-->2.7.1<!--[endif]-->Reproduction: Is an important function of the

family because it is believed to contribute to the workforce for the family and also
provide continuity of the lineage. However, the size of the family has declined from
about 5 - 7 children to just 1 or 2 children. The reason for these changes is because of
the social conditions affecting the family and the economic advancement

< !--[if !supportLists]-->2.7.2<!--[endif]-->Socialization: Teaches individuals societal values,

beliefs and skills to take up roles in society. There are two types of socialization that
include:

< !--[if !supportLists]-->a.<!--[endif]-->Primary

Occurs within the family, playgroups and neghbourhood that gives the individual his
earliest and complete experience. It is in the family: that members of close physical and
emotional proximity socially interact with one another informally and that is where
individuals first encounter the way in which people who have authority behave.

< !--[if !supportLists]-->b.<!--[endif]-->Secondary socialization

Secondary socialization occurs in large institutions such as schools, place of work e.t.c.
Moulds behaviour towards achieving the economic and political goals.

< !--[if !supportLists]-->c.<!--[endif]-->Traditional vs modern societies

In traditional societies a child was socialized by the whole community and the agents of
socialization included: peer groups, grandparents, siblings, foster parents and parents. In
modern societies agents of socialization include: house workers, fathers, grandparents and
peer groups.
 Effective socialization will depend upon: Warmth and nurturance, consistency, freedom,
communication, punishment

< !--[if !supportLists]-->2.7.3<!--[endif]-->Economic function: Provides emotional and

financial support for each individual. Children are also provided with love and affection
and shelter, nourishment, education and protection.

< !--[if !supportLists]-->2.7.4<!--[endif]-->Sexual Function: Sexual intercourse in marriage

is a right for both the partners and must be accorded. Sexual function may not just be
confined to one legal partner. For example, in the Nayar community a woman could
have as many as twelve lovers and for a man there was no limit.

< !--[if !supportLists]-->2.7.5<!--[endif]-->Emotional support: Provides love and affection to

members. Children who are loved will also learn to love others.

< !--[if !supportLists]-->2.7.6<!--[endif]-->Assignment of social roles: Provides a racial,

ethnic, religious, and gender identity to children. Gives people a sense of belonging.

2.8 The family and rapid socio-economic changes

Under this we are going to discuss family structure, economic changes, socialization and
educational changes, nurturance and support, reproduction and assignment of roles.

Let’s now proceed to discuss them

< !--[if !supportLists]-->1. <!--[endif]-->Family structure

The 1960 Women's Liberation Movement and the shifting roles of women within the home
devalued the importance of the family as a sacred and important institution. Mothers are
working outside the home and neglecting their children. Marriages are breaking down at an
increasing rate.

Step – families are emerging due to remarriages. Nuclear families have emerged instead of
extended families. Migration from rural to urban centres in search of employment resulted in
disintegration of the extended family system.

< !--[if !supportLists]-->2. <!--[endif]-->Economic changes

Economic changes are the number one stress factors. Extended families are no longer economic
units due to the increase in single – parent families and inflation has resulted in both parents
working.

< !--[if !supportLists]-->3. <!--[endif]-->Socialization/educational changes

Schools have become the main source of education that was once the domain of the family

< !--[if !supportLists]-->4. <!--[endif]-->Nurturance and support

Family’s role of providing care to children, the sick and the elderly has diminished. Families
are relying more on childcare centres and homes
< !--[if !supportLists]-->5. <!--[endif]-->Reproduction

The size of the family has decreased considerably

< !--[if !supportLists]-->6. <!--[endif]-->Assignment of social roles

Family roles have changed and not well defined.

2.9 Consequences of the Socio-Economic Changes

The consequences of socio-economic changes include psychological, social and economic

problems. Let’s now look at these problems in turn.

2.9.1 Psychosocial and Economic Problems

These problems are discussed below.

< !--[if !supportLists]-->1. <!--[endif]-->Conflicts

Some of the social problems due to socio-economic changes are marital disharmony, role
conflicts etc. These conflicts in the family have resulted in separation and divorce, violence
e.g.child physical abuse, wife and husband battering. Children from such families may suffer
neglect and may not receive love and affection. Social problems like poverty, drought,
negative ill health conditions like AIDS, have affected the family negatively.

< !--[if !supportLists]-->2. <!--[endif]-->Economic problems

Possible economic problems include financial difficulties, poor environmental conditions and
unemployment. The social and economic problems are likely to contribute to psychological
problems.

< !--[if !supportLists]-->3. <!--[endif]-->Psychological problems

Separation and divorce result in creation of two families in distress instead of one. The
husband may suffer from depression due to role conflicts. The wife may also suffer from
depression as a result of too much responsibility that she may not be able to cope with.

Abused children may develop behaviour or personality problems. They may also suffer from
anxiety, depression and PTSD.

Poor living conditions are stressful resulting in depression, antisocial behaviour, and alcohol
and drug abuse among the family members. Marital disharmony has negative psychological
effect on children and the spouses.

2.8 Intervention
In the next section we will look at the various intervention strategies which include
psychotherapy, provision of practical help, chemotherapy and admission to hospital.

2.10.1 Psychotherapy

When family members develop psychological problems they will require individual, family
therapy and supportive psychotherapy. In the case of marital disharmony the couple may
require marital therapy to help the couple cope.

2.10.2 Provision of Practical Help

When the family is unable to cope financially then financial assistance would be necessary.
In case of violence where the child or a family is being abuse then environmental
manipulation would be indicated.

2.10.3 Chemotherapy

Chemotherapy may be indicated in certain conditions such as depression and anxiety.

2.10.4 Admission to Hospital

Individuals with suicidal intention may require admission.

2.9 Summary

We have come to the end this section. In this section we defined the family as social unit
which consists of two adults relating together with their offspring and sharing things in
common. We also learned that the family is a sacred and important institution in society with
various functions including reproduction, socialization, economic, sexual, assignment of roles
and provision of support. These functions are important for the wellbeing of an individual in
the society. For example, it is in the family where individuals learn to interact with others
which prepare them for their relationships with others outside the family. They also learn to
take up roles for their future responsibility in the society. Due to the rapid socio- economic
and cultural changes the family has disintegrated resulting in social, economic and
psychological problems. However, others see it as achieving a new vitality and stability
because the family houses and sustains the socialization and confirmation of future society.
We hope you have enjoyed the lecture.

2.10 Suggested further readings

1. Kayongo – Male D., and Onyango P. (1984) “The Sociology of the African Family”
Longman Group Ltd. 1984.
2. Goode W. J. (1987) “The Family” Second Edition. Prentice-Hall, Inc., Englewood
Cliffs, N.J., USA.
3. Josef G. and Flanagan W. (1978) “Urbanization and Social change in West Africa”,
London, Cambridge University Press, 1978.
4. Ernest W. Burgess. "The Family in a Changing Society," American Journal of
Sociology, LIII (May, 1948), 417-422.
 5. Carle C. Zimmerman. Family and Civilization. New York: Harper, 1947.

Let’s now proceed to the third section under this unit which is the individual and society.

SECTION 3: THE INDIVIDUAL AND SOCIETY

Welcome to this lecture on the individual and society. This section is tied to the previous
section on the family because it is in the family where the individual. It is in the family where
they acquire skills for socialization in the wider society where he/she now interacts with people
outside the family. In this lecture we will define the individual and society, state the types of
society, the various institutions in society and the individuals integration within these
institutions and finally discuss culture and the problems that an individual encounter in the
society.

Section Objectives

By the end of this section, you should be able to:

1. <!--[if !supportLists]--> <!--[endif]-->Define concepts

2. <!--[if !supportLists]-->Describe the role of society and basic institutions.
3. <!--[if !supportLists]--><!--[endif]-->Describe culture and society.
4. Describe possible problems an individual encounters in society.

3.3 Definition of Concepts

An individual is part and parcel of the society and has a role to play in society just as the society
plays an

3.3.1 An Individual

In-text Question 1.12

Who is an individual?

An individual is a person considered separately rather than as part of a group or a person who
is original and very different from others.

According to Oxford advanced learners dictionary an individual is a specific object and

according to sociologists individual refers to single mortal human being regardless of his/her
social position.

In lay terms, an individual is referred to as Man or is just you and me.

3.4.3 The Relationship between the Individual and Society

In-text Question 1.13

Are individuals separate from society or part of society?

According to sociologists, no man is an island; every man is a part of the main. This means
that from birth to death each person is a participating part of the larger society. No one has
existed independent of the society. For example, individual is a social animal that lives in a
social group in communities and in society.

Society is an essential condition for human life to begin and continue. It is in the society that
the individual is surrounded and encompassed by culture which is a societal force. Individuals
conform to the norms, occupy statuses, and become member of groups. They acquire language
through social interaction with others. For example, interacts with others in schools, at the
workplace, in the market place, at home between parents and their children. Each individual
feels thinks and acts as a result of social interaction.

Though individuals have their own identity, each one of us is bound in some degree to other
people and society in general.Socialization has broken the individual barrier and merged him
into the society.

Take Note 1.13

Individual and society therefore, are closely intertwined and interdependent. Meaning one
depends on the other.

3.4 Types of Societies

There are two types of societies namely, traditional and modern.We will discuss these two
types of societies in turn.

3.4.1 Traditional Society

Traditional societies include the following:

< !--[if !supportLists]-->1.<!--[endif]-->Hunter/gatherer

< !--[if !supportLists]-->2.<!--[endif]-->Nomadic pastoral

< !--[if !supportLists]-->3.<!--[endif]-->Horticultural – Is agricultural involves cultivation of

land and raising farm animals. The Feudal societies were based on ownership of land

3.4.2 Modern Society

This type of society is based on formal education, automobile and relies heavily on machines
powered by fuel for the production of goods. There is the use of computers and
telecommunications, electronic information resources and Social networks
Modern societies are as a result of transformation of societies which sociologists believe
changed from simpleprimitive complex and civilized societies. They concluded that
societies are not static but keep on changing and in the process the individual is also changing
in terms of behaviour, culture etc.

3.4.3 The Relationship between the Individual and Society

In-text Question 1.13

Are individuals separate from society or part of society?

According to sociologists, no man is an island; every man is a part of the main. This means
that from birth to death each person is a participating part of the larger society. No one has
existed independent of the society. For example, individual is a social animal that lives in a
social group in communities and in society.

Society is an essential condition for human life to begin and continue. It is in the society that
the individual is surrounded and encompassed by culture which is a societal force. Individuals
conform to the norms, occupy statuses, and become member of groups. They acquire
language through social interaction with others. For example, interacts with others in schools,
at the workplace, in the market place, at home between parents and their children. Each
individual feels thinks and acts as a result of social interaction.

Though individuals have their own identity, each one of us is bound in some degree to other
people and society in general.Socialization has broken the individual barrier and merged him
into the society.

Take Note 1.13

Individual and society therefore, are closely intertwined and interdependent. Meaning one
depends on the other.

3.5 The Role of Societies and Basic Institutions

This is discussed as follows:

3.5.1 The Role of Society

The following are the roles of society:

<!--[if !supportLists]-->1. <!--[endif]-->Society supports the growth and potential of the

individual.
< !--[if !supportLists]-->2. <!--[endif]-->Recognizes and empowers the individual at the
economic level.
< !--[if !supportLists]-->3. <!--[endif]-->Empowers the individual culturally.
< !--[if !supportLists]-->4. <!--[endif]-->Fosters personal growth and development of its
individual citizens.
< !--[if !supportLists]-->5. <!--[endif]-->Offers a wide scope for the individual to become
independent after acquiring the necessary skills.
< !--[if !supportLists]-->6. <!--[endif]-->The individual in turn supports the growth and
development of society in terms of culture, economics, psychological and spiritual. His
work is more and more for groups, society and the world.
3.5.2 The Role of Basic Institutions in Society

The basic institutions in society include: the family, schools, community, organizations and
the state. These institutions are important in every society whether traditional or modern
because they:

< !--[if !supportLists]-->1. <!--[endif]-->Satisfy basic needs of individuals

< !--[if !supportLists]-->2. <!--[endif]-->Define dominant social values for the individual.
< !--[if !supportLists]-->3. <!--[endif]-->Establish permanent patterns of behaviour –
laws/norms.
< !--[if !supportLists]-->4. <!--[endif]-->Provide roles for the individual.
< !--[if !supportLists]-->5. <!--[endif]-->Provide medical care and social welfare.
< !--[if !supportLists]-->6. <!--[endif]-->Provide education – knowledge and skills.
< !--[if !supportLists]-->7. <!--[endif]-->Provide opportunities for Interaction with others.

Let’s now discuss the functions of the various institutions in turn beginning with the family.

< !--[if !supportLists]-->1. <!--[endif]-->The family

< !--[if !supportLists]-->a. <!--[endif]-->It is within the family that individuals interact with
adults in authority.
< !--[if !supportLists]-->b. <!--[endif]-->Learns family values and ideals and internalizes
them.
< !--[if !supportLists]-->c. <!--[endif]-->Family provides sex roles for the individual.
< !--[if !supportLists]-->d. <!--[endif]-->Prepares the individual for interaction with others
outside the family.
 < !--[if !supportLists]-->e. <!--[endif]-->It is in the family that process of socialization
begins.
< !--[if !supportLists]-->f. <!--[endif]-->It is also in the family where individuals become
acquainted and learn about their culture which represents values and ideals.
< !--[if !supportLists]-->g. <!--[endif]-->The individual identifies with the cultural values
transmitted by the family.

The role of the family in life then begins to vanish, as the individual person is learning to stand
on his own and this brings us to the next institution which is the school.

< !--[if !supportLists]-->2. <!--[endif]-->The schools

< !--[if !supportLists]-->a. <!--[endif]-->The schools play a role in transmitting culture

through interaction with others.
< !--[if !supportLists]-->b. <!--[endif]-->Prepares the individual for occupational roles
< !--[if !supportLists]-->c. <!--[endif]-->Provides the individual with knowledge and skills
for personal growth and functioning in society.
< !--[if !supportLists]-->d. <!--[endif]-->Education serves as means to convert individuals
into fully functioning members of society.

It is in the school that the individual first interacts with people outside the family and then
the wider community which brings us to the functions of the next institution which is the
community

< !--[if !supportLists]-->3. <!--[endif]-->The community

< !--[if !supportLists]-->a. <!--[endif]-->Provides environment for the individual to adapt,

achieve set goals and integrate.
< !--[if !supportLists]-->b. <!--[endif]-->Within the community there are also health
institutions, NGOS, and schools which provides services to the individual in society.
< !--[if !supportLists]-->c. <!--[endif]-->Provide health care and social welfare services.

In the wider community, the individual become integrated into societal institutions such as
the work place when the individual has acquired skills and has secured employment. He learns
to interact with others at the work place and this brings us to the functions of the next
institution which is the organization

< !--[if !supportLists]-->4. <!--[endif]-->The organization

< !--[if !supportLists]-->a. <!--[endif]-->Provides an environment for interaction with

others
 < !--[if !supportLists]-->b. <!--[endif]-->Provides the individual with opportunity for
personal growth and development

< !--[if !supportLists]-->5. <!--[endif]-->The state

< !--[if !supportLists]-->a. <!--[endif]-->The state enforces laws that regulate the society
(Social checks) so that the individuals are not left to their own devices since lack of
regulatory norms lead to social ills committed by individual in society.
Durkheim believed that de-regulation resulted in anomic suicide and other social ills.
Overly strong regulation of individuals as opposed to deregulation results in altruistic
suicide.
< !--[if !supportLists]-->b. <!--[endif]-->Provides courts through which conflicts can be
resolved.
< !--[if !supportLists]-->c. <!--[endif]-->Provides for the welfare of individuals.
< !--[if !supportLists]-->d. <!--[endif]-->Protects citizens from external threats.

Take Note: 1.14

Individuals are also losing faith in the existing institutions due to unresolved social problems
such as: Unemployment, war, poverty, lack of security, disarmament, etc.

3.6 Culture and the Individual

Without culture man would be no more than another species of baboon. The individual
belong to a group - tribe, race, religious group etc. The culture to which one belongs
influences the behaviour, language, dressing, food etc. When dealing with individuals it is
important to know cultural background of the individual because knowing the culture will
help in effective intervention with the person. I wish to refer you to module 5 on the section
that deals with culture and social diversity

3.7 Possible Individual Problems in Society

The following are some of the likely problems the individual may have as a member of a
particular society. We will not describe these problems in details because most of them have
already been covered in unit 3 under the social causes of mental illnesses.

1. <!--[if !supportLists]--> <!--[endif]-->Loneliness

2. <!--[if !supportLists]--><!--[endif]-->Role problems
3. <!--[if !supportLists]-->Lack of skills
4. <!--[if !supportLists]--><!--[endif]-->Crimes and other social ills
5. <!--[if !supportLists]--> <!--[endif]-->Low self-esteem
6. <!--[if !supportLists]--><!--[endif]-->Lack of identity
 7. <!--[if !supportLists]-->Psychological problems
8. <!--[if !supportLists]--><!--[endif]-->Alcohol and drug abuse
9. 3.8 Section Summary
10. We have come to the end of this section in which we talked about the individual and
society. In this section we defined the individual and society in which the individual is
referred to as one who is apart from the other with uniqueness in characteristics.
Society on the other hand is referred to as a group or large social grouping sharing the
same geographical area or territory. The section also looked at types of societies
which include traditional, modern and the transformation of societies, the relationship
between the individual and society that is the influence the various institutions have
on the individual. We noted that society influences the individual and his/her
behaviour, yet the individual exerts an amount of influence on his or her society and
that integration into society depends on factors, such as psychological make-up i.e. if
the individual is psychologically unstable then the he/she will have serious problems
and that if the individual is not integrated into the society then he/she will develop
problems such as alcoholism and drug abuse and other psychological problems.

3.9 Suggested Further Readings

1. <!--[if !supportLists]-->The African Texbook of Clinical Psychiatry and Mental

Health. Eds Professor Ndetei and Colleagues. AMREF 2006.
2. <!--[if !supportLists]-->Triangle “Life Events and Psychiatry”. Sandoz Journal of
Medical Science. Vol 29, No.2/3 1990.
3. <!--[if !supportLists]-->Internet

Unit Activity 1.2

In group

1. Using the materials provided and from elsewhere please discuss selection of a marriage
partner in the context of traditional and western societies.

2. Discuss marriage selection with special reference to your own communities.

3. In your own views, discuss whether the individual is part or separate from the society.

Unit 2 Review Questions

Unit 2 Review Questions

The following are the ingredients of a successful marriage, except:

Each partner getting what they want from the relationship

Both partners should fill productive in their own way.
Have freedom to share tasks and trials with each other.
 They should have the ability to adapt to changes and circumstances affecting them
The in-laws should be the decision makers

The following are purposes of a marriage, except:

Child bearing and continuity of the lineage

Companionship
For regular sex
For economic activities
For wives to remain faithful to their husbands

Which of the following functions of the family is associated with giving love and affection?

Sexual function
Emotional function
Reproduction function
Socialization function

The following are marriage restrictions, except:

Age
Race
Ethnicity
Social class
Child labour

The following are individual problems in society, except:

Loneliness
Crime and other social ills
Social support
Alcohol and drug abuse
Psychological problems
UNIT 3: CRIME, DEVIANCE AND HEALTH IMPLICATIONS

Welcome to this unit on crime, deviance and health implications. Criminology and deviance
are societal malfunctions which sociologists believe are due to lack of regulatory norms or
rules in society and has been associated with mental illnesses. This means that people who are
involved in criminal offence have some element of mental illness and delinquent and antisocial
behaviour result in mental disorder. In this unit we are going to focus on the definition of
concepts, types of crime and deviance, theoretical perspectives of crime and deviance, the
causal factors and the health implications. For easy of delivery of this unit, it has been divided
into the following sections:

Section 1:Concepts and perspectives of crime and deviance

Section 2: The Health implications of crime and deviance.

Before we proceed to look at the different sections of this unit, let’s look at the objectives of
the unit as follows:

Unit Objectives

By the end of this unit, the students should be able to:

1. <!--[if !supportLists]-->Describe the concepts and perspectives of crime and

deviance.
2. Discuss the health implications of crime and deviance.

SECTION 1: CONCEPTS AND PERSPECTIVES OF CRIME AND DEVIANCE

Welcome to this first section of unit 3. Criminal and deviant behaviours in society has
become common in societies due to the transformation of societies which have become
complex and without moral regulations. Sociologists believe that rapid socio - economic
changes have a role to play because these changes have resulted in deregulation of society. In
this section therefore we are going to define crime and deviance, list the types of crime and
deviant behaviours, and describe the theoretical basis of crime and deviance and the
relationship between crime/deviance and mental disorders and the criminal justice system.

Before we proceed to discuss this section in detail, let's look at the objectives of this section
below:

Section Objectives

1. By the end of this section, you should be able to:

2. <!--[if !supportLists]--><!--[endif]-->Define nature and meaning of crime and
deviance.
3. <!--[if !supportLists]-->Describe the types of crime and deviance.
4. <!--[if !supportLists]--><!--[endif]-->Describe the causes of crime and deviance.
5. <!--[if !supportLists]--><!--[endif]-->Describe the theoretical basis of crime and
deviance.
 6. <!--[if !supportLists]-->Discuss the health implications of crime and deviance.
7. Describe the role of criminal justice system.

Let us now proceed to the first sub-section which describes the nature and meaning of crime
and deviance.

1.3 Nature and Meaning of Crime and Deviance

The nature of crime and deviance will be looked at in turn to distinguish between the two.
We now proceed to discuss them as subsections 1.3.1 and 1.3.2

1.3.1 Nature and Meaning of Crime

Criminal activities are on the increase in most parts of the world including Kenya and these
are attributed to the rapid socio-cultural changes that have occurred. However, proper
intervention strategies have not been advanced to help curb this growing problem. Prisons
are there but the victims ones discharged engage in the same behaviour. This indicates that
imprisonment does not really curb the crime problem. Better alternative ways of managing
the problem should be devised

Crime or criminal behaviour is behaviour that goes against the norms and standards of a
particular group. The types of criminal or violent behaviours are discussed under types of
crime below.

1.3.2 Nature and Meaning Deviance

In-text Question 1.14

What does deviance mean to you?

Deviant behavior is a form of behavior which goes beyond the expected or approved behavior
of the group. It is a behavior which may be tolerated, approved or disapproved by the group.
What is considered deviant in one society may not be considered as such in another. What is
deviant in a particular society at a particular time and place may not be considered as deviant
at a future time.

Deviance can be criminal or non‐criminal. Criminal deviant behavior according to the

sociological discipline that deals with crime(behavior that violates laws) is criminology (also
known as criminal justice).

1.4 Types of Crime and Deviance

The types of crime and deviance are discussed below:

1.4.1 Types of Violent Crimes

The types of some violent crimes include the following:

1. Homicide: The killing of one person by another (regardless of the circumstances).

2. Murder: The intentional killing of another human being.

3. Felony murder: A term some states use for a death that occurs during the commission of a
serious felony, such as robbery or kidnapping. (All participants in such a felony can be
charged with murder.)

4. Manslaughter: The unintentional killing of another person, where the killer engages in
reckless conduct that causes a death.

5. Negligent homicide: The causing of someone's death through negligence.

6. Battery: The act of making offensive physical contact with someone.

7. Assault: The threat of a battery, or an attempted battery, without actual physical contact.
There is simple assault or battery - the act of causing someone low-level - not serious -
physical injury and aggravated assault or battery which is a serious felony conduct that
involves the use of a dangerous or deadly weapon or that results in serious injury. Also
spousal assault (also called domestic assault or intimate partner violence): Violence
between domestic partners.

8. Rape: The act of forcibly compelling someone to have sexual intercourse, or sexual
intercourse between an adult and a partner under the age of 18, or the act of having
intercourse with someone whom the law deems incapable of consent because of a mental
handicap.

9. Sodomy: The act of having forced anal or oral sex with someone, or the consensual act of
participating in those same acts between an adult and a juvenile.
Figure 18: The Rate of Violent Crimes by Gender

The indication from figure 18 is that between 1973 and 2003 about 70% of males compared
to 30% of females committed violent crimes.

Take Note 1.14

In criminology, how a violent crime is approached depends very much on how the crime is
defined. So many different legal terms exist for various forms of violent crimes that it’s often
hard for people to keep track of what means what.
Figure 19: Rates of Rape Cases by Countries

It is clear from figure 19 that South Africa had the highest rape cases in 2002 and Saudi
Arabia had none.

1.4.2 Types of Deviance Behaviour

Americans consider such activities such as alcoholism, excessive gambling, being nude in
public places, playing with fire, stealing, lying, refusing to bathe and purchasing the services
of prostitutes to name only a few-as deviant behaviours. People who engage in deviant behavior
are referred to as deviants.

Other specific types of deviant behavior include: Rape, homosexuality, prostitution, adultery -
extra-marital relations, pornography, exhibitionism, nudism, voyeurism, sadism, and
masochism, violations of human rights, juvenile delinquency, vandalism, Criminality e.g.
perjury, arson, robbery, smuggling, murder, homicide, genocide, kidnapping, etc. There are
also victimless crimes such as drug abuse, runaways and suicide which are considered as
deviant behaviours.

1.5 Theories of Crime and Deviance

The theories of crime and deviance are important because they act as guiding principles in
helping the learner understand these concepts much better. The theories are discussed as
follows:

1.5.1 Important Theories of Crime

In criminology, examining why people commit crime is very important in the ongoing debate
of how crime should be handled and prevented. Many theories have emerged over the years,
and they continue to be explored, individually and in combination, as criminologists seek the
best solutions in ultimately reducing types and levels of crime. Here is a broad overview of
some key theories:

1. Rational choice theory: People generally act in their self-interest and make decisions to
commit crime after weighing the potential risks (including getting caught and punished)
against the rewards.

2. Social disorganization theory: Developed by researchers at the University of Chicago in

the 1920s and 1930s, social disorganization theory asserts that crime is most likely to occur
in communities with weak social ties and the absence of social control. An individual who
grows up in a poor neighbourhood with high rates of drug use, violence, teenage delinquency,
and deprived parenting is more likely to become a criminal than an individual from a wealthy
neighbourhood with a good school system and families who are involved positively in the
community.

Figure 20: Impoverished Areas more likely to lead to Deviant or Criminal Behaviors

(Photo courtesy of Apollo 1758/Wikimedia Commons)

3. Strain theory: Most people have similar aspirations, but they don't all have the same
opportunities or abilities. When people fail to achieve society's expectations through
approved means such as hard work and delayed gratification, they may attempt to achieve
success through crime.

4. Social learning theory: People develop motivation to commit crime and the skills to
commit crime through the people they associate with.

5. Social control theory: Most people would commit crime if not for the controls that
society places on individuals through institutions such as schools, workplaces, churches, and
families.

6. Labeling theory: People in power decide what acts are crimes, and the act of labeling
someone a criminal is what makes him a criminal. Once a person is labeled a criminal,
society takes away his opportunities, which may ultimately lead to more criminal behavior.

7. Biology, genetics, and evolution:Poor diet, mental illness, bad brain chemistry, and even
evolutionary rewards for aggressive criminal conduct have been proposed as explanations for
crime.

1.5.2 Theories of Deviance

A number of theories related to deviance and criminology have emerged within the past 50
years or so. Four of the most well‐known are as follows:

1. Differential-association theory - Edwin Sutherland

He believed that people learn deviance from their interactions with others. Just like
people learn their norms from various socializing agents-parents, teachers, ministers, family,
friends, co‐workers, and the media, they also learn criminal behaviours from interacting with
others, especially in intimate groups. People learn deviance from the people with whom they
associate.

The differential‐association theory applies to many types of deviant behavior. For example,
juvenile gangs provide an environment in which young people learn to become criminals.
These gangs define themselves as countercultural and glorify violence, retaliation, and crime
as means to achieving social status. Gang members learn to be deviant as they embrace and
conform to their gang's norms.

Critics of the differential‐association theory, on the other hand, claim the vagueness of the
theory's terminology does not lend itself to social science research methods or empirical
validation.

2. Anomie theory - Robert Merton

Anomie refers to the confusion that arises when social norms conflict or don't even exist.
Merton in the 1960s in the 1960s used the term to describe the differences between socially
accepted goals and the availability of means to achieve those goals. Merton stressed, for
instance, that attaining wealth is a major goal of Americans, but not all Americans possess
the means to do this, especially members of minority and disadvantaged groups. Those who
are not able to attain the goals to riches experience anomie, because an obstacle has thwarted
their pursuit of a socially approved goal and therefore, may employ deviant behaviors to
attain their goals, retaliate against society, or merely "make a point."

The anomie theory has been criticized for its generality. Critics note the theory's lack of
statements concerning the process of learning deviance, including the internal motivators for
deviance. Like differential association theory, anomie theory does not lend itself to precise
scientific study.

3. Control theory - Walter Reckless

He believed that sometimes people may want to act in deviant ways but they may be
restrained by internal controls such as conscience, values, integrity, morality, and the desire
to be a "good person"; and outer controls, such as police, family, friends, and religious
authorities. These self controls prevent acting against social norms. The key to developing
self‐control is proper socialization, especially early in childhood. Children who lack this self‐
control, then, may grow up to commit crimes and other deviant behaviors.

This theory, therefore, discusses the relationships between socialization, social controls, and
behavior.

4. Labeling theory

This theory holds that behaviors are deviant only when society labels them as deviant. As
such, conforming members of society, who interpret certain behaviors as deviant and then
attach this label to individuals, determine the distinction between deviance and non‐deviance.
Labeling theory questions who applies what label to whom, why they do this, and what
happens as a result of this labeling.

Labelled persons may include drug addicts, alcoholics, criminals, delinquents, prostitutes, sex
offenders, retarded people, and psychiatric patients, to mention a few. The consequences of
being labelled as deviant can result in lower self‐images, rejection of themselves, and may
even act more deviantly as a result of the label. Labelling may be done by the most powerful
people in the society such as the doctors, politicians, teachers, government official etc.

Proponents of labelling theory support the theory's emphasis on the role that the attitudes and
reactions of others, not deviant acts per se, have on the development of deviance. Critics of
labelling theory indicate that the theory only applies to a small number of deviants, because
such people are actually caught and labelled as deviants. Critics also argue that the concepts
in the theory are unclear and thus difficult to test scientifically.

1.6 Section Summary

We have now come to the end of this section in which we looked at the nature and meaning
of crime and deviance, the types of crime deviance behavior, and the theories of crime and
deviance. We realized that people we interact with, environment from which we hail, lack of
self control, lack of regulatory norms and labeling of people have a role to play in crime and
deviance. We hope you have enjoyed the section

1.7 Suggested Further Readings

Macionis, J.; Gerber, L. (2010). Sociology (7th Canadian ed.). Toronto: Pearson. ISBN 978-0-
13-511927-3).

SECTION 2: THE HEALTH IMPLICATIONS ON CRIME AND DEVIANCE

Welcome to this section on health implication of crime/deviance. Lack of regulatory norms in

most societies due to the rapid socio-economic and cultural changes, contribute to the
increase in criminal behaviours including delinquency and antisocial behaviour. There is also
an association between mental disorders of varying types and crime and deviance. In this
section we are going to look at the nature and meaning of health implications, delinquency
and antisocial behaviour, risk factors and protective factors in delinquency, the association
between crime and mental illness and the role of criminal justice systems.

Before we proceed to discuss this section, it is important that we look at the objectives of this
section as follows:

2.2 Section Objectives

By the end of this section, you should be able to:

<!--[if !supportLists]-->1. <!--[endif]-->Explain the nature of health implications.
< !--[if !supportLists]-->2. <!--[endif]-->Explain the nature and meaning of delinquency and
antisocial behavior.
< !--[if !supportLists]-->3. <!--[endif]-->List the risk and protective factors of delinquency
and antisocial
Behavior.
< !--[if !supportLists]-->4. <!--[endif]-->Discuss the association between mental disorders
and criminality.
Describe the role of the criminal justice systems.

SECTION 2: THE HEALTH IMPLICATIONS ON CRIME AND DEVIANCE

Welcome to this section on health implication of crime/deviance. Lack of regulatory norms in

most societies due to the rapid socio-economic and cultural changes, contribute to the
increase in criminal behaviours including delinquency and antisocial behaviour. There is also
an association between mental disorders of varying types and crime and deviance. In this
section we are going to look at the nature and meaning of health implications, delinquency
and antisocial behaviour, risk factors and protective factors in delinquency, the association
between crime and mental illness and the role of criminal justice systems.

Before we proceed to discuss this section, it is important that we look at the objectives of this
section as follows:
 2.2 Section Objectives

By the end of this section, you should be able to:

<!--[if !supportLists]-->1. <!--[endif]-->Explain the nature of health implications.
< !--[if !supportLists]-->2. <!--[endif]-->Explain the nature and meaning of delinquency and
antisocial behavior.
< !--[if !supportLists]-->3. <!--[endif]-->List the risk and protective factors of delinquency
and antisocial
Behavior.
< !--[if !supportLists]-->4. <!--[endif]-->Discuss the association between mental disorders
and criminality.
Describe the role of the criminal justice systems.

2.4 Nature and Meaning of Health Implications

These are factors that may influence the outcome of delinquency and antisocial behaviour.
They are discussed as follows:

2.4.1 Risk Factors of Delinquency

A number of risk factors exist which increase the chances that a child or adolescent will
become delinquent. Some of the risk factors that influence the outcome of delinquency
include:

1. Those that relate to the individual are:

a. Demographic characteristics (e.g., age, race/ethnicity, gender)

b. Aggression, particularly early onset aggressive behaviour

c. Antisocial beliefs, attitudes and behaviours, including early onset antisocial behaviour and
conduct problems

d. Impulsivity

e. Low intelligence, particularly verbal IQ

f. Frequent medical or physical problems

2. Those factors that relate to the family are:

a. Antisocial/criminal family members, including parents and siblings

b. Parent-child separation, which may be either permanent or temporary, resulting from
family disruptions, including out-of-home placement (e.g., foster care or other
residential or institutional care)
c. Parental conflict, including witnessing domestic violence
d. Poor family management practices, including lack of parental monitoring and
supervision, harsh, inconsistent and/or lax discipline, and low parental support
 e. Child maltreatment, including physical, sexual and emotional abuse, and physical and
emotional neglect
f. Large sibship (i.e., 4 or + children)
g. Low family socioeconomic status

3. Those that relate to peer

a. Antisocial/delinquent peer associations

b. Gang membership

c. Peer rejection

4. Those that relate to the school

a. Poor academic performance

b. Poor school attendance, including suspension, expulsion, truancy and dropping out
c. Low school bonding

5. Those that relate to the community/neighbourhood

a. Community disadvantage
b. Community safety/violence

2.4.2 Protective Factors

Protective factors are those factors that protect against the influence of crime and deviance.
These factors include the following:

a. Positive attachment
b. High I.Q
c. Supportive environment
d. 2.5 Risk and Protective Factors in Delinquency
e. The implications of delinquency and antisocial behaviour are outlined below:
f. 1. It is evident that no single risk factor or set of risk factors emerges as the most
salient predictor of antisocial and delinquent behaviour. Rather, a range of factors
from across five life domains interact together and contribute to the emergence and
maintenance of such patterns of behaviour.
g. 2. Understanding the causes of antisocial and delinquent behaviour is best viewed
through a developmental lens. That is, young people who manifest antisocial and
delinquent behaviour may experience different developmental pathways, comprised
of both unique and common risk factors, with certain risk factors likely having their
greatest influence at certain developmental periods during the life course (e.g., the
effects of family factors are likely strongest during early and middle childhood,
whereas peer factors exert their primary influence in adolescence).
h. 3. From a policy and practical perspective, findings from this literature review
underscore the importance for interventions to be targeted to the risk factors that
reflect the specific pathways and that are most salient during different developmental
periods. This is important to ensure maximum impact of the interventions, and so
most efficient and cost-effective use of resources.
 i. 4. Most of the research on the risk factors for antisocial and delinquent behaviour has
been conducted on males. Mental health problems and intimate/romantic relationships
appear especially relevant for females with respect to antisocial and delinquent
behaviour. However, developing a better and more refined understanding of the
causes of crime among young girls is critical and warrants further investigation.
j. 2.6 The Association between Mental Disorders and Criminal Behaviour
k. The criminal justice system consists of agencies like the police, Prosecution Services,
courts, prisons and the probation service which are overseen by the government
departments of home affairs and ministry of justice. The youth offenders are overseen
by the juvenile justice court. These agencies are the main means of identifying,
controlling and punishing known juvenile offenders and other offenders.
l. Let's now look at the role of these agencies in turn.
m. 1. The Police: The police maintain public order by enforcing the law. Police use
personal discretion in deciding whether and how to handle a situation. Research
suggests that police are more likely to make an arrest if the offence is serious and if
bystanders are present.
n. 2. The Courts: Courts rely on an adversarial process in which lawyers,-one
representing the defendant and one representing the defendant present their cases in
the presence of a judge who monitors legal procedures. In practice, courts resolve
most cases through plea bargaining. Though efficient, this method puts less powerful
people at a disadvantage because of lack of bargaining power
o. 3. Punishment: There are four jurisdictions for punishment: retribution, deterrence,
rehabilitation, societal protection. Community-based corrections include probation
and parole. These programs lower the cost of supervising people convicted of crimes
and reduce prison overcrowding but have not been shown to reduce recidivism
(Macionis, J.; Gerber, L. (2010).
p. The question is whether imprisonment prevents crime.
q. To answer this question, we look at the prison systems which are meant to be the
ultimate deterrent, both controlling crime and punishing offenders, but it does not
actually seem to work very well as a crime- prevention measure. There is no
convincing evidence that putting more people in prison significantly reduces crime
and this is because a study in England and Whales found that about 65 per cent of
former prisoners released in 2004 were reconvicted within two years of being
released, and for young men (18-20) it was 75 per cent. (Macionis, J.; Gerber, L.
(2010). Imprisonment therefore, does not stop people from reoffending, nor are high
levels of imprisonment making much impact on reducing crime.
r. 2.7 Section Summary
s. We have now come to the end of this section on the health implications. In this
section we learned about the nature and health implications of delinquency and
antisocial behaviuors. We have also looked at the relationship between mental
illnesses and crime and deviance and finally the role of criminal justice systems which
include prisons, the court, punishment and probation. However, it is evident that
imprisonment does not prevent or control crime conclusively and therefore there is
need for more effective intervention strategies.

2.9 Suggested Further Readings

Day, D.M., & Wanklyn, S.G. (2012). Identification and Operationalization of the Major Risk
Factors for Antisocial and Delinquent Behaviour among Children and Youth.NCPC Research
Report. Ottawa, ON: Public Safety Canada.
After coming to the end of the unit, it is important that we now proceed to look at some
activities and model question or quizzes to test your knowledge about the sections in this
unit. The activities and model questions are as follows:

Unit Activity 1.3

In your groups,

1. <!--[if !supportLists]--><!--[endif]-->Using materials from the sections and from

elsewhere, assess the usefulness of the various theories of crime and deviance.
2. <!--[if !supportLists]--><!--[endif]-->Discuss the effectiveness of the criminal justice
systems in Kenya.
3. Using materials from other sources describe the role of probation department in the
criminal justice system.

Unit 3 Review Questions

Unit 3 Review Questions

A student wakes up late and realizes her sociology exam starts in five minutes. She jumps
into her car and speeds down the road, where she is pulled over by a police officer. The
student explains that she is running late, and the officer lets her off with a warning. The
student’s actions are an example of _________

primary deviance
positive deviance
secondary deviance
master deviance
Tolerant deviance

According to social disorganization theory, crime is most likely to occur where?

A community where neighbors don’t know each other very well

A neighborhood with mostly elderly citizens
A city with a large minority population
A college campus with students who are very competitive
A neighborhood where people know each other well
A convicted sexual offender is released on parole and arrested two weeks later for repeated
sexual crimes. How would labelling theory explain this?

The offender has been labeled deviant by society and has accepted a new master status.
The offender has returned to his old neighborhood and so reestablished his former
habits.
The offender has lost the social bonds he made in prison and feels disconnected from
society.
The offender is poor and responding to the different cultural values that exist in his
community

The criminal justice system consists of the following, except:

The courts
The prisons
The police

Punishment
mob

The jurisdictions for punishment include the following, except:

Retribution
Rehabilitation
Societal protection
Recidivism

UNIT 4: FUNDAMENTALS AND METHODS OF SOCIAL INVESTIGATIONS

Welcome to this unit on fundamentals and methods of social investigation. Methods of Social
investigations are necessary in social research and include observations, focused group
discussions, semi structured interviews. These methods are mainly used in field type of
researches. This unit will also look at the steps in social research. For effective delivery of this
unit, it is divided into 2 sections as follows:

Section 1: Concepts and fundamentals of social research

Section 2: Techniques of data collection in social research

We will now proceed to look at the objectives of this unit as follows:

 Unit Objectives

By the end of this unit the students should be able to:

1. <!--[if !supportLists]-->Describe fundamentals of social research.

2. Describe the techniques in social research.

Next we go straight into the discussion of the first section of this unit.

SECTION 1: FUNDAMENTALS OF SOCIAL RESEARCH

Welcome to this section on methods of sociological investigations. In this section we are going
to define social research and state the purpose of research. We will also look at the types of
sociological research and research design.

We will now proceed to look at the objectives of this section.

1.2 Section Objectives

By the end of the section you should be able to:

1. <!--[if !supportLists]-->Define the concepts of sociological research.

2. <!--[if !supportLists]--><!--[endif]-->State the purpose of sociological research.
3. <!--[if !supportLists]-->Describe types of sociological research.
4. Describe the research designs.

1.3 Definition of Sociological Research

We will begin by the definition of some concepts relevant to sociological research.

1.3.1 Research

Research or investigation means collecting, analyzing, and interpreting information or data in

an attempt to answer questions.

1.3.2 Sociological Research

Social investigation or research is investigation that focuses on how: people behave

generally, interact and earn a living, worship, and raise their children.

Sociological investigation is carefully conducted research through:

a. Observations
b. Recording of facts

c. Focused group discussions

d. Making conclusions

1.4 Purpose of Research

The purpose of research is to:

<!--[if !supportLists]-->• <!--[endif]-->Identify problems and deal with the problems.

< !--[if !supportLists]-->• <!--[endif]--> Answer research questions

1.5 Types of Sociological Research

The following are some of the types of social investigations:

1.5.1 Ethnographic Research

This is a field research which is observational. For example, a tribe in a community can be
studied by field research through observation. In this type of field research qualitative
methods are used. The following are the qualitative methods used

In depth interview, observation (participant observation), focused group discussion, key

informants interviews by use of semi-structured interview schedule and unstructured
interview schedule, case narratives and taking pictures, for example, clothes, cosmetics and
room design and hardware, CDs or DVDs etc.,

An ethnographic research is typically naturalistic i.e. studying events as they appear in real
natural settings. They are Reliable because information is collected through direct means of
observation. It is less biased than survey method because it is done in the field over a period
of time.

a. Participant Observation

Involves, going out to the club with the group of young people or students, etc. Studying a
group of patients in a mental institution, prisoners in jail, delinquents and criminal gang or a
tribe in a community can be studied by field research.

Figure 21 is a tribal group that was studied by an anthropologist by the name Brownslaw
Malinowski. This was a field research in which Malinowski had to live among the tribal
group for a period of time observing their way of life and participating in their daily
engagements (the method referred to as participant observation).
Figure 21: Malinowski with a Tribal Group

b. Focused group discussions

In these focused groups the members discuss items like pictures of the themes, clothes,
pictures of themselves favorite magazines, favorite things, etc.

Figure 22 shows a focused group discussion with an anthropologist as the facilitator.

Figure 22: Focus Group Discussion

1.5.2 Exploratory Research

In exploratory research, the researcher attempts to find out or establish certain facts relating
to the event or phenomena. For example, when establishing the relationship between
ethnicity and promotion in the civil service or any other organization the exploratory research
becomes the ideal type of research to use. This is because this type of research is done
through indepth interviews
1.5.3 Experimental Research

Experimental research involves laboratory experiments. For example, in the case of field
clinical drug trials or procedures and also in the case of use of case controls

1.5.4 Survey Research

Survey research is a form of special field research in which data is collected using
questionnaires and structured interview - administered orally in a face to face situation. Most
surveys are descriptive in nature and uses statistical methods of data analysis. Generalization
can be made and is favoured because it is efficient and relatively precise

1.5.5 Descriptive Research

The study describes some phenomena, attributes, characteristics and functions in detail. For
example, case studies are descriptive. They are narratives.

1.5.6 Library Research/Use of Available Data

Library research involves examination of books, newspapers, published reports and materials
in the library. Useful information in patients' files for example, the diagnosis and treatment
provided, is part of available data. This method is useful in documentary or library research.

1. Advantages of library research/available data

This type of research can provide sources of in-depth materials and is often essential when a
study is either wholly historical

2. Disadvantages

The researcher depends on the sources that exists, which may be partial and the sources may
be difficult to interpret e.g. in cases of official statistics

Take Note 1.14

These types of researches are not mutually exclusive one can lead into another which is
often the case.

1.6 Research Designs

The following are research designs:

1.6.1 Qualitative Design

This type of research design is descriptive and background information oriented. Most field
research such as ethnographic research is approached qualitatively. Drawings, photographs,
charts and objects are qualitative data. Qualitative research tells us what something is rather
than how much of it is there.

1.6.2 Quantitative Design

Derived from statistics e.g. hospital records, census figures, ministry of health reports. This
type of design involves demonstration of an association between independent and dependent
variables. For example, that the users of one substance are psychologically different from users
of the other substances (Spotts and Shontz, 1984). Also involves the use of controls.

1.6.3 Cross-Sectional Design

In cross - sectional study design, the collection of date is on the whole population. It is done
at single point in time to examine the relationship between disease (or other health related
state) and other variables of interest.

Cross-sectional studies therefore provide a snapshot of the frequency of a disease or other

health related characteristics in a population at a given point in time. This methodology can
be used to assess the burden of disease or health needs of a population, for example, and is
therefore particularly useful in informing the planning and allocation of health resources.

1. Types of cross-sectional study

a. Descriptive

A cross-sectional study may be purely descriptive and used to assess the frequency and
distribution of a particular disease in a defined population. For example a random sample of
schools across London may be used to assess the burden or prevalence of asthma among 12-
14 year olds.

b. Analytical

Analytical cross-sectional studies may also be used to investigate the association between a
putative risk factor and a health outcome. However this type of study is limited in its ability
to draw valid conclusions about any association or possible causality because the presence of
risk factors and outcomes are measured simultaneously. It may therefore be difficult to work
out whether the disease or the exposure came first, so causation should always be confirmed
by more rigorous studies. The collection of information about risk factors is also
retrospective, running the risk of recall bias.

In practice cross-sectional studies will include an element of both types of design.

2. Issues in the design of cross-sectional surveys

a. Choosing a representative sample

A cross-sectional study should be representative of whole the population, if generalizations

from the findings are to have any validity. For example a study of the prevalence of diabetes
among women aged 40-60 years in Town A should comprise a random sample of all women
aged 40-60 years in that town. If the study is to be representative, attempts should be made to
include hard reaching groups, such as people in institutions or the homeless.

b. Sample size

The sample size should be sufficiently large enough to estimate the prevalence of the
conditions of interest with adequate precision. Sample size calculations can be carried out
using sample size tables or statistical packages such as Epi Info. The larger the study, the less
likely the results are due to chance alone, but this will also have implications for cost.

c. Data collection

As data on exposures and outcomes are collected simultaneously, specific inclusion and
exclusion criteria should be established at the design stage, to ensure that those with the
outcome are correctly identified. The data collection methods will depend on the exposure,
outcome and study setting, but include questionnaires and interviews, as well as medical
examinations. Routine data sources may also be used.

3. Potential bias in cross-sectional studies

Non-response is a particular problem affecting cross-sectional studies and can result in bias
of the measures of outcome. This is a particular problem when the characteristics of non-
responders differ from responders.

4. Analysis of cross-sectional studies

In a cross-sectional study all factors (exposure, outcome, and confounders) are measured
simultaneously. The main outcome measure obtained from a cross-sectional study is
prevalence:

For continuous variables such as blood pressure or weight, values will fall along a continuum
within a given range. Prevalence may therefore only be calculated when the variable is
divided into those values that fall below or above a particular pre-determined level.
Alternatively mean or median levels may be calculated.

In analytical cross-sectional studies the odds ratio can be used to assess the strength of an
association between a risk factor and health outcome of interest, provided that the current
exposure accurately reflects the past exposure.

5. Strengths and weaknesses of cross-sectional studies

a. Strengths

 Relatively quick and easy to conduct (no long periods of follow-up).

 Data on all variables is only collected once.
  Able to measure prevalence for all factors under investigation.
 Multiple outcomes and exposures can be studied.
 The prevalence of disease or other health related characteristics are important in
public health for assessing the burden of disease in a specified population and in
planning and allocating health resources.
 Good for descriptive analyses and for generating hypotheses.

b. Weaknesses

 Difficult to determine whether the outcome followed exposure in time or exposure

resulted from the outcome.
 Not suitable for studying rare diseases or diseases with a short duration.
 As cross-sectional studies measure prevalent rather than incident cases, the data will
always reflect determinants of survival as well as aetiology.
 Unable to measure incidence.
 Associations identified may be difficult to interpret.
 Susceptible to bias due to low response and misclassification due to recall bias.
 1.6.4 Longitudinal Design (Retrospective)

 In-text question 1.15


What is a longitudinal design?
 Longitudinal research is a type of research method used to discover relationships
between variablesthat are not related to various background variables. This
observational research technique involves studying the same group of individuals over
an extended period of time.
 Data is first collected at the outset of the study and may then be gathered repeatedly
throughout the length of the study. In some cases, longitudinal studies can last several
decades designed to allow observations over a period of time.
 Having defined longitudinal design, we now proceed to look at the types of longitudinal
designed.
 1. Types of Longitudinal Designs
 The types of longitudinal studies designs include cohort studies, panel studies and
retrospective studies.
 a. A Cohort Studies
 A cohort is a group of people who share a common characteristic or experience within
a defined period (e.g., are born, are exposed to a drug or vaccine or pollutant, or
undergo a certain medical procedure). Thus a group of people who were born on a
day or in a particular period, say 1948, form a birth cohort. The comparison group
may be the general population from which the cohort is drawn, or it may be another
cohort of persons thought to have had little or no exposure to the substance under
investigation, but otherwise similar. Alternatively, subgroups within the cohort may
be compared with each other.
 b. Panel Studies
 Panel studies involve sampling of a cross-section, and surveying it at (usually regular)
intervals. Household panel surveys are an important sub-type of cohort study. These
draw representative samples of households and survey them, following all individuals
through time on a usually annual basis
 c. Retrospective Studies
  This involves looking to the past by looking at information such as medical records.
 2. Benefits of longitudinal study designs
 The benefit of this type of research is that it allows researchers to look at changes
over time. Because of this, longitudinal methods are particularly useful when studying
development and lifespan issues
 3. Disadvantages of Longitudinal Study Designs
 However, longitudinal studies require enormous amounts of time and are often quite
expensive. Because of this, these studies often have only a small group of subjects,
which makes it difficult to apply the results to a larger population. Another problem is
that participants sometimes drop out of the study, shrinking the sample size and
decreasing the amount of data collected.
 1.7 Section Summary
 We have now come to the end of the first section in unit one. Like natural sciences
sociology depends on the assumption that all events have causes. In this section we
have looked at the definitions of research and social research, the purpose of research,
the types of social research and the research designs One of the main tasks of
sociological research is to identify causes, effects and draw conclusions.

1.8 Suggested Readings

1. <!--[if !supportLists]-->Gratton, C., & Jones, I. (2004). Research Methods for sports
studies. London: Routledge.
2. Trochin, W.M.K. (2006). Time in research. Research Methods Knowledge Base. Web
center for Social Research Methods. Found online at http://www.social research
methods.net/kb/timedim.phd

SECTION 2: DATA COLLECTION TECHNIQUES IN SOCIOLOGICAL RESEARCH

Welcome to this section on techniques of data collection. In this section we are going to look
at the methods of data collection and sampling techniques and steps in the research process.
The techniques are important in any research because without them it is like a navigator without
a campus. They guide the research in every step in research. I hope you will enjoy.

We now proceed to look at the objectives of this section as follows:

2.2 Section Objectives

By the end of this section, you will be able to:

1. <!--[if !supportLists]--><!--[endif]-->Describe the techniques in data collection.

2. <!--[if !supportLists]-->Describe Sampling techniques.
3. Describe steps in conducting social research.

2.3 Techniques in Data Collection

Data-collection techniques allow us to systematically collect information about our objects of

study (people, objects, phenomena) and about the settings in which they occur. In the collection
of data we have to be systematic. If data are collected haphazardly, it will be difficult to answer
our research questions in a conclusive way.

Data collection techniques include the following:

2.3.1 Use of Available Data

Usually there is a large amount of data hat has already been collected by others, although it
may not necessarily have been analysed or published. Locating these sources and retrieving the
information is a good starting point in any data collection effort

Use of available data involves examination of books, newspapers, letters, other available
materials and patient files. Information on patient files will include the diagnosis, and treatment
provided for the patient which may be useful information for the research. This method is
useful in documentary or library research

2.3.2 Observations

Observation is a technique that involves systematically selecting, watching and recording

behaviour and characteristics of living beings, objects or phenomena. Observation of human
behaviour is a much-used data collection technique. It can be undertaken in different ways:

1. Participant Observation

The investigator participates in the way of life of the people, their tradition, rituals and other
activities. This method is useful in field research like in ethnographic research. This type of
observation is used to study rural and traditional people, organizations such as schools and
hospitals, religious groups, delinquents and criminal gang. The advantages of this technique
are that it is typically naturalistic i.e. studying events as they appear in real natural settings. It
is reliable and information is collected through direct means of observation. It is less biased
than the survey method because done in the field over a period of time.

2. Non participant observation (Mere observation)

This involves observation of what goes on in certain situations. It is useful in studying

behaviors, family interactions, family atmosphere and interpersonal relationships. The
observer watches the situation, openly or concealed, but does not participate.

2.3.3 Questionnaires

A written questionnaire (also referred to as self-administered questionnaire) is a data collection

tool in which written questions are presented that are to be answered by the respondents in
written form. A written questionnaire can be administered in different ways, such as by:
Sending questionnaires by mail with clear instructions on how to answer the questions and
asking for mailed responses; Gathering all or part of the respondents in one place at one time,
giving oral or written instructions, and letting the respondents fill out the questionnaires; or
Hand-delivering questionnaires to respondents and collecting them later. Questionnaire is the
most commonly used method of investigation administered through interviews, mailed or over
the phone. Respondents are asked questions directly e.g. in populations censor surveys.
2.3.4 Interviews

An interview is a data-collection technique that involves oral questioning of respondents, either

individually or as a group. Answers to the questions posed during an interview can be recorded
by writing them down (either during the interview itself or immediately after the interview) or
by tape-recording the responses, or by a combination of both. Interviews can be conducted with
varying degrees of flexibility. The two extremes, high and low degree of flexibility, are
described as high degree of flexibility and low degree of flexibility.

2.3.5 Focus Group Discussions (FGDs)

A focus group discussion allows a group of 8-12 informants to freely discuss a certain subject
with the guidance of a facilitator or reporter. Focus research and develop relevant research
hypotheses by exploring in greater depth the problem to be investigated and its possible
causes. Formulate appropriate questions for more structured, larger scale surveys. Help
understand and solve unexpected problems in interventions. Develop appropriate messages
for health education programmes and later evaluate the messages for clarity.

Table 2: Data Collection Techniques and Tools

Data Collection Methods Data Collection Tools

Use of Available data Checklist, data compilation forms
Observing Eyes and other senses, pen/paper, Watch, scales,
Microscope
Interviewing Interview guide, checklist,

questionnaire, tape recorder

Answering written questions Questionnaires
Focus group discussion Groups, tape recorder, interview guide, pen and paper

Table 3: Advantages and Disadvantages of the Various Data Collection Techniques

Technique Advantage Possible Constraints

Use of Is inexpensive, because data is Data is not always easily accessible.
available data already there. Permits Ethnical issues concerning confidentiality
examination of trends over the
past may arise. Information may be imprecise
or incomplete
Observing Gives more detailed and context- Ethnical issues concerning confidentiality
related information. Permits or privacy may arise. Observer bias may
collection of information on occur. (Observer may only
facts
notice what interests him or she.) The
not mentioned in an interview, presence of the data collector can influence
Permits tests of reliability of the situation observed. Thorough training
responses to questionnaire of research assistants is required
Interviewing Is suitable for use with both The presence of the interviewer can
literates and
 illiterate. Permits clarification of influence responses.
questions.
Reports of events may be less complete
Has higher response rate than than
written questionnaires
information gained through observations.
Answering Is less expensive. Cannot be used with illiterate respondents.
written
questions Permits anonymity and may Require some extra training of researches.
result in more honest responses.
Does not require research
assistants.

Eliminates bias due to phrasing

questions differently with
different respondents.
Focus group Is less expensive and can be used The presence of interview and others in the
discussion with both illiterate and literate group can influence responses.
respondents. Allows free
expression of feelings and
opinions

2.4 Sampling Techniques

Sampling is useful in social research as well as other researches. Sampling help us avoid total
coverage therefore saves time and money.

2.4.1 Types of Sampling Techniques

1. Random sampling: Gives equal opportunity for every member of the population to be
selected into the sample.

2. Stratified sampling: The population to be studied is divided into strata. For example, in a
survey of a group of farmers, they are divided into large scale, small scale, peasant farmers or
subsistence or cash crop farmers. Stratified sampling compliments random sampling.

3. Cluster sampling: Used effectively in household surveys where the entire city is divided
into zones and then certain zones are selected and all the houses in the selected zones are
surveyed.

4. Purposive sampling: Done according to the researcher’s convenience. It lacks all the vigour
of real sampling.

2.5 Steps in Conducting Social Research

When conducting your research, the following steps will be followed.

2.5.1 Selection of a Problem

The first step in conducting research is selecting a problem. For example, an investigator may
be interested in finding out whether crime is on the increase and why?

Once the problem has been identified, the investigator then reviews literature around the
problem and this is the next step in conducting research.
2.5.2 Reviewing of Evidence

This involves familiarizing oneself with existing research on the topic i.e. reviewing literature
on the topic. The next step is stating the problem which follows the literature review.
2.5.3 Problem Statement

This involves stating the magnitude of the problem based on the evidence from reviewing of
the literature and identifying the gaps which the proposed study intends to fill.
2.5.4 Assumptions about the Problem

The researcher then makes assumptions about the study. For example, we may say that the
rising incidence of highway robbery in Kenya is related to the increase in wealth of a few
people. Or that the high rate of divorce is associated with alcoholism in families

2.5.5 Formulation of Hypotheses about the Problem

For example, we may say that the rising incidence of highway robbery in Kenya is related to
the increase in wealth of a few people. Or that the high rate of divorce is associated with
alcoholism in families.
2.5.6 Selection of Research Design and Methodology

Researcher decides how research materials are to be collected. The design chosen will
depend on the study objectives.
2.5.7 Selection of Research Method

Ones an investigator is clear about what he wants to do, he/she proceeds to find out how
he/she will tackle the problem i.e. methods to use. Choose one or more methods. For
example, experimental, survey, observation or use of existing sources. This will also depend
on the study objectives and aspects of behaviour to be analysed. For some, survey may be
the most suitable and for others observational.

2.5.8 Carry out the Research

The investigator then proceeds to collect data and record information using the various data
collection techniques and tools.
2.5.9 Interpretation of Results

After data collection, analysis is done and the results are discussed and interpreted – that is
stating the implications of the collected data.
2.5.10 Report the Research Findings

The work is then disseminated through publication in a journal, article, or a book. Provides an
account of the nature of the research and justify whatever conclusions are drawn. Suggesting
further research questions that remain unanswered and can profitably be carried in future.
The findings are registered discussed in the wider community leading perhaps to initiation of
further research.

Take Note 1.15

The steps in social research process can be duly restricting. Most outstanding sociological
research are not strictly fitted into the process but some of the steps would be there. Like
natural sciences sociology depends on the assumption that all events have causes. One of
the main tasks of sociological research is to identify causes, effects and draw conclusions.

2.6 Section Summary

We have come to the end of this section on the techniques of sociological investigations. In
this section we have looked at the data collection methods or techniques which included
participant observations, non participant observations, interviews the use of available data,
use of questionnaires and focused group discussion through in-depth interviews and
recording of facts. We have also looked at the sampling techniques which include random,
stratified, cluster and purposive samplings. Finally, we looked at the steps in conducting
research. These steps are necessary in any research. I hope you have enjoyed the section.

2.7 Suggested Further Readings

The following are some of the suggested readings for this section.

1. <!--[if !supportLists]--><!--[endif]-->Giddens A., (2001): Sociology. 4TH Edition.

Polity Press and Blackwell Publishers Ltd.2001.Cambridge U.K.
2. Shontz F.C.,(1986): Fundamentals of Research in the Behavioural Sciences.
American Psychiatric Press, Inc.

We have now come to the end of the 4thunit which was on the methods of sociological
investigations. It is therefore important that we look at some activities and model questions that
will test whether you have understood the concepts and fundamental of the sections of the unit.

Unit 4 Activity

In groups,
< !--[if !supportLists]-->1. <!--[endif]-->Discuss the steps used in sociological research.
Using materials available please discuss the most effective social research method.

Unit 4 Review Questions

Unit 4 Review Questions

Ethnographic research is?

Field research
Library research
Survey research
Psychological research
Critical research

The following are steps in conducting research, except:

Problem statement
Literature review
Drawing assumptions
Data collection
Exploratory research

Which of the following sampling techniques do not have the real vigor of sampling?

Random sampling
Stratified sampling
Cluster sampling
Purposive sampling
All of the above

Data collection methods include the following, except:

Interviewing
Use of questionnaires
 Focus group discussion
Observation
None of the above

The third step in conducting research is:

Problem statement
Literature review
Data collection
Making assumptions
Formulation of hypothesis

HCH 100: BEHAVIOURAL SCIENCES - SOCIAL PSYCHOLOGY

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE

HCH 100: BEHAVIOURAL SCIENCES

MODULE 5: SOCIAL PSYCHOLOGY

MODULE FIVE: SOCIAL PSYCHOLOGY

Congratulations for coming this far. You are now in the fifth module of behavioural sciences.
We are going to learn how people behave in different situations and have a better understanding
of how stereotypes are formed .You will study how and why people think, feel and do things
they do depending upon the situation they find themselves in and how they fall in love.

The key figures whom you have already been introduced to in the previous modules and have
contributed tremendously to social psychology and particularly to our context includes: Allport
(1920) who introduced the idea of social facilitation theory that the presence of others can
improve one’s performance in a well learned task but decrease performance in a newly learned
or difficult task due to social inhibition .Albert Bandura (1963) introduced the social learning
theory where he alluded that behaviour in the social world can be modelled through the reward
system . Festinger (1950) described the cognitive dissonance theory where he brought in the
idea that when we hold beliefs, attitudes, or cognitions which are different there is an
inconsistency that causes discomfort that he called cognitive dissonance .Tajfel (1990)
described social identity theory which alludes that individuals need to maintain a positive sense
of personal and social identity even when in a group. Weiner (1986) explained that human
beings look for explanations of their behaviours in a social world due to experiences of both
success and failure; this was called the attribution theory. Milgram (1963) conducted the shock
experiment where he was able to demonstrate that obedience is most likely to occur in an
unfamiliar enviroment and in the presence of authority figure especially when covert pressure
is applied on the people to obey. Zimbardo et al in 1973 conducted the prison study and
concluded that conformity to social roles occurred as part of social interaction and loss of a
sense of identity.

In this module therefore we will describe the experiments and studies of some of these
psychologists in the context of human relations that we will study.

This module is divided into three units as follows:

Unit One: Social relations and Influence

Unit Two: Conflicts, Peacemaking, Cognitive Dissonance

UNIT ONE: SOCIAL RELATIONS AND INFLUENCE

Wеlсоmе to the first unit of Module 5. We hope that you are еnjоying lеаrning аbоut human
bеhаviоur and psyсhоlоgy. In this unit we are going to discuss the quality of our social
relationships and how they influence mental health, physical health and our behaviour.

As you go through the sections in the unit, you will find some questions and activities. Make
sure you answer the questions and perform the exercises as these will hеlp yоu tо соnsоlidаtе
yоur lеаrning.

This unit is divided into two sесtiоns as follows:

Sесtiоn 1: Social Relations

Sесtiоn 2: Social Influence

Before we proceed on to the specific sections, here are the unit objectives.

Unit Objectives

By the end of this unit you should be able to:

1. Describe Social Relations

2. Discuss Social Influence

Good! We shall now proceed to the first section of this unit.

UNIT ONE: SOCIAL RELATIONS AND INFLUENCE

Wеlсоmе to the first unit of Module 5. We hope that you are еnjоying lеаrning аbоut human
bеhаviоur and psyсhоlоgy. In this unit we are going to discuss the quality of our social
relationships and how they influence mental health, physical health and our behaviour.

As you go through the sections in the unit, you will find some questions and activities. Make
sure you answer the questions and perform the exercises as these will hеlp yоu tо соnsоlidаtе
yоur lеаrning.

This unit is divided into two sесtiоns as follows:

Sесtiоn 1: Social Relations

Sесtiоn 2: Social Influence

Before we proceed on to the specific sections, here are the unit objectives.

Unit Objectives

By the end of this unit you should be able to:

1. Describe Social Relations

2. Discuss Social Influence

Good! We shall now proceed to the first section of this unit.

SECTION ONE: SOCIAL RELATIONS

1.1 Sесtiоn Intrоduсtiоn

Welcome to this section on social relations. In this section we are going to find out how we
relate to others.This sесtiоn will prоvidе yоu with аn оvеrviеw on how people think about,
influence, and relate to one another.

Here first is a look at the objectives we will cover in this section.

1.2 Section Objectives

By the end of this section you should be able to:

1. Describe interpersonal attraction.

2. Discuss prejudice in social relations.
3. Explain altruistic behavior from the perspective of social exchange theory and social
norms.
4. Describe aggression in the social psychology context.

SECTION ONE: SOCIAL RELATIONS

1.1 Sесtiоn Intrоduсtiоn

Welcome to this section on social relations. In this section we are going to find out how we
relate to others.This sесtiоn will prоvidе yоu with аn оvеrviеw on how people think about,
influence, and relate to one another.

Here first is a look at the objectives we will cover in this section.

1.2 Section Objectives

By the end of this section you should be able to:

1. Describe interpersonal attraction.

2. Discuss prejudice in social relations.
3. Explain altruistic behavior from the perspective of social exchange theory and social
norms.
4. Describe aggression in the social psychology context.

1.3 Interpersonal Attraction

Have you ever asked yourself why we like - and are attracted to - certain individuals more
than others? Well, let’s find out as you read on.
 It's important to note that when we talk about attraction, we aren't always talking about
sexual attraction. By definition, attraction is just something that draws people together. There
are factors that determine if we are attracted to someone enough to develop a relationship
with that person.

These factors that influence attraction are:

a. Proximity,
b. Similarity,
c. Reciprocal liking, and
d. Ingratiation.

Activity 1.1
Explain in your own words how proximity and similarity can influence interpersonal
attraction.

I hope you got them right. Now compare your response with the text that follows.

1.3.1 Proximity

Proximity is when people tend to like people who are closer to them (more proximal, greater
proximity) rather than people who are farther away from them. If people are closer
geographically, then they are more likely to run into one another. It is difficult to make friends
with people that you see infrequently or not at all. This may explain why long distant
relationships are difficult.

Proximity—geographical nearness—promotes attraction; in part because it increases the

opportunities for interaction and in part because of the mere exposure effect (repeated exposure
to novel stimuli enhances liking).

1.3.2 Similarity

Imagine you meet someone for the first time and discover you have a lot in common. You
cheer for the same sports team, enjoy watching the same TV shows, and even love the same
restaurants. With so much in common, chances are that you'd be attracted to this person.
Similarity, or a match of personal aspects with those of another person, is one of the most
powerful forces behind attraction and the creation of close relationships. As the old saying
goes, and as you have likely experienced for yourself, birds of a feather do flock together.

We are attracted to others who share our attitudes, values, personality characteristics,
communication style, background, and so on. Over and over again, research has shown that the
more similar a person is, the more likeable we find that person. Interestingly, research has also
shown that even more important than similarity is perceived similarity.
For example, one particular study was designed to compare actual and perceived similarity
between personalities of college roommates. The psychologists found that friendships grew
between roommates who shared values and personality traits, but even more so when they
simply perceived their roommates as similar. This was the same result of a more recent meta-
analysis.

A different group of psychologists found that in long-term relationships, perceived similarity

was a better predictor of liking and attraction than actual similarity. It appears that similarity
in reality matters, but the simple belief that someone is similar to us is actually more important.

By now, you may be wondering about the old saying that 'opposites attract.' To a certain
extent, it does make sense that two people could have personality traits or strengths that
would complement the other person, completing what is missing. All of us could probably
think of a romantic couple or two who view their differences as complementary, especially if
one is significantly more outgoing than the other. However, research has been unable to
confirm this. Study after study shows that at least for the vast majority of us, similarity, not
complementarity, is what promotes liking and attraction.

In-text Question 1.1

What is reciprocal liking and how does it influence affection?

1.3.3 Reciprocal Liking

Beyond similarity, another extremely powerful predictor of liking and attraction is our
perception of another person's liking of us. We like to be liked, and just knowing that someone
likes us is enough for us to feel attracted to that person. This is a phenomenon known as
reciprocal liking. Romantically, discovering that someone whom we find appealing really
likes us seems to get our engines going. Experiments confirm that people who are told others
like them usually feel affection for them, in turn. The phenomenon may work because knowing
that we are liked makes us feel good about ourselves, and we like being around someone who
gives us positive feelings.

Reciprocal liking is so powerful that sometimes it can even make up for a lack of similarity. In
one well-known study, male participants expressed increased interest in a female confederate
that disagreed with them on important issues, simply because she made eye contact, leaned in,
and listened attentively. Because it appeared that the female confederate was interested in the
male, the male was interested in return.

One way to get someone to like you is to like them. This action is supported by the reciprocity
norm, which states that whatever is done to you should be done in return. The reciprocity norm
is very powerful. When someone does something good for us, we often feel indebted to that
person, so we will often reciprocate the action.

1.3.4 Ingratiation
As we will see in Section Two on social influence, ingratiation involves gaining someone’s
approval so they will be more likely to appease your demands.

1.3.5 Physical Attractiveness

Another factor in attraction is physical attractiveness. People who are physically attractive
enjoy several benefits, as they are better thought of (e.g., kinder, gentler, more able) than
unattractive people. Thus, there is often a halo effect with physical attractiveness, such that
people who are above average in attractiveness are thought to be above average in other aspects
as well.

Physical attractiveness also increases opportunities for interaction. People prefer being with
attractive people and perceive them as healthier, happier, more sensitive, more successful, and
more socially skilled. Judgments of attractiveness vary by culture, and as time goes by we find
those we care about to be more attractive.

Physical attractiveness can be a disadvantage too, however. For example, people who are
physically attractive may think that others are doing things for them, praising them, etc.
merely because they are attractive. That is, they may come to doubt anything positive anyone
else says to them, because they attribute that to their attractiveness, rather than to their self.

Activity 1.2
In the context of interpersonal attraction, what is the effect of physical attractiveness? What
influence does it have in our relations? Put down in your note book.

Effects or Influence of physical attractiveness

We like to be around attractive people because of the esthetic pleasure we obtain, and because
interactions with attractive people are generally positive and pleasant. The common stereotype
of attractive people is that they are warm, friendly, and social. This stereotype becomes self-
fulfilling when people act differently around attractive people because of their expectations,
which as a result brings out the best in attractive people.

The importance of physical attractiveness differs for people with high and low self-monitor
personalities, and for men and women.

High self-monitors are more sensitive to their environment, and place more value on physical
attractiveness than low self-monitors do.

In long-term relationships, men attach more importance to physical attractiveness than women
do. From an evolutionary perspective this is explained by differences in parental investments
for men and women. The investment for men is small, thus men can maximize their
reproduction. They look for beautiful women because this is an indicator of women being
young (so more fertile) and healthy. For women the investment is bigger, so they search for a
supporting male, and thus seek for indicators of men's resources, such as dominance, status,
etc.

1.3.6 Love

Liking is often one stage on the way to loving someone. That is, life partners typically like each
other before they love each other.

There is a distinction drawn in types of love - passionate love and companionate love.
Passionate love is the initial attraction between two people, which leads to feelings of lust when
the attraction is mutual and to feelings of despair when the attraction is not. Companionate love
follows passionate love, and it is less intense but more intimate, as the individuals feel
comfortable sharing their personal thoughts, hopes, dreams, etc.

Figure 1 that follows illustrates the two important requirements of compassionate love:

a. Equity and
b. Self disclosure.

Figure 1: Compassionate love

We will now shift our focus on another aspect of social relations that is, prejudice.

1.4 Prejudice in Social Relations

This is an unjustifiable attitude towards a group of people. Prejudism usually involves

stereotyped belief(s) about a group of people. It is often directed towards different cultural,
ethnic or gender groups.
Prejudice is prejudgment, or forming an opinion before becoming aware of the relevant facts
of a case. The word is often used to refer to preconceived, usually unfavourable, judgments
toward people or a person because of gender, political opinion, social class, age, disability,
religion, sexuality, race/ethnicity, language, nationality, or other personal characteristics. In
this case, it refers to a positive or negative evaluation of another person based on their perceived
group membership. Prejudice can also refer to unfounded beliefs and may include "any
unreasonable attitude that is unusually resistant to rational influence". Gordon Allport defined
prejudice as a "feeling, favourable or unfavourable, toward a person or thing, prior to, or not
based on, actual experience".

1.4.1 Components and Forms of Prejudice

Prejudice is an attitude composed of beliefs, emotions, and predispositions to action. The

beliefs are frequently stereotypes (sometimes accurate but often over-generalized beliefs). The
emotions are most often negative, and the action is usually discrimination (unjustifiable
negative behaviour).

It manifests as:

a. In-group: people with whom one shares a common identity “US".

b. Out-group: people perceived as different and do NOT share a common identity

“THEM"

c. In-group bias: the tendency to favour an individual from one’s own group.

Prejudice works at the conscious but more at the unconscious level meaning it is more or less
like a knee jerk response.

The other forms of prejudice are:

a. Overt prejudice, such as denying a particular ethnic group the right to vote, is
discrimination that explicitly (openly and consciously) expresses negative beliefs and
emotions.

b. Subtle prejudice, such as feeling fearful in the presence of a stranger with a particular
ethnic background, is an implicit (often unconscious) expression of negative beliefs and
emotions.

c. 1.4.2 Reason for Prejudice in the World

d. Activity 1.3
e. Outline the factors that contribute to prejudice in the society.
f.
g. There are several factors that contribute to or help create prejudice in the world. These
can be social factors or cognitive processes.
h. 1. Social factors

i. One social factor contributing to prejudice is inequality (unequal distribution of money,

power, and prestige) within a group; in such conditions, the “haves” usually develop
negative attitudes toward the “have-nots” to justify their more privileged positions.
Definitions of social identity (“we” the ingroup versus “they” the outgroup) are another
source of prejudice because they promote ingroup bias (a tendency to favor one’s own
group) and discrimination.

j. 2. Cognitive processes

k. Cognitive processes help create and maintain prejudice. We simplify the world around
us by creating categories, but when we categorize people, we often stereotype them,
overgeneralizing their characteristics and underestimating their differences. We also
tend to judge the frequency of events by vivid cases (violence, for example) that come
to mind more readily than the long string of less vivid events involving the same group.
We may justify people’s less-privileged or punished position by the just-world
phenomenon, assuming that the world is just and people get what they deserve.
Hindsight bias (the tendency to believe, after learning an outcome, that we would have
predicted it beforehand) may contribute to this tendency to blame the victim.

l. A common illustration to the emotional component of prejudice is the scapegoating

theory. Troubled times, especially those that remind us of our own mortality, produce
feelings of fear and anger. As in-group loyalty and out-group prejudice intensify, people
may search for a scapegoat—someone to blame for the troubling event. Such
denigrating of despised others can boost in-group members’ self-esteem.

m. The Scape-Goat Theory

n. This is a theory that prejudice provides an outlet for anger by providing someone to
blame. This means that they use the group they dislike as the target of their anger or
their vent. Scape-goating requires the in-group members to settle on specific target for
their problems.

o. Social Psychology is the study of the way people relate to others. As a rule you will
meet all these people and your interaction with them will have an impact on your
treatment outcome. We perceive culture by our five senses showing the scapegoating
requires the manifestations of our deeper meaning of culture of what we think, feel and
do. The society teaches culture both formally and informally, it is learned and shared.
Culture is symbolic through our behaviour, our words and objects. The more we know
the cultures of others, the more open minded, tolerant we become. It allows us to
function with one another without negotiations every moment we interact. An
Anthropologist, Edward B. Taylor described it as a powerful tool for survival, but as a
fragile phenomenon that is constantly changing and is easily lost since its only in
existence in our minds.
p. Well done. Let us now move on to altruism.

q. 1.5 Altruism
r. Altruism is the unselfish regard for the welfare of others. Examples of altruism include
helping victims of a natural disaster, giving blood, or donating to local food pantries
with no expectation of personal reward.

s. The bystander effect is the tendency for any given observer to be less likely to help if
others are present. To offer help, a person must notice the incident, interpret it as an
emergency, and assume responsibility for offering help. Diffusion of responsibility
lowers the likelihood of helping. Odds of helping are highest when the victim is similar
to us and appears to need and deserve help, and when we observe others helping, are
feeling guilty, are not in a hurry or preoccupied, are in a small town or rural area, and
are in a good mood.

t. 1.5.1 Social Exchange Theory

u. Social exchange theory proposes that our social behaviors—even altruistic, helpful
acts—are based on self-interest: maximizing our benefits (which may include our own
good feelings) and minimizing our costs. Social norms influence altruistic behaviors by
telling us how we should behave. The reciprocity norm is the expectation that we will
help those who help us, and the social-responsibility norm is the expectation that we
will help those who are dependent on us.

v. Lastly, in social relations we now look at aggression next.

w. 1.6 Aggression
x. Psychology’s definition of aggression is “any physical or verbal behavior intended to
harm or destroy.” This is more precise than the everyday definition of aggression and
includes behaviors (such as killing in combat) that might not be included in everyday
usage.

y. In-text Question 1.2

z.
What is the cause of aggressive behaviour?

aa.
bb. Read on the content that follows to find out more.

cc. 1.6.1 The Biology of Aggression

dd. There are three levels of biological influences on aggression. Psychologists dismiss the
idea that aggression is instinctual and confirm that it results from an interaction between
biology and experience. Genes influence aggression, for example by influencing our
temperament. Experiments stimulating portions of the brain (such as the amygdala and
frontal lobes) demonstrate that the brain has neural systems that facilitate or inhibit
aggression. Studies of the effect of hormones (such as testosterone), alcohol (which
 releases inhibitions), and other substances show that biochemical influences also
contribute to aggression.

ee. 1.6.2 The Psychology of Aggression

ff. Biological conditions set the threshold for aggressiveness, but psychological factors
trigger aggressive behaviors. Aversive events (such as environmental conditions or
social rejection) can create frustration, leading to feelings of anger and hostility.
Reinforcement for aggressive behavior (such as gaining a treat from another student
by bullying) can establish learned patterns of aggression that are difficult to change.
People can also learn aggression and become desensitized to violence by observing
models act aggressively in person (watching violence within the family or
neighborhood, for example) or in the media (watching violence or sexual aggression on
TV or in movies). Media depictions of violence can trigger aggression in another way:
by providing social scripts (culturally sanctioned ways of acting in a given situation).

gg. Violent video games can heighten aggressive behavior by providing social scripts and
opportunities to observe modeled aggression and to role-play aggression. Playing these
games can increase arousal and feelings of hostility; prime aggressive thoughts and
increase aggression; and (in adolescents) lead to increased participation in arguments
and fights and falling grades. Virtual reality games may heighten these effects.

hh. 1.6.3 Frustration-Aggressive Principle

ii. When people perceive that they are being prevented from achieving a goal, their
frustration is likely to turn to aggression.

jj. The closer you get to a goal, the greater the excitement and expectation of the pleasure.
Thus the closer you are, the more frustrated you get by being held back. Unexpected
occurrence of the frustration also increases the likelihood of aggression.

kk. Frustration does not always lead to aggression, particularly when we deliberately
suppress it because either we know that it is wrong or we fear the social consequences
of being aggressive (e.g. losing friendship of target, criticism from others). As a result,
we often displace aggression into other activity, such as sports, driving fast and so on.

ll. Some people are more predisposed to aggression and find it harder to contain it. For
such people, frustration is more likely to that lead directly to aggression than for other
people with a calmer disposition or greater self-control.

mm. Well done. Now here is the summary of what we have learnt.

nn. 1.7 Section Summary

oo. Dear learner we have come to the end of this section on social relations. We have learnt
about interpersonal attraction and how this is influenced by proximity, reciprocal liking,
similarity and physical attractiveness. You also learnt about prejudice and factors
contributing to it including the scapegoat theory. Lastly we discussed altruism and
aggression.
 pp. In the next section, we will discuss social influence.

SECTION TWO: SOCIAL INFLUENCE

Welcome to this section on social influence. In this section we are going to find what influence
our relations and interactions with others in a social context. This sесtiоn describes some
specific studies whose findings explain individuals behavior in social human interactions. The
knowledge you will acquire from this section can help you understand what influences
particular human relations in the society.

Before we move further let us look at the objectives we will cover in this section.

2.2 Section Objectives

By the end of this section you should be able to:

1. Define social influence

2. Describe the components of social influence
3. Explain resistance to social influence

2.3 Definition of Social Influence

Social influence is the change in behavior that one person causes in another, intentionally or
unintentionally, as a result of the way the changed person perceives themselves in relationship
to the influencer, other people and society in general.

Social influence is defined as change in an individual’s thoughts, feelings, attitudes, or

behaviors that results from interaction with another individual or a group. Social influence is
distinct from conformity, power, and authority. Conformity occurs when an individual
expresses a particular opinion or behavior in order to fit in to a given situation or to meet the
expectations of a given other, though he does not necessarily hold that opinion or believe that
the behavior is appropriate. Power is the ability to force or coerce particular way by controlling
the outcomes. Authority is power that is believed to be legitimate (rather than coercive) by
those who are subjected to it.

Social influence, however, is the process by which individuals make real changes to their
feelings and behaviors as a result of interaction with others who are perceived to be similar,
desirable, or expert. People adjust their beliefs with respect to others to whom they feel similar
in accordance with psychological principles such as balance. Individuals are also influenced
by the majority: when a large portion of an individual’s referent social group holds a particular
attitude, it is likely that the individual will adopt it as well.

2.4 Components of Social Influence

The three areas of social influence are:

a. Conformity

b. Compliance

c. Obedience

To be able to understand these components we will now look at each of them in more detail
starting with conformity.

2.4.1 Conformity

Conformity is a type of social influence involving a change in behavior, belief or thinking to

align with those of others or to align with normative standards. It is the most common and
pervasive form of social influence. It is changing how you behave to be more like others. This
plays to belonging and esteem needs as we seek the approval and friendship of others.
Conformity can run very deep, as we will even change our beliefs and values to be like those
of our peers and admired superiors.

In text Question 2.1

What is social conformity?

Social conformity is a type of social influence that results in a change of behavior or belief in
order to fit in with a group. This type of influence is best illustrated by a famous experiment
conducted by Solomon Asch in 1951as we will see later in this section.

Conformity can be in appearance, or it may be a complete conformity that impacts an individual

both publicly and privately.

In the case of peer pressure, a person is convinced to do something (such as illegal drugs) which
they might not want to do, but which they perceive as "necessary" to keep a positive
relationship with other people, such as their friends. Conformity from peer pressure generally
results from identification within the group members, or from compliance of some members to
appease others.

Activity 2.1
Differentiate between conformity, compliance and congruence in social influence.

Compliance (also referred to as acquiescence) demonstrates a public conformity to a group

majority or norm while the individual continues to privately disagree or dissent, holding on to
their original beliefs or an alternative set of beliefs differing from the majority. Compliance
appears as conformity but there is a division between the public and the private self.

What appears to be conformity may in fact be congruence. Congruence occurs when an

individual’s behavior, belief or thinking is already aligned with that of the others and no change
occurs.

In situations where conformity (including compliance, conversion and congruence) is absent,

there are non-conformity processes such as independence and anti-conformity. Independence
(also referred to as dissent) involves an individual, through their actions and/or inactions, or
the public expression of their beliefs or thinking, being aligned with their personal standards
but inconsistent with that of other members of the group (either all of the group or a majority).
Anti-conformity (also referred to as counter-conformity) may appear as independence but lacks
alignment with personal standards and is for the purpose of challenging the group. Actions as
well as stated opinions and beliefs are often diametrically opposed to that of the group norm or
majority. The underlying reasons for this type of behavior may be rebelliousness/obstinacy or
it may be to ensure all alternatives and view points are given due consideration.

Social psychology research in conformity tends to distinguish between two varieties:

a. Informational conformity and

b. Normative conformity.

To understand the two varieties of conformity let us look at Asch’s experiment.

Asch’s Experiment on Conformity

Before we proceed go through the activity that follows.

Activity 2.2
Imagine you've volunteered for a study. You arrive and sit at the end of a row that has four
other participants. The presenter gives you two cards: one has one line, and the other has
three lines. You are asked to compare the length of the one line with the other three to
determine which is the same length as the original line. The other participants give their
answers, one by one. They unanimously give an answer that is clearly wrong. When it's your
turn, do you change your answer to match theirs, or do you stick with the answer you know is
correct?

Types of conformity

Well regardless of your response, the scenario in the activity is actually part of a famous
experiment conducted by Solomon Asch in 1951. The purpose was to study social conformity.
Asch wanted to see how often people conform and why. In his experiment, the person at the
end of the row was actually the only participant; the other people in the room were actually
confederates, or actors, and were purposefully giving the incorrect answer to some of the
questions. Asch measured the number of times each participant conformed to the obviously
incorrect answer. Approximately 25% of the participants conformed most of the time, and an
additional 50% of the participants conformed at least once. That means that only 25% never
conformed.

This study is well known and demonstrates the power of social influence. When the participants
were asked why they went along with the clearly incorrect answer, most of them said that they
had just gone along with the group in fear of being ridiculed. Some of them even said they
believed that the group's answer was correct and that they must have been missing something.

These results suggest that conformity can be influenced both by a need to fit in and a belief
that other people are smarter or better informed. Given the level of conformity seen in Asch's
experiments, conformity can be even stronger in real-life situations where stimuli are more
ambiguous or more difficult to judge.

Later studies also supported this finding (Morris & Miller, 1975), suggesting that having social
support is an important tool in combating conformity.

The findings of Ash experiment represent the two types of social conformity: normative and
informational.

Let us now discuss each of these types of conformity further.

1. Normative Conformity

Normative conformity is conformity that occurs because of the desire to be liked and
accepted. Most people probably think of peer pressure amongst teens when they think of
normative conformity, and for good reason. Most teens and pre-teens are particularly
vulnerable to influence because they long to be accepted by their peers. I'm sure when you
were a teenager you heard the phrase, 'If all of your friends jumped off a bridge, would you do
it, too?' Peer pressure is certainly a good example of normative conformity, but it happens to
adults, too.

For example, have you ever attended a performance that was, at best, mediocre? Maybe it was
a play you saw, and you thought it was just okay. However, at the end of the play, several
people around you may have stood while clapping. It wouldn't take very long for every person
in the auditorium, including you, to participate in the standing ovation. Even though you didn't
think the performance was necessarily deserving of the praise, you joined in rather than
remaining seated, so you wouldn't stand out like a sore thumb. Standing ovations, peer pressure,
fashion trends, body image, and following traditions are just a few examples of normative
conformity.

2. Informational Conformity

The other type of conformity is informational conformity, which is conformity that occurs
because of the desire to be correct. In Asch's experiment, some of the participants stated that
they believed they must be wrong since no one else agreed with them. They changed their
answer so that they would be 'right.' Informational conformity is so named because we believe
that it gives us information that we did not previously have. For example, imagine you walk
into a food court at a mall. There are three stalls open, yet the entire crowd is seated and eating
in front of only one of them. Would you, as the newcomer, assume that that particular stall has
the best food because everyone else is eating there?

Informational conformity typically comes from the thought of, 'They must know something I
don't know.' In many situations, we are unsure of how to act or what to say. So, another example
of informational conformity is when we travel to other countries. Typically, we're unsure of
how to act and rely on our observations of others to point us in the right direction. When we
change our behavior based on the actions of the locals, we are demonstrating informational
conformity

Factors that Influence Conformity

Asch went on to conduct further experiments in order to determine which factor influenced
how and when people conform. He found that:

a. Conformity tends to increase when more people are present, but there is little change
once the group size goes beyond four or five people.

b. Conformity also increases when the task becomes more difficult. In the face of
uncertainty, people turn to other for information about how to respond.

c. Conformity increase when other members of the group are of a higher social status.
When people view the others in the group as more powerful, influential, or
knowledgeable than themselves, they are more likely to go along with the group.

d. Conformity tends to decrease, however, when people are able to respond privately or if
they have support from at least one other individual in a group.

e. 2.4.2 Compliance
f. Compliance is where a person does something that they are asked to do by another.
They may choose to comply or not to comply, although the thoughts of social reward
and punishment may lead them to compliance when they really do not want to comply.

g. Compliance is the act of responding favorably to an explicit or implicit request offered

by others. Technically, compliance is a change in behaviour but not necessarily attitude-
one can comply due to mere obedience, or by otherwise opting to withhold one’s private
thoughts due to social pressures. According to Kelman’s (1958), the satisfaction derived
from compliance is due to the social effect of the accepting influence (i.e. people
comply for an expected reward or punishment-aversion).

h. We will now look at the compliance techniques employed in compliance next.

i. 1. The Foot in the Door Technique

j. The foot in the door technique (Freedman & Fraser, 1966) assumes agreeing to a small
request increases the likelihood of agreeing to a second, larger request. So, initially you
make a small request and once the person agrees to this they find it more difficult to
refuse a bigger one.

k. For example, imagine one of your friends missed the last psychology class and asked
to borrow your notes. This is a small request that seems reasonable, so you lend the
notes to your friend. A week later, the same friend asks to borrow all of your psychology
notes. This is large request – would you agree or not?

l. The foot-in-the-door technique works on the principle of consistency (Petrova et al,

2007). This means that as long as the request is consistent with or similar in nature to
the original small request, the technique will work.

m. 1. The Low-Ball Technique

n. Low-ball technique refers to a strategy to gain compliance by making a very attractive

initial offer to get a person to agree to an action and then making the terms less
favourable.

o. It refers to a tactic for getting people to agree to something. People who agree to an
initial request will often still comply when the requester ups the ante. People who
receive only the costly request are less likely to comply with it. This is a two-step
compliance strategy in which the influencer secures agreement with a request by
understanding its true cost.

p. Agreeing to purchase something at a given price increases the likelihood of agreeing to

purchase it at a higher price. Initially you get the individual to agree to your request and
then afterwards you increase the original terms. Trick them into agreeing more than
they intended.

q. For example, when buying a car the salesman agrees a price, but must “check” with his
manager if this is acceptable. While waiting you think you have secured a good deal.
The salesman returns and says he manager would not agree the deal and the price is
raised. Most people agree to the higher price.

r. The success of this technique works on the principle of commitment. Because the
person has said “yes” or agreed to an initial request, commitment has been given. When
the request changes or becomes unreasonable, the person will (to a degree) find it
difficult to say “no” because of having originally committed themselves.

s. 2. Ingratiation

t. This attempt to obtain compliance involves gaining someone’s approval so they will be
more likely to appease your demands. Three forms of ingratiation that have been
 mentioned are: use of flattery; opinion conformity and self presentation (presenting
one’s own attributes in a manner that appeal to the target).

u. 3. Norm of reciprocity

v. This technique explains that due to the injunctive social norm that people will return a
favor when one is granted to them; compliance is more likely to occur when the
requestor has previously complied with one of the subject’s requests.

w. Let’s now turn to obedience.

2.4.3 Obedience

Here is an in- text question for you before you proceed.

In- text Question 2.2

Define the term obedience

Obedience is a form of social influence where an individual acts in response to a direct order
from another individual, who is usually an authority figure. It is assumed that without such an
order the person would not have acted in this way.

Obedience occurs when you are told to do something (authority), whereas conformity happens
through social pressure (the norms of the majority). Obedience involves a hierarchy of power
/ status. Therefore, the person giving the order has a higher status than the person receiving the
order.

Obedience is different from compliance in that it is obeying an order from someone that you
accept as an authority figure. In compliance, you have some choice. In obedience, you believe
that you do not have a choice. Many military officers and commercial managers are interested
only in obedience.

Obedience is a form of social influence that derives from an authority figure. The Milgram
Experiment, Zimbardo’s Stanford prison experiment, and the Hofling hospital experiment are
three particularly well-known experiments on obedience, and they all conclude that humans
behave surprisingly obedient in the presence of perceived legitimate authority figures.

We will however consider the Milgram experiment in our discussion to understand obedience.

The Milgram Experiment on Obedience

Milgram developed an intimidating shock generator, with shock levels starting at 30 volts and
increasing in 15-volt increments all the way up to 450 volts. The many switches were labeled
with terms including "slight shock," "moderate shock" and "danger: severe shock." The final
two switches were labeled simply with an ominous "XXX."
Each participant took the role of a "teacher" who would then deliver a shock to the "student"
every time an incorrect answer was given. While the participant believed that he was delivering
real shocks to the student, the “student” was a confederate in the experiment who was simply
pretending to be shocked.

As the experiment progressed, the participant would hear the learner plead to be released or
even complain about a heart condition. Once they reached the 300-volt level, the learner banged
on the wall and demanded to be released. Beyond this point, the learner became completely
silent and refused to answer any more questions. The experimenter then instructed the
participant to treat this silence as an incorrect response and deliver a further shock.

Most participants asked the experimenter whether they should continue. The experimenter
issued a series of commands to prod the participant along:

a. "Please continue."

b. "The experiment requires that you continue."

c. "It is absolutely essential that you continue."

d. "You have no other choice; you must go on."

The measure of obedience was the level of shock that the participant was willing to deliver.
How far do you think that most participants were willing to go?

When Milgram posed this question to a group of Yale University students, it was predicted that
no more than 3 out of 100 participants would deliver the maximum shock. In reality, 65% of
the participants in Milgram’s study delivered the maximum shocks.

It is important to note that many of the subjects became extremely agitated, distraught and
angry at the experimenter, but they continued to follow orders all the way to the end.

Why did so many of the participants in this experiment perform a seemingly sadistic act on the
instruction of an authority figure? According to Milgram, there are some situational factors
that can explain such high levels of obedience which include:

a. The physical presence of an authority figure dramatically increased compliance.

b. The fact that Yale (a trusted and authoritative academic institution) sponsored the study
led many participants to believe that the experiment must be safe.

c. The selection of teacher and learner status seemed random.

d. Participants assumed that the experimenter was a competent expert.

e. The shocks were said to be painful, not dangerous.

Figure 2 illustrates the Milgram’s experiment.

Figure 2: The Milgram’s Experiment

Well now you understand the effect of authority on obedience based on the Milgram study.

2.5 Resisting Social Influence

There are many factors that might make a person resist social influence.

Activity 2.3
List down the factors that lead to resistance to social influence

Good. Let us now go through some of these factors next.

2.5.1 Resisting Pressures to Conform

Let us begin by looking at the roles of allies.

1. The role of allies

One of the key things Asch’s study has shown us is how important having an ally is when
resisting social influence. This could be because it gives you more confidence in your own
opinion if they give the same answer as you. However, even an ally who gives a wrong answer,
but one that is different to the majority, increases the level of resistance to conformity. This
means there must be other reasons other than the correct answer that an ally helps. It could be
that you don’t feel so singled out as going against the majority, or the way the ally is treated
when they give a answer different to the majority could convince you that you won’t suffer as
a result of not conforming.

2. Moral considerations

Most of the research conducted in this area (for example, Asch) ask you to do fairly trivial
tasks, so conforming to this doesn’t necessarily mean you are being morally wrong by
conforming, making conforming easier. However, research shows that if you are being asked
to conform to something you consider to be morally wrong, then conforming levels drop
drastically.

3. The Non-conformist personality

Some people have a personality that means they are less likely to conform. Often a person who
resists majority influence is just less concerned with social norms, so they feel less pressure to
“fit in”. However, some people are completely against majority influence, whatever it is. These
people will go against the social influence at all times, they are showing anticonformity.

2.5.2 Resisting Pressures to Obey

These include aspects like:

1. Status of environment and authority figure

When Milgram’s experiment was moved from the prestigious Yale University to a downtown
office obedience dropped massively. This is probably because the participants felt that the
experiment wasn’t so important, so withdrawing wouldn’t be so terrible.

2. Removing the factors which make people obey

There are many factors that cause people to obey, for example buffers, agentic shift, gradual
commitment etc. If you remove these it instantly becomes easier to disobey. For example when
Milgram moved the “learner” to a position where the participant could see him (removing the
buffer), obedience sharply decreased. This is probably because the participant is more aware
of the consequences of his action now that there is no buffer.

3. Moral considerations

Similarly to the reasons moral consideration lowers conformity, if people think that the actions
they are being asked to obey are morally unjust then obedience drops.

4. Social Heroism

Zimbardo says that some people have a ‘heroic imagination’ which means they are more
likely to act in a heroic way. This means that when faced with orders to obey, they are more
likely to resist, especially if the order is morally unjust. Zimbardo points towards Nelson
Mandela and Michael Bernhardt as cases of social heroism, resisting pressures to obey.
2.6 Section Summary

We have learnt about social influence and how it shapes the beliefs, thoughts and attitudes of
individuals from interaction with others. You also learned about the components of social
influence which are conformity, compliance and obedience and looked at Milgram’s study on
obedience. Lastly we discussed the factors that may make an individual resist social
influence.

Dear learner that marks the end of this unit on social relations and influence. In the next unit
we will look at conflict, peacemaking and cognitive dissonance. Before you proceed to that
unit, answer the self test questions that follow to evaluate your understanding of this unit.

UNIT SELF TEST QUESTIONS

1. Describe the influence of proximity, physical attractiveness, and similarity on interpersonal

attraction. (10
marks)

2. Define altruism, and give an example. (3 marks)

3. Discuss Asch’s experiments on conformity, and distinguish between normative and

informational social influence. (10 marks)

4. Contrast overt and subtle forms of prejudice, and give examples of each. (5 marks)

5. Discuss the social factors that contribute to prejudice. (5 marks)

6. Cite four ways that cognitive processes help create and maintain prejudice. (4 marks)

7. Outline four psychological triggers of aggression. (4 marks)

UNIT 2: SOCIAL RELATIONS II

Wеlсоmе tо the second unit of this module on social psychology. In unit one you learnt about
social relations and influence. In this unit we continue to look at other aspects of social
relations. We will discuss the various types and causes of social conflict, the concept of
peacemaking and how this can be utilized in conflict resolution; and lastly discuss cognitive
dissonance theory.

This unit is dividеd intо three sесtiоns аs fоllоws:

Sесtiоn 1: Social Conflicts

Section 2: Peacemaking

Sесtiоn 3: Cognitive Dissonance Theory

Here are the unit objectives.

 Course Objectives

By the end of this unit, you should be аblе to:

1. Discuss social conflict

2. Describe the concept of Peacemaking
3. Explain Cognitive Dissonance Theory

Good! We will now proceed to the first section of this unit.

sSECTION ONE: SOCIAL CONFLICTS

Welcome to the first section of this unit. In this section you will learn about social conflicts. In
human relations, disagreements are bound to occur between two or more people in different
forms and contexts. This often times is due to incompatible actions or goals. In this section
therefore you will be able to understand various causes and types of social conflicts as well the
motivators of conflict within the context of social psychology.

Let us take a look at the section objectives then continue.

1.2 Objectives
By the end of this section you should be able to:

1. Define Social conflict

2. State the causes of social conflict
3. Outline the different types of social conflicts
4. Social/psychological motivations for conflict
5. 1.3 Definition of Social Conflict

6. In- text Question 1.1

7. What is Conflict?
8. Social conflict is the struggle for agency or power in society. Social conflict or group
conflict occurs when two or more actors oppose each other in social interaction,
reciprocally exerting social power in an effort to attain scarce or incompatible goals
and prevent the opponent from attaining them. It is a social relationship wherein the
action is oriented intentionally for carrying out the actor's own will against the
resistance of other party or parties.
As a process, it is the anti-thesis of cooperation. In other words, conflict is a
competition in its more occasional, personal and hostile forms. It is a process of
seeking to obtain rewards by eliminating or weakening the competitors.
Through it, one party attempts to destroy or annihilate or at least reduce to a
subordinate position the other party. Further, though normally violence is associated
with conflict, it can occur without it.
 9. 1.4 Causes of Social Conflict
10. Conflict arises due to various reasons. Malthus, the eminent economist says that
reduced supply of the means of subsistence is the root cause of conflict. According to
him, conflict is caused by the increase of population in geometrical progression and the
food supply in arithmetical progression.

11. According to Charles Darwin, the biological principles of "Struggle for existence" and
"the survival of the fittest" are the main cause of conflict.

12. Sigmund Freud and other psychologist hold the view that the innate instinct for
aggression in man is the main cause of conflict. Thus, various causes lead to conflict.

13. Perform the activity that follows as you continue.

14. Activity 1.1

15. Which are the main causes of conflict in your view? Put them down in your note
book.

2.4 Components of Social Influence

The three areas of social influence are:

a. Conformity

b. Compliance

c. Obedience

To be able to understand these components we will now look at each of them in more detail
starting with conformity.

1.4 Causes of Social Conflict

Conflict arises due to various reasons. Malthus, the eminent economist says that reduced supply
of the means of subsistence is the root cause of conflict. According to him, conflict is caused
by the increase of population in geometrical progression and the food supply in arithmetical
progression.

According to Charles Darwin, the biological principles of "Struggle for existence" and "the
survival of the fittest" are the main cause of conflict.

Sigmund Freud and other psychologist hold the view that the innate instinct for aggression in
man is the main cause of conflict. Thus, various causes lead to conflict.

Perform the activity that follows as you continue.

 Activity 1.1
Which are the main causes of conflict in your view? Put them down in your note book.

1.4.1 Misperception and Miscommunication

1. Misperceptions

Many conflicts contain but a small core of truly incompatible goals; the bigger problem is the
misperceptions of the other’s motives and goals.

Since conflict is the product of a perceived incompatibility, it is likely that by misperception

of others actions, most conflicts are created. This coincides with the concept of a self-serving
bias, in that we often justify our own actions and take credit for our successes but justify our
mistakes. At the same time we tend to judge others’ actions or motives more harshly than our
own, leading us to condemn others prematurely. We can also commit the fundamental
attribution error in our misperceptions giving us a one-dimensional perception of another
which can be very inaccurate.

Misperception Mirror

Image perception refers to the reciprocal views of one another often held by parties in conflict;
for example, each may view itself as moral and peace-loving and the other as evil and
aggressive. If misperceptions accompany conflict, then they should appear and disappear as
conflicts wax and wane. The same process that create the enemy’s image can reverse that image
when the enemy becomes an ally

When one puts faith and trust in another, and that confidence is broken, it can create an
emotional response that elevates to conflict. To trust someone is to place a high confidence
level that the relationship will not be compromised in any way...that I can expect you to do
what you say. A trusting relationship leads to feelings of confidence and security. A breach of
trust unleashes our strongest emotions that frequently lead to conflict.

2. Miscommunication

MiscommunicationThe ability to communicate is one of our most commonly used skills. we

use to communicate don't always clearly state the picture in our minds. When this occurs, errors
often result that lead to frustration. Depending on a multitude of factors (stress level for one),
the error sometimes results in conflict if neither person is willing to accept responsibility for it.

1.4.2 Personality Clashes

These natural sets of differences are some of our greatest strengths as individuals and teams;
however, they are also sources of conflict. If I, for example, prefer to look at only the "big
picture," then I may become frustrated by your attempts to discuss details. You, on the other
hand, may see me as irresponsible for not doing the analysis. Result: potential conflict.
1.4.3 Escalated disagreement

Disagreements are normal. When they are left unresolved, however, the associated feelings and
emotions will remain in force, at least at some level. When another situation brings this
disagreement back to the forefront, these suppressed emotions can erupt with force, usually far
in excess of those associated with the original disagreement. Therefore, it is critically important
to resolve disagreements as soon as possible and not let them fester

1.4.4 Differences in acquired values

Values are the beliefs we hold that help us to make decisions about what is right or wrong,
good or bad. Our values come from parents, siblings, friends, mentors, coaches, teachers,
books, churches, movies, television, and music ...life in general. No two people ever have the
same life experience, so we ultimately have different sets of values and beliefs that guide our
decisions and behavior. People struggle over religion, politics, race, humanitarian issues, ethics
and morals, abortion, sex, and more. In extreme cases, some people will, literally, die for their
beliefs

1.4.5 Ego Problems

Ego is another strong driver of our behavior and decisions. Ego wants us to be "right," and
moves us into defending our position, sometimes unreasonably

1.5 Types of Conflict

George Simmel has mentioned four types of conflict:

a. War

b. Feud or factional Strife

c. Litigation and

d. Conflict of impersonal ideals.

Look at each in greater detail.

1. War

According to Simmel, war represents a deep seated antagonistic impulse in man. It is a worst
type of conflict which aims at the destruction of the opponent. When all the efforts to resolve
the conflict between two nations fail, war finally breaks out as it in the only alternative to the
peaceful means of solution.

2. Feud or Factional strife

It is an intra- group conflict. It takes place among the members of the same group. The degree
of feud varies in groups.
3. Litigation

Litigation is a judicial form of conflict. People take recourse to legal means in the courts of law
to protect their right to possessions. This type of conflict is more objective in nature.

4. Conflict of impersonal ideals

When individuals fight not for their personal gain, but for some ideal, it is called the conflict
of impersonal ideals. In such a conflict, each party attempts to justify truthfulness of its own
ideals. For example, a political party always tries to prove that its ideals are better than that of
the other political parties.

In- text Question 1.2

What are the forms of conflict?

Forms of conflicts

Let us now look at these forms of conflict a little further.

1. Personal Conflict

Personal conflict occurs on personal level. It arises when the ideals and aims of two individuals
clash with each other. The fight of the students for the office of the Students’ Union provides
a bright example of this form of conflict.

2. Racial Conflict

Racial conflict is mostly due to the physical differences. Some races consider themselves
superior to other races and there are also races which feel that they are inferior to other. The
feeling of superiority or inferiority is the root cause of racial conflict. Conflict between the
Whites and Negroes in the U.S.A. provides an example of racial conflict.

3. Political Conflict

Political conflict arises when different political parties with their own ideologies try to achieve
their interest. The main cause of this kind of conflict is power which they want to capture. The
conflict between different political parties is an example of this type of conflict.

4. International Conflict

International conflict occurs among the different nations of the world. It may take place for
political, religious economic, ideological or for any other reasons. The conflict between India
and Pakistan is an example of such type of conflict.

5. Class Conflict
Class conflict takes place among classes with their differing interests. In the feudal society
there was conflict between the landlords and the peasants. The capitalist society is
characterized by the bourgeoisie and proletariat.

In addition to the conflicts discussed above there are a few other forms of conflict. They are
stated below:

1. Personal and Corporate Conflict

Conflict may be personal as well as corporate. Personal conflict takes place within the groups.
It arises on account of various motives, envy, hostility, treachery etc. The group does not derive
any benefit from this kind of internal conflict.

Corporate conflict occurs among the groups within a society or between two societies. Race-
riots, communal riots, war between nations are some of the examples of corporate conflict.

2. Latent and Overt Conflict

Conflict may be latent or overt. Sometimes individuals or groups do not want to express their
feeling of conflict due to some reasons. This unexpressed conflict is known as the latent
conflict. In other words, social tension and dissatisfactions, before their expression in the form
of hostile action, are two important kinds of latent conflict.

On the other hand, the overt conflict is the conflict expressed by a part or parties. Latent conflict
becomes overt conflict when an issue is declared and when hostile action is taken. The war
between India and Pakistan is an example of overt conflict.

Let us now look at the motivations for conflict next.

1.6 Social or Psychological Motivations for Conflict

Theories of social-psychological motivations for conflict locate the sources of conflict in the
way in which individuals perceive their environment, locate themselves in it, and on that basis
form individual and group identities that guide their behaviour and actions.

The most important social-psychological theories of conflict are realistic group conflict theory,
social identity theory, and psychoanalytic/psychodynamic theories.

We will now proceed to discuss each of these theories in some detail starting with realistic
group conflict theory.

1.6.1 Realistic Group Conflict Theory

This theory was first formulated by Muzafer Sherif in 1966 and then revisited in 1988. The
theory adopts basic premises of the rational choice approach in assuming that inter-group
conflict originates in the perceptions of group members with regard to real competition for
scarce resources, thus suggesting that hostility between groups results from real or perceived
conflicting goals because they generate inter-group competition. In other words, the dynamic
that evolves when groups are engaged in competitive zero-sum competitions leads to each
group developing negative stereotypes about, and enmity toward, the other group(s) with which
it competes.

Sherif et al. (1988) verified these basic premises in the so-called Robbers' Cave experiment
involving boys in a summer camp who had never met before. When they were split into two
groups engaging in competitive activities with conflicting goals (i.e., goals that can be achieved
only at the expense of the other group, such as sports tournaments) inter-group hostility
emerged very quickly and almost automatically.

1.6.2 Social Identity Theories

The most important theorists in the social identity approach are Henri Tajfel (1981), Michael
Billig (1976), and Donald Horowitz (1985). According to this theory, every individual divides
his/her social world into distinct classes or so-called social categories and locate themselves
and others in relation to them. On the basis of a cumulative process of locating oneself,
individuals can constitute their social identity, i.e., defines themselves in social category such
as gender, geographic location, class, profession, ethnicity, etc.

The basic assumption is that people strive for a positive social identity. As social identity is
derived from membership in groups, a positive social identity is the outcome of favourable
social comparisons made between the in-group (i.e., the group to which one belongs) and other
social groups. As long as membership in a group enhances one’s self- esteem, that is, as long
as social comparisons remain (on balance) favourable, one will remain a member of that group.
However, if the group fails to satisfy this requirement, the individual may try to change the
structure of the group (social change), seek a new way of comparison which would favour
his/her group, and hence, reinforce his/her social identity (social creativity), or leave/abandon
the group with the desire to join a 'better' one (social mobility).

For individuals that are members of a minority group to achieve a positive social identity is
very difficult because minorities almost always have an inferior status in comparison with the
majority. Thus, for members of minorities, different strategies are required to confront the
challenge of a achieving a positive social identity. First, if the social system is perceived as
legitimate and stable, and there are no visible alternatives to the status quo, or there is no
conceivable prospect of any change in the nature of the system (such as in a feudal society),
they just accept their inferiority and acquiesce. Second, if the system is perceived as illegitimate
by the minority, very soon alternatives begin to be envisioned. The system loses its stability,
and oppression and terror by the majority-controlled state becomes the only way to maintain
it. Third, if majority-minority relations are perceived as illegitimate and the system is no longer
stable, the minority group members will tend towards a rejection of their inferior status. They
then may reinterpret and redefine their group's characteristics and, thus, try to transform their
social identity into a positive one.

Donald Horowitz (1985) offers the best-known application of social identity theory to cases of
ethnic conflict. It focuses on group comparison between backward and advanced groups in
which members of the backward groups must decide whether to emulate out-group behaviour
in order to compete or adopt different coping strategies, such as claiming preferential treatment
or compensation if backwardness is perceived to have emerged from past injustices and
discrimination. Backward groups harbour fears extinction if they cannot catch up with
advanced groups or if preferential treatment is limited, and their anxiety flows from diffuse
danger of exaggerated dimensions, limits and modifies perceptions, and produces extreme
reactions to modest threats. Horowitz also stipulates a relation between self-esteem, anxiety
and prejudice in relation to conflict. Self-esteem is raised by aggression, especially if
aggression is projected on others as justification for own actions, i.e., prejudices about other
groups’ aggressiveness produces and intensifies anxiety and justifies aggression (as self-
defense).

Comparisons between ethnic groups center on their relative group worth and relative group
legitimacy and merge easily into a politics of ethnic entitlement in which the quest for power
is both instrumental (power as a means to an end, e.g., averting the threat of group extinction)
and symbolic (power as a confirmation of status). This means that in unranked systems, groups
will make efforts to dominate and avoid domination by others. What may thus have initially
been a conflict over needs and interests becomes subordinate to conflicts over status and over
the rules of the political system (citizenship, electoral systems, official languages, constitution,
etc.). The intensity of ensuing conflict is, according to Horowitz, a function of the relative
strength of group claims: the more invidious the group comparison and the larger the area of
unacknowledged claims to group legitimacy, the more intense the conflict.

1.6.3 Psychoanalytic or Psychodynamic Theories

The most important representatives of the psychoanalytic approach to inter-group conflict are
Vamik Volkan (1988, 1992, 1994, 1998), Marc H. Ross (1993, 1995) and Joseph Montville
(1990).

Their theories mainly seek to explain how people form images about themselves and others.
Volkan argues that there are suitable targets of externalization determined either by culture
(familiar objects of a child's environment), or shown to the children by parents and other adults.
Such suitable targets of externalization are symbols such as flags, songs, special dishes, places
of worship, religious icons, memorials, certain animals (Ross, 1995), but also people, and
groups of people (Volkan 1988), and they can have both positive and negative connotations.
Yet, this is not sufficient for the definition of group identity. In addition to cultural symbols
and rituals, a group identity needs enemies (who help the group members define who they are
not), chosen glories (important, usually mythologized and idealized achievements that took
place in the past), chosen traumas (losses, defeats, humiliations -also mythologized- that are
usually difficult to mourn), and borders (physical and/or mental) that facilitate a clear
distinction between in-group and out-group.

Minorities, especially if they are considered impossible to assimilate into the majority can
easily become suitable targets for externalization of the majority’s negative feelings and self-
images. In this case, minorities not only attract hatred, suspicion, and rage of the majority
because of the characteristics they allegedly have but they also serve as reservoirs of the
majority's negative self-images whose very existence is blamed on the minority (e.g., majority
aggressiveness is necessary as a self-defence against minority aggressiveness). Relations
between minority and majority may become even more strained if that minority is linked to a
state or nation that in the past inflicted a deep trauma upon the majority group (e.g.,
favoured/ruling majorities in colonial regimes). In that case, and after the balance of power
changes in favour of the majority, the minority often becomes a target of ethnic cleansing,
massacres, and genocide.

1.7 Section Summary

We have now come to the end of section one on conflicts. In this section we learnt that
conflict is perceived incompatibility of actions or goals and can have varied causes including
misperceptions and miscommunication. We also looked at various types of conflicts and the
social/ psychological motivations for conflict.

SECTION TWO: PEACEMAKING

Welcome to this section on peacemaking. In the previous section we learnt about social
conflicts and their causes. In order to solve conflicts and enhance social relations peacemaking
is necessary. This section therefore will be useful in helping you understand the concept of
peacemaking and how you can apply this in resolving conflicts.

To start with, here are the objectives for this section.

2.2 Section Objectives

By the end of this section you should be able to:

1. Describe the Concept of peacemaking.

2. Explain the Four Cs of Peacemaking.

2.3 The Concept of Peacemaking

Peacemaking is a complicated concept because peace can be defined in so many different ways.
For our purposes, peacemaking is not a process of passive acceptance of mistreatment, a
turning of the other cheek in the face of clear injustice or abuse, or other weak images of
meekness or nonresistance. Instead, peacemaking is a vibrant, powerful concept.

At its best, peacemaking creates relational and structural justice that allows for social and
personal well being. This is an ideal objective, perhaps not attainable in all conflicts.
Nevertheless, peacemaking implies the use of cooperative, constructive processes to resolve
human conflicts, while restoring relationships. Peacemaking does not deny the essential need
for adversary processes, but peacemaking places adversary processes into a larger perspective.
Litigating disputes is not seen as a primary dispute resolution mechanism, but as a last-resort
process.
 In-text Question 2.1

What do you understand by the term negative peace?

Negative Peace

Good! Let us begin with negative peace.

1. Negative Peace

First, there is negative peace. Negative peace means the absence of violence, typically through
coercion rather than cooperation. When a mother tells her son Tom to stop beating up on a
younger sibling Jim, she is imposing a negative peace in the household. Tom’s conflict with
Jim is not resolved, but merely suppressed. The concept of negative peace extends not only
from our mundane example in the home, but also to international peace. International peace is
said to exist during a cessation of violence and hostility. This form of peace is often imposed
by U.N. peacekeepers.

Again, peace is defined as an absence of war and is imposed coercively. Our law enforcement
mechanisms, euphemistically called criminal justice, create another form of negative peace.
The bad guys are taken off the street so that crimes are reduced. Thus, law enforcement officials
are called “peace” officers even though they use extremely coercive and sometimes violent
means to achieve their ends. Finally, the legal system perpetuates a form of negative peace. At
best, the civil justice system renders a fair and impartial decision. However, the result is just a
decision, not a resolution to or transformation of the conflict. Upon judgment, the legal conflict
is finished and people are expected to get on with their lives. Generally speaking, however, the
underlying causes of the conflict are left unresolved. How satisfied are a father and daughter
after a judgment in favor of one or the other after a bitterly contested trial? So, the legal system
does not provide for peace; it only provides for decisions.

Positive Peace

Activity 2.1
From the scenario depicted in negative peace, explain your understanding of positive peace.

Now read on the content that follows to understand more.

1. Positive Peace

The second way of understanding peace is as positive peace. Positive peace implies
reconciliation and restoration through creative transformation of conflict. In positive peace, the
mother sits Tom and Jim down and invites them to exchange stories about what led to their
fight. Mom and Jim learn for the first time that Tom feels angry at the way Jim ignores him. In
five minutes, they work out a plan that allows Tom the safety and security to speak out about
what he is feeling. Jim promises to listen more carefully to Tom. Tom promises not to hit Jim
when he, Tom, becomes frustrated. The fighting has stopped, but more importantly the
relationship has been reconciled and restored. In the process, Tom and Jim have grown morally
just a little. In the same way, a lawyer as peacemaker looks at conflict not just as an abstract,
intellectual exercise in analysis and persuasion, but as an opportunity to help people reconcile.
When reconciliation is not possible, separation and resolution is possible with a minimum of
hostility and acrimony.

So peacemaking concerns a deeper way of looking at conflicts than just winning or losing. It
looks at conflicts as opportunities for people to grow, to accept responsibility for the
relationships they are in, and for the potential of apology and forgiveness.

Idealistic? Not at all! Time after time, when people are placed in a safe and secure environment,
they naturally seek out their capacity for goodness. Even the most cynical, hardened business
people have recognized the importance of relationships when they are invited and allowed to
do so. We don’t see this side of people often only because they are not given the space, safety
and security to express their anger, their true concerns and their interests. Furthermore, they
are not placed in a position where they can honestly listen and hear the perspectives of others.
Perhaps the greatest difference between peacemaking and other forms of conflict resolution is
that opportunities for exploitation are taken away. Once the fear of vulnerability is neutralized,
people can aspire to their higher good and really find excellent solutions to their conflicts.

Well done. Now you understand the concept of peacemaking. Let us now look at the process
of peacemaking by discussing the 4C’s of peacemaking next.

2.4 The 4 C's of Peacemaking

Social psychologists have focused on four strategies for helping enemies become comrades.
We can remember these as the four C’s of the peacemaking:

a. Contact,

b. Cooperation,

c. Communication, and

d. Conciliation.

Let us now explain each of these aspects of peacemaking in more detail starting with
Contact.

1. Contact

Might putting people into close contact reduce their hostilities? There are good reasons to think
so. Yet, despite some encouraging early studies of desegregation, other studies show that in
schools mere desegregation has little effect upon racial or tribal attitudes. A case worth
mentioning is the study by social psychologist Walter Stephan (1986). According to him,
sometimes desegregation has led to increased prejudice (especially by Whites toward Blacks)
and sometimes to decreased prejudice (especially by Blacks towards Whites). But on balance
the effects are minimal for both Black and White students. In most schools, interracial contact
is seldom prolonged or intimate. When it is structured to convey equal status, hostilities often
lessen.

Here equal-status contact means the contact made on equal basis. Just as a relationship between
people of unequal status breeds attitudes consistent with their relationship, so do relationships
between those of equal status. Thus, to reduce prejudice, contact (for example interracial)
should be between persons equal in status.

2. Cooperation

Although equal-status contact can help, it is sometimes not enough. Contacts are especially
beneficial when people work together to overcome a common threat or to achieve a
superordinate goal. A superordinate goal is a shared goal that necessitates cooperative effort; a
goal that overrides people’s differences from one another.

In his boys’ camp experiments, Sherif used the unifying effect of a common enemy to create
cohesive groups. Then he used the unifying power of cooperative effort to settle the conflicting
groups. Taking their cue from experiments on cooperative contact, several research teams have
replaced competitive classroom learning situations with opportunities for cooperative learning.
Their heartening results suggest how to constructively implement desegregation and strengthen
our confidence that cooperative activities can benefit human relations at all levels.

Extending these findings, Samuel Gaertner with his fellows (1990, 1991) reports that working
cooperatively has especially favorable effects under conditions that lead people to define a
new, inclusive group that dissolves their former subgroups. If, for example, the members of
two groups sit alternately around a table, (rather than on opposite sides), give their new group
a single name, and then work together, their old feelings of bias against the former outsiders
will diminish. “Us” and “them” become “we”.

3. Communication

Conflicting parties can also seek to resolve their differences by bargaining either directly with
one another or they can ask a third-party to mediate by making suggestions and facilitating
their negotiations. Or they can arbitrate by submitting their disagreement to someone who will
study the issues and impose a settlement.

When a pie of fixed size is to be divided, adopting a tough negotiating stance tends to gain one
a larger piece (for example, a better price). When the pie can vary in size, as in the dilemma
situations, toughness more often backfires.

Third-party mediators also help resolve conflicts by facilitating constructive communication.

Their first task is to help the parties rethink the conflict and to gain information about the other
party’s interests. By prodding them to set aside their conflicting demands and opening offers
and to think instead about underlying needs, interests and goals, the mediator aims to replace
a competitive “win-lose” orientation with a cooperative “win-win” orientation that aims at a
mutually beneficial resolution. Mediators can also structure communications that will peel
away misperceptions and increase mutual understanding and trust.

4. Conciliation

Sometimes tension and suspicion run so high that communication becomes all but impossible.
Each party may threaten, coerce or retaliate against the other. Unfortunately, such acts tend to
be reciprocated, thus escalating the conflict. In such times, small conciliatory gestures by one
party may elicit reciprocal conciliatory acts by the other party. Thus tension may be reduced to
a level where communication can occur. One such conciliatory strategy is GRIT (Graduated
and Reciprocated Initiatives in Tension reduction) which aims to alleviate tense international
situations.

Those who mediate tense labor-management and international conflicts sometimes use one
other peacemaking strategy. They instruct the participants in the dynamics of conflict and
peacemaking. The hope is that understanding – understanding how conflicts are fed by social
traps, perceived injustice, competition and misperceptions and understanding how conflicts can
be resolved through equal-status contact, cooperation, communication and conciliation – can
help us establish and enjoy peaceful, rewarding relationships.

Perform the activity that follows before you continue.

Activity 2.2

Outline the difference between GRIT and TFT strategy

2.5 Section Summary

Well done. We have now come to the end of this section on peacemaking. In this section we
described the concept of peacemaking and its relevance in social relations. We also described
the four C’s of peacemaking that is contact, cooperation, communication and conciliation. In
the next section you will learn about cognitive dissonance theory.

SECTION THREE: COGNITIVE DISSONANCE THEORY

Welcome to this section on cognitive dissonance theory. In this section we will get to
understand the meaning of cognitive dissonance and trace its origins as well as explore the
specific concepts of this theory and its relevance in social psychology.

We will start off by going through the section objectives.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Define Cognitive Dissonance

2. Explain the origin of Cognitive Dissonance
3. Describe the Concepts in Cognitive Dissonance
4. Outline "The Fox and the Grapes" illustration
5.
6. 3.3 Definition of Cognitive Dissonance
7. Cognitive dissonance refers to a situation involving conflicting attitudes, beliefs or
behaviors. This produces a feeling of discomfort leading to an alteration in one of the
attitudes, beliefs or behaviors to reduce the discomfort and restore balance etc.

8. For example, when people smoke (behavior) and they know that smoking causes
cancer (cognition).

3.4 Origins of Cognitive Dissonance

Cognitive dissonance was first investigated by Leon Festinger, arising out of a participant
observation study of a cult which believed that the earth was going to be destroyed by a flood,
and what happened to its members — particularly the really committed ones who had given up
their homes and jobs to work for the cult — when the flood did not happen.

While fringe members were more inclined to recognize that they had made fools of themselves
and to "put it down to experience", committed members were more likely to re-interpret the
evidence to show that they were right all along (the earth was not destroyed because of the
faithfulness of the cult members).

Festinger's (1957) cognitive dissonance theory suggests that we have an inner drive to hold all
our attitudes and beliefs in harmony and avoid disharmony (or dissonance).

Attitudes may change because of factors within the person. An important factor here is the
principle of cognitive consistency, the focus of Festinger's (1957) theory of cognitive
dissonance. This theory starts from the idea that we seek consistency in our beliefs and attitudes
in any situation where two cognitions are inconsistent.

Leon Festinger (1957) proposed cognitive dissonance theory, which states that a powerful
motive to maintain cognitive consistency can give rise to irrational and sometimes maladaptive
behavior.

According to Festinger, we hold much cognition about the world and ourselves; when they
clash, a discrepancy is evoked, resulting in a state of tension known as cognitive dissonance.
As the experience of dissonance is unpleasant, we are motivated to reduce or eliminate it, and
achieve consonance (i.e. agreement).

3.5 Concepts in Cognitive Dissonance Theory

According to cognitive dissonance theory, there is a tendency for individuals to seek
consistency among their cognitions (i.e., beliefs, opinions). When there is an inconsistency
between attitudes or behaviors (dissonance), something must change to eliminate the
dissonance.

Dissonance can be reduced in one of three ways:

1. First, individuals can change one or more of the attitudes, behavior, beliefs etc. so as to
make the relationship between the two elements a consonant one. When one of the
dissonant elements is a behavior, the individual can change or eliminate the behavior.
However, this mode of dissonance reduction frequently presents problems for people, as it
is often difficult for people to change well-learned behavioral responses (e.g. giving up
smoking).

2. A second (cognitive) method of reducing dissonance is to acquire new information that

outweighs the dissonant beliefs. For example, thinking smoking causes lung cancer will
cause dissonance if a person smokes. However, new information such as “research has not
proved definitely that smoking causes lung cancer” may reduce the dissonance.

3. A third way to reduce dissonance is to reduce the importance of the cognitions (i.e.
beliefs, attitudes). A person could convince themself that it is better to "live for today" than
to "save for tomorrow." In other words, he could tell himself that a short life filled with
smoking and sensual pleasures is better than a long life devoid of such joys. In this way, he
would be decreasing the importance of the dissonant cognition (smoking is bad for one’s
health).

Notice that dissonance theory does not state that these modes of dissonance reduction will
actually work, only that individuals who are in a state of cognitive dissonance will take steps
to reduce the extent of their dissonance. One of the points that dissonance theorists are fond of
making is that people will go to all sorts of lengths to reduce dissonance.

Attitude Change

Various factors that have been identified which may be important in attitude change can be
di3.6 Reduction of Dissonance

Cognitive dissonance theory is founded on the assumption that individuals seek consistency
between their expectations and their reality. Because of this, people engage in a process called
dissonance reduction to bring their cognitions and actions in line with one another. This
creation of uniformity allows for a lessening of psychological tension and distress.

Before you go further, here is an activity for you.

Activity 3.1
Outline the strategies for reduction of dissonance.

vided into three main areas:

a. Forced compliance behavior

b. Decision-making

c. Effort.

We will look at the main findings to have emerged from each area.

1. Forced Compliance Behavior

When someone is forced to do (publicly) something they (privately) really don't want to do,
dissonance is created between their cognition (I didn't want to do this) and their behavior (I did
it).

Forced compliance occurs when an individual performs an action that is inconsistent with his
or her beliefs. The behavior can't be changed, since it was already in the past, so dissonance
will need to be reduced by re-evaluating their attitude to what they have done. This prediction
has been tested experimentally:

In an intriguing experiment, Festinger and Carlsmith (1959) asked participants to perform a

series of dull tasks (such as turning pegs in a peg board for an hour). As you can imagine,
participant's attitudes toward this task were highly negative. They were then paid either $1 or
$20 to tell a waiting participant (relay a confederate) that the tasks were really interesting.
Almost all of the participants agreed to walk into the waiting room and persuade the subject
accomplice that the boring experiment would be fun.

2. Decision Making

Life is filled with decisions, and decisions (as a general rule) arouse dissonance.

For example, suppose you had to decide whether to accept a job in an absolutely beautiful area
of the country, or turn down the job so you could be near your friends and family. Either way,
you would experience dissonance. If you took the job you would miss your loved ones; if you
turned the job down, you would pine for the beautiful streams, mountains, and valleys.

Both alternatives have their good points and bad points. The rub is that making a decision cuts
off the possibility that you can enjoy the advantages of the unchosen alternative, yet it assures
you that you must accept the disadvantages of the chosen alternative.

People have several ways to reduce dissonance that is aroused by making a decision (Festinger,
1964). One thing they can do is to change the behavior. As noted earlier, this is often very
difficult, so people frequently employ a variety of mental maneuvers. A common way to reduce
dissonance is to increase the attractiveness of the chosen alternative and to decrease the
attractiveness of the rejected alternative. This is referred to as "spreading apart the alternatives."

3. Effort

It also seems to be the case that we value most highly those goals or items which have required
considerable effort to achieve.

This is probably because dissonance would be caused if we spent a great effort to achieve
something and then evaluated it negatively. We could, of course, spend years of effort into
achieving something which turns out to be a load of rubbish and then, in order to avoid the
dissonance that it produces, try to convince ourselves that we didn't really spend years of effort,
or that the effort was really quite enjoyable, or that it wasn't really a lot of effort.

In fact, though, it seems we find it easier to persuade ourselves that what we have achieved is
worthwhile and that's what most of us do, evaluating highly something whose achievement has
cost us dear - whether other people think it's much cop or not! This method of reducing
dissonance is known as 'effort justification'.

If we put effort into a task which we have chosen to carry out, and the task turns out badly, we
experience dissonance. To reduce this dissonance, we are motivated to try to think that the task
turned out well.

3.6 Reduction of Dissonance

Cognitive dissonance theory is founded on the assumption that individuals seek consistency
between their expectations and their reality. Because of this, people engage in a process called
dissonance reduction to bring their cognitions and actions in line with one another. This
creation of uniformity allows for a lessening of psychological tension and distress.

Before you go further, here is an activity for you.

Activity 3.1

Outline the strategies for reduction of dissonance.

3.7 The Fox and the Grapes illustration

A classic illustration of cognitive dissonance is expressed in the fable "The Fox and the Grapes"
. In the story, a fox sees some high-hanging grapes and wishes to eat them. When the fox is
unable to think of a way to reach them, he decides that the grapes are probably not worth eating,
with the justification the grapes probably are not ripe or that they are sour (hence the common
phrase "sour grapes"). The moral that accompanies the story is "Any fool can despise what he
cannot get". This example follows a pattern: one desires something, finds it unattainable, and
reduces one's dissonance by criticizing it.
This pattern can also be referred to as "adaptive preference formation".

Here now is the summary of the section.

3.8 Section Summary

Congratulations! You have now come to the end of this section on cognitive dissonance. In this
section we defined the term cognitive dissonance and discussed its origin. We also described
the concepts in cognitive dissonance theory including reduction of dissonance. You also learnt
that attitude change is key in reduction of dissonance.

That marks the end of Unit 2 of the module on social psychology. I hope you found the learning
interesting. Before you take a break, make sure you attempt the end of unit questions that follow
to find out how much you can remember from what you have learnt in the entire unit.

HCH 100: BEHAVIOURAL SCIENCES - ANTHROPOLOGY

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY

ANTHROPOLOGY

FOR

BACHELOR OF MEDICINE AND SURGERY STUDENTS

MODULE 6: ANTHROPOLOGY

2015

Copyright
 Behavioural Sciences Course to Undergraduate Students in the College of Health
Sciences by Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Writer: Dr. Wangari Kuria MbCHB, Mmed (Psych), PhD Psych.

Reviewer:

Chief Editor: Joshua M. Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

Module Introduction

Welcome to this module on anthropology. It introduces you to basic anthropology

and its relevance to the medical profession. This is the approved course outline for
this module (link). This module is an important basis for dealing with human behavior
as related to culture, health, illness and health care. You are expected to carefully
read the e-content, complement these with the recommended reference books and
other reading material. The text- tasks included in the modules are important and
you should carefully go through them to enable you understand the module content.
It is also crucial that you take time to reflect on the posed questions and complete
the assignments and activities suggested. You are advised to discuss the module
and assignments with other students and consult the module teacher if necessary.

The module consists of 4 units as follows:

Unit 1: Fundamentals of anthropology

Unit 2: Health behavior

Unit 3: Communication

Unit 4: Modern and traditional medical care

Module Objectives
 By the end of this module, you should be able to:

1. Discuss the fundamentals of anthropology.

2. Describe health behavior.
3. Describe communication in the context of anthropology.
4. Discuss Modern and traditional medical care.

Section 1: Introduction to Anthropology

Section Outline

1.1 Section Introduction

1.2 Section objectives

1.3 Definition of anthropology

1.4 Subfields of anthropology

1.5 Constitutes of culture

1.6 Characteristics of culture

1.7 Summary

1.8 Activity

1.1 Section Introduction

In section one you will be introduced to the various types of anthropology and
discuss its relevance to human behavior and psychiatry in general.

Welcome to this section on the introduction to anthropology. Anthropology and

psychiatry are both concerned with understanding human behavior. Understanding
human behavior is an important factor in providing appropriate health professional
services to the people. In this section we will define anthropology, outline the
subfields of it, and describe what constitutes culture and characteristics of culture.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define of anthropology
2. Outline subfields of anthropology
 3. Describe constitutes of culture
4. Describe characteristics of culture

1.3 Anthropology

Anthropology is the study of humankind from a comparative perspective that

emphasizes the diversity of human behavior and the importance of culture in
explaining that diversity.

1.4 Subfields of Anthropology

Anthropology is typically divided into four sub-fields:

a. Cultural anthropology (also called social anthropology)

b. Archaeology
c. Linguistic anthropology
d. Biological/physical anthropology which is also referred to as medical
anthropology.

Medical anthropology focuses on the practice of medicine and cultural aspects of

providing and receiving health care. The section will lay emphases on this subfield

1.5 Culture

Culture is the external expression of individual mental life as represented by

1. Manners: these are the unenforced standards of conduct which show the actor that
you are proper, polite and refined.
2. Customs: A practice followed by people of a particular group or region.
3. Skills: Communication of thoughts and feelings through a system of arbitrary signals,
such as voice sounds, gestures, or written symbols.
4. Language: An art, trade, or technique, particularly one requiring use of the hands or
body.
5. Parent-child interactions: Child-rearing patterns and other parent - child interactions
6. Beliefs: an acceptance that a statement is true or that something exists
7. social life: this includes the social models and expectations, role opportunities and
other variables of social life

1.6 Characteristics of Culture

Culture is traditional in that social practices are passed on from generation to

generation. Culture encompasses the notion of a group of persons sharing a system
of action and belief of persisting longer than the life span of one person. In that
sense every culture is historical and genetic. A culture possesses a value system of
good, bad, desirable and undesirable behavioral patterns. Culture can be examined
from both a psychological viewpoint and a normative viewpoint in terms of how the
majority adapt to stresses unique to particular culture. There are characteristics that
are similar across most cultures e.g. Studies have concluded the following:

1. Indulgence and care in early infancy are important determinants of adult mental
health
2. That nature of the child by various caretakers, in addition to mother, is not harmful.
3. Smiling is a social greetings exhibited by all normal members of every known
society.
4. There is a taboo against incest and homicide.
5. There are gender differences in roles that go beyond reproduction.
6. Males are more aggressive than females
7. Strong attachments and fear of separation and strangers appear in the second half of
the first year of life.

It is important to note that some characteristics are shared by humans and higher
primates including:

1. Single birth
2. Frequent nursing
3. Late weaning
4. High mother-infant proximity
5. Gradual transition to peer play in groups
6. Variable but low direct involvement by adult males in child rearing.

1.7 Activity

Activity
Form a discussion group consisting of student in your class from
varies cultures.

1. Explore the child rearing practices in your culture.

2. Discuss how they differ from those of other cultural groups.
3. Outline this practices those that are useful to the child's health
4. Outline the practice that endanger or affect the health of the
child

1.8 Summary

Cultural concepts of health care are best understood within the context
of particular culture under study. There are similarities and differences
in the various characteristics across culture. An understanding of this
will enable the clinician to institute the necessary health promotion
strategies without conflicting with the cultural concepts. This will be the
focus of our next few sections.

In Section 2 you will learn the intersection between culture and psychiatry and its
relevance to the provision of mental health care.
Section 2: Culture and Psychiatry

Section Outline

1.1 Section Introduction

1.2 Section objectives

1.3 Cultural psychiatry

1.4 Intersection between culture and psychiatry

1.5 Dimensions in culture psychiatry intersection

1.6 Relevance of intersection in clinical and research setting Summary

1.7 Summary

1.8 Activity

2.1 Section Introduction

Welcome to this section on culture and psychiatry. The intersection between culture
and psychiatry has been known over the years. In recent years, the field of cultural
psychiatry has gained recognition and accumulated evidence of its clinical relevance.
There are 5 dimensions in the intersection between culture and psychiatry as
discussed below. These five dimensions should be considered in clinical settings,
research and in policy formulation. This intersection presents differently in different
communities depending on how deep the people are acculturated.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Define cultural psychiatry.

2. Discuss the intersection between culture and psychiatry.
3. Describe the 4 dimensions in culture psychiatry intersection.
4. Discuss the relevance of intersection in clinical and research
setting.

2.3 Cultural Psychiatry

Cultural psychiatry deals with the description, definition, assessment, and
management of all psychiatric conditions, inasmuch as they reflect and are subjected
to the patterning influence of cultural factors.

2.4 Culture and Psychiatry

The range of possible interactions between culture and its components with clinical
phenomena in general and psychiatric diagnosis in particular, is broad and
multifaceted. There are numerous cultural explanations for psychopathology, for
examples people hearing voices of people they cannot see will attempt to explain the
experience. For some the belief in curses vexes and spells will advise the kind of
help sort, mainly traditional or religious help while others will focus on self-inflicted
problems through their past evil acts and breaking of cultural taboos. An
understanding of this cultural background is important in psychiatry since it allows
the therapist to offer a holistic therapy by use of bio-psychosocial spiritual model of
treatment (refer module 8, section 8).

2.5 Dimensions in culture psychiatry intersection

The following are the 5 dimensions that demonstrates the intersection between
culture and psychiatry

 Interpretive
 Pathogenic agent
 Diagnostic
 Therapeutic/protective element
 Service/management instrument.

Let us look at each of these dimensions in detail.

a) Interpretive dimension

This is also referred to as the explanatory dimension of the psychopathology. This

offers idiosyncratic perspective of the patient and relatives about the origin of the
problem. In other words the patient and the relatives will be asking and looking for
answers for the following questions; why the symptoms did occur, what was the
process of getting sick or what is the source of the illness, why this particular
individual and not another, what can be done to alleviate the illness. It is important to
know that in most African cultures there is a strong belief that most illnesses and
death have a cultural origin. The cultural stamp of these explanations should not be
underestimated, as the information is valuable and relevant for both the diagnosis
itself, and for aspects of the eventual multidisciplinary management process. This
may include helping the patient choose the right coping skills for their situations.

b) Pathogenic/ Pathoplastic dimension

The macro environment is an almost inexhaustible source of both benign (or

preventive) and harmful factors in the development of any clinical condition. A
culturally-based diagnosis should include the identification of environmental
pathogenic factors. Such factors include not only family, but also media, socio-
political structures, rules and values of public behavior, church affiliation, schedules,
rituals and schooling norms. Cultural factors may have a powerful pathogenic impact
as triggers of psychopathology (e.g., the role of violence in television shows in the
development of violent behavior among probably predisposed children or
adolescents). They can also contribute to higher or lower levels of severity of
psychiatric symptoms (e.g., delayed help-seeking response to the appearance of
acute psychotic symptoms in a family member). They can be agents in the
expression of clinical symptoms, reflecting the dominant themes of the historical
period in which the illness occurs. They are certainly decisive elements in treatment.

Pathoplastic factors refer to the uniqueness of symptom expression. It is important to

recognize that the narrative component of the patient/relative - professional
interaction respond to a particular moment in which they are occurring. Environment
shapes the content and form of the symptoms. For example a delusion (false fixed
belief that is not in keeping with the education and cultural background) has
remained the same in form but the content may be different depending on whether
the patient is from a rural or urban background. The distinction between the
appearance of the symptom, its verbal description, and the patient's surrounding
reality continues to be the key element of this part of the evaluation.

c) Diagnostic dimension

In making a psychiatric diagnosis, cultural psychiatry should be considered not only

for the ethnic minorities but also for the "developed" communities because culture
impacts on all. The recognition of cultural components in psychiatric diagnosis for all
patients irrespective of their cultural background is important. The patient's cultural
background and identity must be thoroughly understood by the clinician, and its
impact duly recognized and evaluated. Involving a crucial set of factors, culture plays
several roles in the diagnostic process.

Currently most psychiatrists do not refer to culture in their diagnostic practice.

Cultural factors are important in psychiatric diagnosis and a check on the race and
ethnicity of patients is important.

d) Therapeutic/protective element

Certain cultures have higher prevalence of certain conditions. For example it has
been reported that the Kikuyu women from central Kenya suffer more depression
than other women in the country due to the excessive responsibilities assigned to
them. The notion of culture bound syndromes suggests that some of the cultural
groups are more likely to suffer some conditions than others. Some of this culture
bound syndromes will be discussed in details latter in section 3 of unit 1. Culture may
have factors that are therapeutic or protective against particular conditions. Cultural
factors including religion and beliefs are important decisive elements in treatment. It
is important to utilize culturally available protective and therapeutic factors when
designing the management of the patient. It is also important to know the cultural
factors that would negatively influence the management of the patient.

e) Service/management instrument
The health services provided to the patient should be tailored according to the needs
of the cultural group or community concern. Some communities will need particular
services more than others. For example some communities may be in need of drug
treatment facilities than others because of the high prevalence of substance uses
disorders. Professionals and policy makers must have in mind the cultural
environment when they design health services

2.6 Intersection in Clinical and Research Setting

Every patient has a unique cultural background that should be evaluated during the
doctor -patient interaction. The cultural content of psychiatric diagnosis should
include the main, well-recognized cultural variables, adequate family data,
explanatory models, and strengths and weaknesses of every individual patient.
Understanding the cultural variables enables the clinician to provide the culturally
appropriate therapy and counsel while in research it helps to adopt the research
instruments to be culturally appropriate.

2.7 Summary

Culture and psychiatry intersect in 5 main dimensions namely; in

symptom interpretation, pathogenesis, diagnosis, treatment and
services/management provision. The intersection is important and
clinical settings and in research.

2.8 Activity

Activity
Explore how your cultural group deals with mentally ill patients.

Section 3 will provide information on how cultural concepts influence health/illness

and how this can be used to the advantage of the patient in some cases.

SECTION 3: CULTURE HEALTH AND ILLNESS

Section Outline

3.1 Section Introduction

3.2 Section objectives

3.3 Relevance of culture to medicine

3.4 culture concept and illness

3.5 Unique Cultural Behaviours

3.6 Culture bound syndrome

3.7 Culture shock

3.8 Summary

3.9 Activity

3.1 Section Introduction

Welcome to this section on culture, health and illness. Cultural concepts are relevant
to medicine and some syndromes are only found in certain cultures and understood
within the concept of the concerned culture. This is crucial for clinical understanding
of the various illness behavior displayed by various culture. You are requested to
read unit 1 to enable you to clearly understand section 2.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss the relevance of culture to medicine.

2. Appraise the Culture concept and illness.
3. Describe Unique Cultural Behaviours.
4. Outline Culture bound syndromes.
5. Describe Culture shock.

3.3 Relevance of Culture to Medicine

The study of culture has special importance for profession of medicine for example:

1. effective prevention program for alcohol dependence will involve changing

attitudes and values about drinking
2. the success of anti-smoking campaign depends on altering attitudes about
tobacco

Cultural aspects of health care are best understood within the context of the
particular culture under study. Patients must be understood in terms of specific
cultures or ethnic groups to which they belong. The clinician must find out how
acculturated the patient is to the cultural mainstream of life. Class status and ethnic
identity influence the experience of illness and this too must be considered. The
environment of a hospital especially mental hospital is as much a therapeutic agent
as medication a patient receives. It is therefore important to have a conducive
hospital environment for quick recovery.
Various culture assign different roles depending on the status, which may contribute
to certain illnesses in those individuals e.g.

 Research has shown a high incidence of depression among adult women in

Kikuyu society where woman are subject to heavy role demands.
 There is also a high prevalence of schizophrenia (type of mental illness)
among last-born sons in rural Ireland because of the stresses linked to it.

The health professional must always consider influence on reporting and the
presentation of symptoms. You should bear in mind that a reluctance to discuss
certain topics may stem from the patients individual psychology or from adherence to
the customs and etiquette of the social group.

3.4 Cultural and influence on illness

Cultural concept will influence the following aspects related to illness:

1. Presentation of symptoms.
2. Reporting of symptoms of illness.
3. Seeking medical advice
4. The type of therapist that is consulted.
5. The compliance to drug treatment.

It is necessary that the health professions consider the cultural influence on the
above 5 aspects of illness.

3.5 Unique Cultural Behaviours

The medical care expert must be aware of unique cultural behavioral patterns. The
following are examples

1. Japanese may say yes as a sign of polite participation in a conversation

rather than a sign of agreement.
2. Others cultures will avoid eye contact if they were taught that eye contact is a
sign of aggression.
3. Chinese patients may smile or laugh when they are embarrassed or sad.
4. Other cultures may miss medical sessions because it is socially acceptable to
be casual about fixed dates and appointment.
5. In some cultures especially in Native Americans there is a long traditional of
healing rituals. Illness is thought to result from a disharmony among a person
natural, super natural and human environment caused by culturally
unacceptable behavior or by witchcraft. Prayer rites, hexes, curses and other
practices are used to influence health and illness.
6. The past two decades have seen a growing interest in Christian faith healing
directed towards what is called sickness of the spirit, the emotions and the
body. According to certain fundamentalist groups any form of illness may
have a demonic origin and those cases call for prayer and exorcism for
recovery to occur.
7. Some faith healers are willing to work with physicians.
 8. Others however believe that participation in a close knit Christian community,
participation in a bible study group and prayers are sufficient.

3.6 Culture bound syndromes

Some disorders are found only in certain cultures or among certain groups. The
disorders often occur with little warning; their course is usually short and their
prognosis generally favorable. The notion of culture- bound syndrome is
conceptually simple but operationally complex. Because culture is the matrix in
which all biological, psychological and social functioning operates it follows that
psychological syndromes, are to some extent culture- bound. Below is a description
of some of the culture bound syndromes

1. Amok

This is a sudden rampage, which usually including homicidal and suicidal

behavior. It ends in exhaustion and amnesia and common in south East Asia and
Malasyia.

2. Brain fag syndrome - This was a term coined by Nigerian students

This is common in sub- Saharan African students both at home and in foreign
universities and presents with headache, amnesia, chronic fatigue, visual difficulties,
anxiety impaired concentration, difficulty in comprehension and difficulty in retaining
learned materials seen in male students.

Such psychological problem may result in under performance or failure.

3. Koro

This is common in Asia and presents with fear that penis will withdraw in to the
abdomen causing death.

4. Anorexia nervosa

This is a condition that is common in women. The symptoms of anorexia nervosa

include a body weight of more than 25% below standard weight and an intense wish
to be thin. The symptoms of anorexia nervosa are usually associated to the cultural
expectation of weight and body image in modern western industrial society

5. Bulimia nervosa

This is common in persons with anorexia nervosa, who present with food binges,
self-induced vomiting

6. Whitigo -
It is a psychotic depressive mood of deep sorrow and hopelessness. Patients believe
and fear that they may be transformed into whitigo (a giant monster that eats human
flesh) when they suffer from loss of appetite and nausea.

This is a psychiatric disorder confined to the Gree, Ojibwa and Salteaux Indians of
North America.

3.7 Culture Shock

Occurs when the cultural change is sudden and sweeping, the adaptive mechanisms
of individuals and of their social support may be overwhelmed. It is common in new
immigrants. Culture shock is characterized by anxiety or depression and a sense of
isolation. Culture shock is minimized if persons are part of an intact family unit and if
they are prepared for the new culture in advance.

3.8 Summary

Cultural determinants of illness must be considered when treating

patients. The physician is expected to have basic information on the
cultural beliefs and practices of where they work.

Culture bound syndromes are specific to the cultural group under

consideration.

In view of the fact that illness is influenced either in way of presentation

and in way of seeking medical advice, it is important that the individual
be treated as whole not just symptoms.

3.9 Activity

Describe a culture bound syndrome in your culture or any other culture.

Do not describe any of those discussed above.

SECTION 4: DOCTOR-PATIENT AND CULTURE

Section Outline

1.1 Section Introduction

1.2 Section Objectives

1.3 Influence of culture on treatment process

1.4 Cultural influence to therapist and patient interaction

1.5 Summary

1.6 Activity

4.1 Section Introduction

This section will be closely tied to section 4 where you will be taught the relationship
between doctor patient and culture. If you recall from the Section 1, culture is the
external expression of individual mental life as presented by: manner, customs, and
skills, language, parent-child interactions, beliefs and social lives. In order to interact
well with the patient and help them appropriately the doctor must acquire varies skills
for example, in patient relationship and the influence of culture in doctor-patient
relationship. It is necessary that you develop these skills during the course of your
study to make you an effective health profession. Different skills may be useful when
dealing with a particular culture group and not the other.

Look at the objectives of the section before proceeding.

4.2 Section Objectives

By the end of this section, you should be able to:

1. Influence of culture on treatment process

2. Cultural influence to therapist and patient interaction

4.3 Influence of Culture on Therapeutic Process

In-text Questions

What is culture?

As a doctor it is necessary that you continuously acquire skills that will help you
relate comfortably with patients from diverse cultures. For example you must learn to
listen to not only what the patient is saying but also to the unspoken feelings in the
patient (non-verbal communication). You must also be sensitive to the effects that
history, culture and environment has on the doctor-patient relationship.

Example: A patient from an ethnic group that in the past has been at war with that of
the doctor treating her/him, may mistrust the intentions of the doctor. An awareness
of this will prepare you to relate to the patient in a way that past traumatic events are
addressed without hindering proper health care.
4.4 Cultural Influence on Therapist to Patient Interaction

Culture differs in their practices some of this practices are useful determinants of the
adult mental health. A good example is in the child-rearing practices that may differ
in terms of permissiveness, constraint, reward, punishment and bowel and bladder
training. Understanding some of these differences enables you to be more efficient
and non-judgmental in treating various health problems.

Some factors that may influence the therapist to patient interaction are as follows:

1. Illness behavior is the term used to describe patient's reaction to the

experience of being sick. Some describe aspects of illness behavior as sick role.
This may affect the doctor- patient relationship, if the patients and doctors
expectations differ during the management of a particular condition. It is crucial that
such differences are addressed by the doctor.

2. Expected manners

Doctor must be respectable; in the way they dress, talk and walk. This should meet
the cultural expectations of the community. Social interactions should be within
allowed cultural limits.

3. Beliefs

It is important for the doctor to be aware of certain cultural beliefs that may affect the
relationship between the doctor and the patient. Certain cultures believe that certain
illnesses are caused by;

 Witchcraft, and thus may prefer a witchdoctor rather than a medical

 Curses, therefore would want to break the curses by certain cultural rituals or
spiritual rituals
 Taboos because the individual failed to conform to certain social norms

It is therefore important to discuss with the patient about their illness and what they
think has caused it. This enables the doctor to explain various issues regarding
illness.

4. Language

Language is the human and non-instinctive method of communicating ideas, feelings

and desires by means of a system of sound symbols. Various cultural groups use
various languages. In order for the doctor to relate with the patient it is important that
there be a language of communication. In absence of this an interpreter who is able
to pass the message unchanged has to be used. Notice that various cultural topics
for examples relating to sex are difficult to approach in some cultures because the
taboos surrounding such matters. Certain use of words and language may be
offensive to the patient e.g. the Kikuyu word for female is the Kamba word for male.

5. Social life and social habits

The doctor should find out the patient social life and nature of friendship with an
emphasis of the depth, duration and quality of human relationships. Enquire on the
types of relationship with people of the same sex and opposite sex. Is the patient
social and isolated? The social habits should also be inquired about. This is
especially important in the following conditions; personality disorder, mental
illness when patient requires social support, Heart diseases e.g. coronary heart
disease where socialization habits like alcohol and cigarette use may be important.

6. Skills

Some cultures have skills that may be unique to them e.g. carving for the Akamba,
and hunting skills for the Maasai and athletic skill for the Kalejin. These skills may
be useful when rehabilitating patients who have lost occupation skills due to mental
illness or other disorders.

4.5 Summary

Relationship between doctor- patients is influenced by the culture. The

doctor must be aware of these cultural differences between him as a
health profession and the patient. Developing the ability to interact with
patients from different cultural backgrounds is a useful and necessary
skill that a doctor should have.

4.6 Activity

1. Describe a nasty experience that you or someone close to you

has had with a doctor.
2. In you view was this experience avoidable?
3. How would the doctor have prevented or minimized the
consequences?

Finally you will learn the best skills that a doctor should acquire to effectively relate
with the patient in section 5. This is a very important unit that will impact on your
performance as a doctor.

SECTION 5: DOCTOR-PATIENT RELATIONSHIP

Section Outline

5.1 Section Introduction

5.2 Section objectives

5.3 Models of doctor patient relationship

5.4 General Considerations in doctor patient relationship

5.5 Interview techniques

5.6 Summary

5.7 Activity

5.8 Model questions

5.1 Section Introduction

Welcome to this Section 5, Often neither the doctor nor the patient is conscious of
the model they choose. Models chosen mainly depend on personality, needs and
expectation of both patient and doctor. The needs and expectations may differ
causing conflict in patient-doctor relationship and miscommunication. The doctor
must be consciously aware of the model they are using and be able to shift from one
to the other depending on: - patients' specific needs, treatment requirements or
specific clinical situations. In this section we will explore recommended modes of
doctor patient relationship, consider general aspects in a doctor patient relationship
and interviewing techniques.

5.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss models of doctor patient relationship

2. Discuss General Considerations in doctor patient
relationship
3. Discuss Interview techniques

5.3 Models of Doctor Patient Relationship

There are four possible models of relating with the patient. I will discuss each model
to demonstrate when each model may be used and the disadvantages of some of
the model.

1. Active passive model

2. Teacher- student model( or parent-child, or guidance -cooperation model)
3. Mutual participation model
4. friendship (or socially intimate) model

5.3.1 Active Passive Model

This implies the complete passivity of patient resulting to the doctor taking over. The
patient assumes virtually no responsibility in any process of treatment. Model is
appropriate when patient is unconscious, immobile or delirious.

5.3.2 Teacher Student Model or parent child or guidance cooperation model

The dominance of the doctor over the patient is emphasized and the role of the
doctor is paternalistic and controlling while the patient is one of dependence and
acceptance. This is appropriate for patients who are recovering from surgery.

5.3.3 Mutual Participation

In this form of model there is equality between doctor and patient with both
depending on each other and actively participating. It is a Useful model in conditions
where patient's knowledge and acceptance of treatment is critical for the success of
treatment. Good examples include; renal failure, diabetes, may also work for
HIV/AIDS.

5.3.4 Friendship Model

This model is generally considered an unethical and dysfunctional relationship. The

doctor is likely to have psychological with an emotional need, turning to the patient
for information, care and love. It perpetuates the relationship and has no appropriate
ending, blurring the boundary between friendship and professionalism.

5.4 General Consideration

The following are important points to consider when relating with the patient;

1. Constantly evaluate your doctor patient relationship

2. The more secure you feel the better you are to modify destructive attitude
3. Empathize but don't unrealistically carry the patient burden
4. Do not carry the patients problems home
5. Do not use the patients as substitute for missing intimacy or a relationship in
your life
6. Do not assume a defensive attitude towards all patients
7. Be flexible
8. Accept that no matter what you do some of your patient will die and you must
learn how to deal with them
9. Avoid side steeping issues that you find difficult
10. Avoid side steeping issues that you find Patient will tolerate your inefficiency if
they sense interest, enthusiasm, interest, and good will

5.5 Interviewing Techniques

Effective interviewing is a critical tool that you will need in your career. You need skill
to gather necessary information from patients and use it for the patients benefit.
Ekkehard Othmer and Sieglinde Othmer described components of an interview. This
is outlined below;

5.5.1 Ekkehard Othmer and Sieglinde Othmer Components of an Interview

According to Ekkehard and Sieglinde Othmer there are 4 components in a patient's

interview by a doctor:
 1. Establishing rapport
2. Assessing patient
3. Using specific techniques
4. Diagnosing

There are seven phases in a interviewing as listed below;

1. Phase 1: Warm up

The warm up phase is meant to put the patient at ease and allows you to observe
the appearance of the patient. Even at this initial stage of the interview it is important
to ask productive questions.

2. Screening

It is important that you empathize with suffering of the patient, and listen
compassionately. You should open the interview with broad screening questions and
classify the chief complaints at the same time assessing the patient's symptoms.

3. Follow up of preliminary impression

At this stage you verify and exclude diagnostic impression. It is useful to use close
ended questions in interviewing the patient.

Confirmatory history

As an interviewer you should show expertise, interest, thoroughness, and leadership

4. Completion of data base

Motivate for testing - laboratory, radiology etc

5. Feedback

In feedback you secure acceptance of the provincial diagnosis that you have made.
Explain the diagnosis, treatment and prognosis. During this phase you also may
require to discuss further evaluation in order to fully confirm the diagnosis or exclude
co morbid conditions (it is possible that a patient is suffering from two disorders at
the same e.g. a patient with pulmonary tuberculosis may have a depression.

6. Treatment contract

You should assume the authority role and assures patients compliance to treatment
and predict treatment effects.

7. Caution

During interaction between the doctor and patient in all the phases of treatment the
doctor should be cautious about issues related to sexuality. Some of the following
are important facts that you as the learner should have in mind as you begin
clerkship.

5.5.2 Sexuality and the Physician

The doctor is a powerful figure and is bound to arouse some fantasies in some
patients. Doctors may also have fantasies of being loved by their patients. A doctor
patient sexual relationship can be destructive, is unethical and prohibited.

Disliking the patient is bound to make you ineffective in treating the patient. If you are
all knowing and all powerful doctors you are bound to hate patients that question
you. It is necessary to rise above your emotions. If you cannot relate with the patient
it is best to request a colleague to treat that patient.

5.6 Summary

A right doctor patient relationship is useful aspect in the management of

the patient and the success of a physician. Four models of doctor-
patient relationship are the active-passive, teacher- student, mutual and
friendship model

It is important that the doctor develops skills of relating to their patient

and Ekkehard Othmer and sieglinde othmer described the 4
components of an interview which are important in doctor patient
relationship.

5.7 Activity

In groups of 2 students, let one of you act as the doctor and the other
assume a patient role. As the "doctor" interview the "patient". Identify
challenges associated with the "interview"

UNIT 1: REVIEW QUESTIONS

UNIT 1: REVIEW QUESTIONS

The following are Constitutes of culture except

Religion

Beliefs
Skills
 Customs

Education

Subfields of anthropology includes the following except

Cultural anthropology
Archaeology
Political
Linguistic anthropology

Biological

Culture and psychiatry intersect in the following areas except in determining the

Pathogenic agent
Diagnosis
Therapeutic process
management
all of the above are true

The following are culture bound syndromes except

amok
brain fog
malaria
Anorexia nervosa
koro

Doctors -Patients relationship is not useful for patients suffering from

Malaria and pneumonia

cancer
depression
 malnutrition
None of the above is true

The following are acceptable models in doctor patient relationship except

Active passive model

Teacher- student model
guidance -cooperation
Mutual participation model
socially intimate model

UNIT 2: HEALTH BEHAVIOR

Unit Introduction

In the previous unit (1) you learned about the fundamentals of anthropology. You
learned the relevance of culture in health related issues. In the two sections of unit
2 you will learn about health behaviour including how the patient health behaviour
impacts their health and illness. You will also learn the role of the family and
community in the recovery of the patient. This unit is extremely for you as a student
since it prepares you to be a skilled clinician who will evaluate patients holistically. It
is also an interesting topic to read and I belief that you will enjoy reading it as learn.

Unit 2 consists of 2 sections as follows:

Section 1: Patient Health Behavior

Section 2: The sick role

Unit Objectives

Objectives
By the end of this unit, you should be able to:

1. Discuss patient health behaviour

2. Describe sick role

In Section 1 of unit 2 you will learn patient health behaviour.

Section 1: Introduction to Anthropology

Section Outline

1.1 Section Introduction

1.2 Section objectives

1.3 Definition of anthropology

1.4 Subfields of anthropology

1.5 Constitutes of culture

1.6 Characteristics of culture

1.7 Summary

1.8 Activity

1.1 Section Introduction

In section one you will be introduced to the various types of anthropology and
discuss its relevance to human behavior and psychiatry in general.

Welcome to this section on the introduction to anthropology. Anthropology and

psychiatry are both concerned with understanding human behavior. Understanding
human behavior is an important factor in providing appropriate health professional
services to the people. In this section we will define anthropology, outline the
subfields of it, and describe what constitutes culture and characteristics of culture.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define of anthropology
2. Outline subfields of anthropology
3. Describe constitutes of culture
4. Describe characteristics of culture

1.3 Illness Behavior

This is a term used to describe patient's reaction to experience of being sick. Some
describe aspects of illness behavior as sick role. Mechanic (1978) suggested the
descriptive term "illness behavior" for the actions which people take when ill. Illness
behavior refers to the ways in which given symptoms may be differentially perceived,
evaluated and acted (or not acted) upon by different kinds of persons (refer section
1). The illness behaviour is likely to influence the kind of sick role provided to the
person.

For example an attention seeking patient may either be provided with excessive sick
role or be denied the same if the relatives realize he/she is demanding too much
unnecessary attention.

Stages of Illness Behavior

Edward Suchman described the five stages of illness behaviour as;

1. The symptom experience stage, in which a decision is made that something,

is wrong.
2. The assumption of the sick role stage, in which a decision is made that one is
sick and needs professional care.
3. The medical care contact stage, in which a decision is made to seek
professional care
4. The dependent-patient role stage, in which a decision is made to transfer
control to the doctor and to follow, prescribed treatment.
5. The recovery or rehabilitation stage, in which a decision is made to give up
the patient role.

The intensity and experience of each stage of illness behaviour depends on whether
the patient has had Prior illness episodes, cultural beliefs concerning the specific
illness and the personal meaning and beliefs about the particular illness.

These actions include:

a. Consulting doctors
b. Taking medicines
c. Seeking help from relatives and friends
d. Giving up various activities

Let us then describe each of these 4 actions in detail.

1. Consulting doctors

Varies considerations are important e.g. which doctor is to be consulted and when?
This will depends on;

a. availability of doctor
b. consultation cost
c. previous doctor patient relationship
d. previous illness experience

2. Drug compliance

Whether the patient takes the drugs as prescribed is important. Compliance to drugs
is influence by:
 a. Taste of drug
b. Number of times to be taken
c. Insight of the patient
d. Side effects profile
e. Seriousness of the condition
f. Number of drugs being taken at the same time( avoid poly pharmacy if you
can)

3. Seeking help from relatives and friends

The patient often finds themselves seeking help from people. The extent to which
they seek help depends on the;

a. Diagnosis
b. Expected benefit/gain
c. Personality of patient
d. Previous experience with the illness
e. Magnitude of need

4. Giving up roles

The level to which the patient will give up roles depends on

a. Severity of illness
b. Personality of the patient
c. Nature of social support system
d. The gains or loss associated sick role
e. 1.4 Health Seeking Behaviour
f. Health seeking behavior is the acts developed by people in search for good
health. This factors are:
g. 1. Age
h. Health problems increases with age and chronic conditions are common with
the elderly for example arthritis, hypertension and heart disease. Young
persons are predisposed than the elderly to acute illness (e.g. upper
respiratory tract infection injuries. Both young persons (20-30) and persons
more than 65yrs tend to have more illness and health care needs than to
persons in the middle adult hood. Young children's health care habits are
often modeled after those of the parents. Elderly persons are more likely to
ignore their health problems when compared with the young persons.
i. 2. Previous experience
j. Previous experiences with health related problems influence future altitude
and behavior toward seeking assistance. Those who have had discouraging
encounters with health care services are more likely to hesitate in seeking
help. Also previous experience with a condition that may have affected a
close relative who died may lead to urgent seeking of health care.
k. 3. Socioeconomic status
l. A person's social economic status (SES) is not based socially on income but
includes such factors as education occupation and lifestyle. Persons of low
(SES) are less likely to seek good health care because other basic needs like
food; water and housing have not been meet. They therefore are less
 concerned about their health. In addition the cost may keep them away from
health services. Persons of low social economic status have a reduced life
expectancy
m. 4. Availability of health facility
n. In some locations patients have few or no health facilities and they are
compelled to utilize available ones or turn to traditional methods of health
care.
o. 5. Nature of illness
p. The nature of illness influences the health seeking behaviour. Patients will go
to bigger health facilities for major health problems while they may use locally
recommended herbs for ailments they consider minor.
q. 6. Personality
r. Different people react differently depending on their habitual modes of
thinking, feeling and behavior. Some people experience poor health as an
overwhelming loss while others see in the health problem a challenge to be
overcome or a punishment for something they feel guilty about
s. 7. Lifestyle
t. Life style and personal behaviors are major factors in causes of illness and
death. It also influences whether one seeks for health services or not.
Diseases related to personal behavior and life style includes obesity, heart
disease and cancer.
u. 8. Education
v. Health education especially prevention and health promotion has been found
to affect the behavior related to health. Among the elderly education after
accidents at home reduces injuries and mortality while among the young it
helps by reducing outdoor accidents including road traffic accidents.
Education also helps to make people assess the severity, and urgency of the
condition.
w. 9. Poverty
x. Poverty is associated with many long-term problems which influence health
seeking behaviour including; Poor health, Increased mortality, Mental
disorders, School failure, Crime and Substance abuse.
y. 10. Ethnicity/culture
z. Every ethnic community has their beliefs about what constitutes: good health
and bad health, what kind of health service should be sought and what kind of
sick role the patient should receive.
aa. 11. Race
bb. Race affects use of health care facilities. In a study in the U.S (1990) the
average number of physician contracts was 10% higher for white persons
than for black persons. In the same study the rates of such chronic conditions
as obesity, diabetes, heart disease, hypertension and arthritis were higher
among blacks than among whites.
cc. 12. Environment
dd. Environment contributes to about ¼ of today's health problems e.g. water
borne diseases, natural disaster, toxic industrial waste. The environment also
determines what kind of health seeking behavior that is acceptable in the
setup to see a doctor and if so which-traditional vs medical.
ee.
ff. 13. Health care cost
 gg. The cost of receiving certain health services is partly determined by the kind
of health service sought after e.g. public or private hospital.
hh. 1.5 Summary

Illness behaviour is an important aspect to consider when dealing

with sick persons. Various factors will influence illness behaviour
and health seeking. A consideration of these factors is useful in
enhancing the recovery and wellness of the patient.

1.6 Activity

In groups of 2 students, let one of you act as the doctor and the other
assume a patient role. As the "doctor" interview the "patient". Identify
challenges associated with the "interview"

SECTION 2: SICK ROLE

Section Outline

1.1 Section Introduction

1.2 Section Objectives

1.3 Concept of sick role

1.4 Components of sick role

1.5 Factors that influence sick role

1.6 Summary

1.7 Activity

1.8 Model questions

1.1 Section Introduction

Physical illness and disability may have widespread effects upon a patient's
adjustment in work, leisure and family life. Patients vary in their capacity to
adjustment socially, most manage well but a few develop social handicaps out of
promotion to the severity of physical illness. Some patients find that physical illness
has advantages; e.g. they may use it as an excuse to avoid responsibilities or as an
opportunity to reconsider their way of life and improve its quality. So on one had
illness has an impact on the patient's social life; on the other hand sociologists have
pointed out that social forces also affect the impact of illness. In this section you will
learn about sick role and illness behavior, able this will enable you understand your
patients and give them better care.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the concept of sick role

2. Describe the components of sick role
3. Outline the factors that influence sick role

2.2 Concept of Sick Role

The sick role is the role that society ascribes to the sick person because he or she is
sick. Characteristics of sick role include such factors as; being excused from certain
responsibilities and being expected to want to obtain help to get well. Certain
cultures will have a more intensive sick role which may affect recovery from certain
psychological conditions e.g. conversion disorder (formally referred to as hysteria). In
such cases the doctor should advice the relatives on levels of necessary sick role.

2.3 Components of Sick Role

Parson holds that the sick role has four components namely:

a. Exemption from the usual social responsibilities

b. Exception from responsibility for certain aspects of behavior
c. Responsibility to try to recover and
d. Responsibility to seek appropriate help

2.4 Factors that influence sick role

The following are factors that influence sick role:
1. Prior illness episodes
A person who has past illness experience will behave differently from a person with no
previous illness.
2. Cultural beliefs concerning the specific problem
The cultural beliefs about the cause of the illness will determine not only the health
behaviour but also the sick role. Some illness that the community may consider as self-
inflicted may cause the sick person to receive sick role.
3. Personal meaning and beliefs about the particular problem
 a. Age

b. Previous experience

c. Socioeconomic status

d. Availability of health facitlity

e. Nature of illness

f. Personality

g. Lifestyle

h. Education level

i. Poverty

j. Ethnicity/culture

k. Race

l. Environment

m. Health care cost

n. 2.5 Summary

Sick role and illness behaviour are important aspects for sick persons.
Previous experience with the illness and treatment, personality of the
patient and cultural factors will influence sick role and illness behaviour.
The health professionals should address aspects of sick role and illness
behaviour that may negatively affect recovering of the patient.

2.6 Activity

Discuss in a group sick role experience either by you or your close

family member.

Unit 2 Review Questions

Unit 2 Review Questions

Components of sick role as described by Parson includes the following except
 Exemption from the usual social responsibilities
Exception from responsibility for certain aspects of behavior
Responsibility to try to recover
Patient resumption to work to raise money hospital bill
Responsibility to seek appropriate help

Edward Suchman's stages of illness behavior includes the following except

death stage
The symptom experience
The assumption of the sick role
The medical care contact
The dependent-patient role

UNIT 3: COMMUNICATION

Unit Introduction

Welcome to Unit 3 of this module. In this unit we are going to cover communication
skills as applied within the healthcare set-up.

This unit has 2 sections namely:

Section 1: Communication Skills

Section 2: Doctor Patient Communication

In Section 1 you will learn the necessary communication skills that a health
profession must acquire while in Section 2 which is closely related you will learn how
these communication skills relate to doctor patient interaction.

Unit Objectives

By the end of this unit, you should be able to:

1. Describe communication skills

2. Describe doctor patient and communication
We shall now proceed to the first section on communication skills.

SECTION 1: COMMUNICATION SKILLS

Section Outline

1.1 Section Introduction

1.2 Section objectives

1.3 Types of communication

1.4 Objective of communication

1.5 Modified model of communication

1.6 Outcomes of poor communication

1.7 Summary

1.8 Activity

1.1 Section Introduction

Communication is a process by which we assign and convey meaning in an attempt

to create shared understanding. Clinical training for patient-oriented communication
skills has been explored as a part of medical education necessary to produce
effective practitioners. Having good communication skills is essential for doctors to
establish good doctor patient relations or rapport. There is an increase in demand
from patient who value doctors who are patient centred who spend time and listen to
them. Effective communication in healthcare delivery is important. Much of the
existing research has centred on patient autonomy and medical paternalism,
referring to ‘asymmetric' doctors' interactions with patients or their unbalanced
control of communication. Research has shown communication difficulties already
arise due to differences in the medical subculture of the doctor and illness subculture
of the patient. One might expect that these problems would be exacerbated further if
the doctor and patient do not share a common ethic and/or cultural background.
There is also a growing cultural diversity among physicians and patients, and the
demand for intercultural communication between doctors and patients. You will
therefore be required to continually develop communication skills to avoid the
negative implications of miscommunication. In this section you will learn the types,
objectives and model of communication. You will also learn the implications of poor
complication.In this section you are going to learn about the various types of
communication. You will also learn about a model of communication referred as the
modified type.

1.2 Section Objectives

 By the end of this section, you should be able to:

1. Discuss types of communication.

2. Discuss modified model of communication.

1.3 Types of communication

Develop content for this objective

1.4 Modified Phase Model of Communication

1.4 Modified Phase Model of Communication

This model describes the logical sequence of events of routine doctor-patient

encounters which includes:

1. Greetings
2. Discovering the season for the visit
3. Verbal examination
4. Physical examination (includes time spent in verbal exchanges during the
physical examination)
5. Diagnosis or consideration talk
6. Detailing treatment or further investigation
7. Termination

The Social talk-a phase for non-problem-focused casual talk is categorized into;

a. Time ratio
b. Back-channel responses and
c. Interruptions.

Let us look at each of these categories in detail.

1. Time ratio

The time ratio for physician to patient speech and it is important allow patient to
speak

2. Back - channel responses

Back-channel responses are verbal markers of continued attention uttered by the

listeners

Example from English includes such verbal acts as "hmn", OK and "right". These
serve as verbal indicators of sustained attention and encouragement emitted by the
person who does not hold the speaking floor
3. Interruption

Interruptions almost always have negative implications in English but, linguistically,

interruptions can have positive or negative effects of communication.

There are seven types of interruptions:

a. Turn interruptions
b. Facilitative interruptions
c. Interruptions confirming speaking partner information
d. Interruptions to voice an opposite opinion
e. Interruptions to ask a question about spoken information
f. Interruptions that make humour/jokes about the speaking partners information
g. And interruptions to monitor (confirm) spoken information

It is important to minimize all forms of interruptions as much as possible

1.5 Summary

Patients expect, respect, Information about the condition

communicated clearly. They also expect the doctor to discuss diagnosis
and management while involving the patient to choose the right
management with doctor's guidance. The physician should develop
appropriate verbal and non-verbal communication.

1.6 Activity

In groups of 2 students, let one of you act as the doctor and the other
assume a patient role. As the "doctor" interview the "patient". Identify
challenges associated with the "interview"

SECTION 2: DOCTOR PATIENT AND COMMUNICATION

Section Outline

2.1 Section Introduction

2.2 Section objective

2.3 Benefits of effective doctor- patient communication

2.4 Important general considerations in doctor - patient communication

2.5 Summary

1.6 Activity
2.1 Section Introduction

Effective Communication is beneficial for both the doctor and the patient. It improves
the interaction process between the doctor and the patient. This is likely to improve
the confidence and trust that the patient has in the doctor resulting to better
treatment outcomes especially for illnesses that have a psychological component.
The doctor on the other hand benefit by reducing his work load since his patients
have better treatment outcomes. This is also likely to make the doctor popular. In this
section you will learn about some of the benefits of proper doctor patient
communication. You will also understand some general considerations in doctor
patient communication that will be useful to you now and in the future

1.2 Section Objectives

By the end of this section, you should be able to:

1. Outline the benefits of effective doctor-patient communication

2. Important general considerations in doctor- patient
communication

1.3 Benefits of an Effective Doctor Patient Communication

As shown earlier in unit 1 section 5, a good relationship between doctor and patient
is useful in providing a therapeutic environment. Effective doctor patient
communication is shown to be highly correlated with patient satisfaction with health
care services.

The following are facts on the benefits of an effective communication:

1. Effective communication has been shown to reduce medical malpractice risk. This
is because the patient understands the treatment process as communicated by the
doctor increasing the level of patient trust in the doctor. Relationship problems
between doctor and patient lead to patients filing malpractice claims against doctors.
Communication between doctor and patient plays an important role in developing a
trusting doctor-patient relationship

2. Communication during history taking or discussion of the management plan has a

significant association with patient outcome outcomes. It has been reported to
improve the treatment outcome of the patients.

3. Malpractice charges against doctors. Most of the malpractice charges are related
to poor communications skills. This includes:
 a. Deserting the patient
b. Devaluing patient or family
c. Delivering information poorly
d. Failing to understand the patient and/or family perspective

It has been shown that the following factors of effective communication are
associated with improved patient satisfaction:

a. doctors attitude towards patients

b. doctors ability to elicit and respect the patients' concern,
c. the provision of appropriate information
d. demonstration of empathy
e. development of patient trust

1.4 Important General Considerations In Doctor- Patient Communication

Being developed

Unit 3 Review Questions

Unit 3 Review Questions

Edward Suchman stages of illness behavior includes the following except

Death stage
The symptom experience
The assumption of the sick role
The medical care contact
The dependent-patient role

Regarding doctor patient relationship, the following are true, except;

Doctor should not assume a defensive attitude towards all patients

Doctor should be flexible
Doctor should accept that no matter what you do some of your patients will die
and you must learn how to deal with death
should avoid side steeping issues that you find difficult
Carrying the patients problems to your home enables you to solve your family
problem
UNIT 4: TRADITIONAL AND MODERN MEDICAL CARE

Unit Introduction

Welcome to this unit on traditional and modern medical care. Traditional medical
practices vary among geographic regions and cultures, and traditional health care is
sought for a variety of reasons. Debate is currently over whether traditional medicine
should be given a more legitimate and prominence within the structure of African
healthcare. Traditional medicine offers many positive aspects to healthcare.

Despite the criticisms of some traditional methods, many techniques used, especially
those involving the use of herbs and roots, have scientific support and proven clinical
success. The problem with traditional medicine lay in the belief of many that it
should be the primary source of medical care. This belief that traditional healers are
the first and last line of defense against an illness can lead to potential life
threatening medical emergencies. Despite the issues, there is room for traditional
and modern methods to work together. Most nations are in the process of developing
policies and regulations for traditional medical care. For example, in Zimbabwe
traditional healers are part of the psychiatry management team.

Instead of working against traditional methods, many healthcare systems are

looking to work with traditional healers. Given the lack of access of many Africans to
quality hospitals, it is important to take advantage of the medical solutions already in
place.

This unit consists of 2 sections namely;

Section 1: Traditional versus modern medical care

Section 2: Traditional medical care at primary health care

Unit Objectives

By the end of this unit, you should be able to:

1. Discuss traditional versus modern medical care.

2. Describe traditional medical care at primary health care.

SECTION 1: TRADITIONAL VERSUS MODERN MEDICAL CARE

Section Outline

1.1 Section Introduction

1.2 Section objectives

1.3 Traditional and Modern medical care

1.4 Integration and collaboration in medical care

1.5 Summary

1.6 Activity

1.1 Section Introduction

In most communities especially in Africa traditional medicine is the only available

form of treatment. Even in areas where modern medicine is available the traditional
medicine has remained relevant and there is currently a wave of renewed interest in
traditional medicines especially herbs. In this section therefore, we are going to
compare the traditional and modern medical care and discusses the advantages and
disadvantages of both while at the same time explaining how the two can be blended
for the advantage of the patient.

Let us go through the objectives before further discussions.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Traditional and Modern medical care

2. Integration and collaboration in medical care

1.3 Traditional and Modern Medical Care

Traditional medicine is the sum total of the knowledge, skills, and practices based on
the theories, beliefs, and experiences indigenous to different cultures, whether
explicable or not, used in the maintenance of health as well as in the prevention,
diagnosis, improvement or treatment of physical and mental illness. "Alternative
medicine" are used inter-changeably with traditional medicine in some countries.

Modern medical care is the applied science or practice of the diagnosis, treatment,
and prevention of disease. It encompasses a variety of health care practices
evolved to maintain and restore health by the prevention and treatment of illness in
human beings. Also referred to as Contemporary medicine, it applies health
science, biomedical research, and medical technology to diagnose and treat injury
and disease, typically through medication or surgery, but also through therapies as
diverse as physiotherapy., prosthesis, radiation and others.

1.3.1 Advantages of Traditional Care

The following are some of the advantages of traditional car:

a. Often Cheap
b. Within reach(availability)
c. Minimal side effects
d. Easy to manufacture
e. Safe even when it is taken in large quantity

1.3.2 Disadvantages of Tradition Care

Listed below are some of the disadvantages of traditional care

a. Slow in function
b. Lack of scientific background in manufacturing
c. Lack of instructions on expiry date
d. May be dangerous since diagnosis of condition may not be known
e. Tiring process of administration
f. May be prepared in unhygienic conditions
g. Often untrained traditional doctors

1.3.3 Advantages of Modern Care

The following some of the advantages of modern care:

1. Fast
2. Specific because the diagnosis is specific
3. Hygienic
4. Expiry of drug is specified clearly
5. The therapist is trained
6. Standardized dosage
7. Trained medical doctor

1.3.4 Disadvantages of Modern Medical Care

Some of the disadvantages of modern medical care include:

1. Expensive

2. Unavailable in some areas

3. Side effects may be disabling

4. Toxic especially in overdose

1.4 Integration and Collaboration in Medical Care

It is importance to encourage collaboration between traditional healers and medical

doctors.

This can encourage the former to support biomedical interventions that improve the
health of their communities The WHO lists the following goals for the integration of
traditional medicine into the modern health care system:

1. Support and integrate traditional medicine into national health systems in combination
with national policy and regulation for products, practices and providers.
2. Ensure the use of safe, effective, and quality products and practices, based on
available evidence.
3. Acknowledge traditional medicine as part of primary health care, to increase access to
care and preserve knowledge and resources.
4. Increase the availability and affordability of traditional medicine, as appropriate, with
an emphasis on access for poor populations.
5. Ensure patient safety by upgrading the skills and knowledge of traditional medicine
providers.
6. 1.5 Summary

You should start with a recap of what has been learned in this section.
There is need to evaluate the benefits of traditional healing and
integrate some of the useful ones into modern medical care.

With the current shortage of medical professionals and modern health

facilities traditional healers remain the only available care for the sick
in many developing countries. Upgrading their skills may be important
to safe guard the lives of their patients.

1.6 Activity

In groups of 5 students:

1. Discuss your experiences with traditional care and modern

medical care experts.
2. Did any of the above experiences contribute to w

SECTION 2: TRADITIONAL MEDICINE IN PRIMARY HEALTH CARE

Section Outline

1.1 Section Introduction

1.2 Section objectives

1.3 Traditional Medicine

1.4 Primary health care

1.5 Summary

1.6 Activity

2.1 Section Introduction

Traditional medicine has been used over thousands of years and has been beneficial
to many communities especially at the primary care level. Traditional medicine
comprises of knowledge, skills and practices based on the theories, beliefs and
experiences indigenous to each culture used in the maintenance of health and in the
prevention, diagnosis, improvement or treatment of physical and mental illness. The
therapies differ from one culture to another. The terms "alternative" or
"complementary" medicine have been used interchangeably with the term traditional
medicine. Traditional medicine has been used for thousands of years with great
contributions made by practitioners to human health, particularly as primary health
care providers at the community level. TM/CAM has maintained its popularity
worldwide. Since the 1990s its use has surged in many developed and developing
countries.

Section 2 is closely related to Section 1 and discusses the role of traditional

medicine at the primary care level. Although you are being trained as a modern
medical doctor, the communities you are likely to work in still embrace traditional
medicine and it is important for you as a doctor to understand how well you can
blend the traditional and modern medicine to benefit the patient.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Describe traditional medicine.

2. Discuss primary health care.

2.3 Traditional Medicine

Traditional medicine has a long history. It is the sum total of the knowledge, skill, and
practices based on the theories, beliefs, and experiences indigenous to different
cultures, whether explicable or not, used in the maintenance of health as well as in
the prevention, diagnosis, improvement or treatment of physical and mental illness.
The terms "complementary medicine" or "alternative medicine" refer to a broad set of
health care practices that are not part of that country's own tradition or conventional
medicine and are not fully integrated into the dominant health-care system. They are
used interchangeably with traditional medicine in some countries.

A wide range of care is referred to as traditional medicine. In some cases the patient
administers treatment by himself or receives advice and treatment from a traditional
medicine man, relative, friend, a neighbour, workmate and a church or from a
layperson.

Other traditional healing practices includes: special prayers, rituals, confessions, or

fasting. Some societies use charms, amulets, and religious meditation to ward off
bad luck or evil, illness and attract good luck and good health. Divine intervention in
which there is a holistic approach to treatment is also a common traditional approach
to treatment. Treatment deals with the patient relationship with others, his natural
environment and with supernatural forces as well as any physical or emotional
symptoms. Ritual divinations such as the use of cards, bones, stones are employed.
The divination aims to uncover the supernatural causes of illness such as witchcraft
and treatment of the illness. Divination sometimes takes place in the presence of
patients, family, friends and other social contacts. The family is therefore, actively
involved in the treatment by participating in the healing rites. When traditional
medicine fails to produce the expected effects, the people move to the modern
medical care at the PHC facilities. Often a mixture of both traditional and modern
medical care occurs at PHC level.

2.4 Primary Health Care

Primary Health Care is the provision of basic care to meet the basic needs of a
community. It describes the nearest contact that individuals have with their local
health service. PHC therefore, is the first thing an individual does for himself right in
the home to avoid getting sick. It is a self - help and its emphasis is on prevention
and control of diseases by the people, for the people and with the people. According
to WHO, PHC is essential health care based on practical, scientifically sound and
socially acceptable methods and technologies.

2.4.1 Alma-Ata Declaration

Prior to the Alma-Ata meeting in 1978, "PHC" meant first contact with a doctor. WHO
and UNICEF in 1978 at the Alma-Ata launched a campaign to achieve "Health for all
by the year 2000" through Primary Health Care.

Health care was to be:

1. Accessible
2. Affordable
3. Acceptable
4. All - inclusive (integral)
5. All - together (participatory)

2.4.2 Components of the PHC

Put a statement to connect this sub-subtitle and these points

1. Education

2. Local/indigenous Disease Control

3. Expanded Immunization programme

4. Maternal and child care

5. Essential drugs

6. Nutrition and food supplies

7. Safe water supply and sanitation

8. Mental health

9. Dental health

10. Treatment of common diseases, including treatment and prevention of injuries.

2.5 Traditional medicine integration and collaboration in medical care

Been developed

2.6 Summary

A recap of the lessons learned

Though the Alma-Ata launched a campaign to achieve "Health for all by

the year 2000" through Primary Health Care, a majority of the
communities have no access to modern medical care at PHC
level.Traditional medicine remains the only available medicine in such
communities. The effectiveness of some of this treatment regimes
require to be explored.

2.7 Activity

Explore the extent to which the PHC components have been achieved
in Kibera informal settlement.
Unit 4 Review Questions

Unit 4 Review Questions

The following is not a component of PHC recommended provisions according to the
Alma Ata declaration 1978.

education
dental health
essential drugs
mental health
Internet connection

Health provision should be

Expensive
Within reach for some people

Without quality standardization

Free
Integral

The following are advantages of traditional medicine except

Cheap
Within reach(availability)
Minimal side effects
unsafe even
Easy to manufacture

The following are disadvantages of modern medicine except

Expensive
Unavailable in some areas
Has minimal or no side effects
Side effects may be disabling
Toxic especially in overdose
BEHAVIORAL SCIENCES: PHYSICAL ILLNESS CAUSING BEHAVIOUR

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

UNIVERSITY OF NAIROBI DEPARTMENT OF PSYCHIATRY

In collaboration with

CENTRE FOR OPEN AND DISTANCE LEARNING

HCH 100: BEHAVIOURAL SCIENCES

MODULE 7: PHYSICAL ILLNESS CAUSING BEHAVIOUR

2014

Copy Right

Copy Right

Behavioural Sciences Course to Undergraduate Students in the College of Health Sciences by

Distance Learning
Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

© University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced
in any form or by any means without permission in writing from the Publisher.

Writer: Dr. Pius Kigamwa

Reviewer:

Chief Editor: Joshua M Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

The University of Nairobi (UoN), College of Health Sciences wish to acknowledge the
contribution of the Department of Psychiatry and PRIME-K whose financial assistance made
the development of this e-learning course possible.

List of Abbreviations

List of Abbreviations

AIDS Acquired Immunodeficiency Syndrome

ART Anti-Retroviral Therapy

AV Atrio-Ventricular

CGD Complicated Grief Disorder

CNS Central Nervous System

DSM Diagnostic and Statistical Manual

HAART Highly Active Anti-Retroviral Therapy

HAD HIV Associated Dementia

HIV Human Immunodeficiency Virus

MCMD Minor Cognitive Motor Disorder

MMPI Minnesota Multiphasic Personality Inventory

PGD Prolonged Grief Disorder

PTSD Post-Traumatic Stress Disorder

SA Sino-Atrial

UNAIDS Joint United Nations Programme on HIV/AIDS

US United States

INTRODUCTION

Congratulations for coming this far. You are now in the seventh module of this course on
Behavioural Sciences. In the last six modules of this course, you learnt about the concept of
psychology, emotional states and awareness, foundations of human behaviour change,
sociology, social psychology and anthropology.

In this module, you will learn the link between psychology and physical illness. Examples of
physical illness will be used to illustrate. I hope you will enjoy it.

This module is divided into six units as follows:

Unit 1: Psychological Aspects of Chronic/Terminal Illness

Unit 2: Psychological Aspects of HIV/AIDS

Unit 3: Psychological Aspects of Ageing and Illness

Unit 4: Psychological Factors in Perinatal Mental Health

Unit 5: Psychological Factors in Cardiology

Unit 6: Death and Dying

 Module Objectives
By the end of this module, you should be able to:
1. Describe the psychological aspects of chronic illness and terminal illnesses.
2. Describe the Psychological Aspects of HIV/AIDS.
3. Describe the psychological Aspects of Ageing.
4. Describe Psychological Factors in Perinatal Mental Health.
5. Describe Psychological Factors in Cardiology.
6. Describe psychological aspects of Death and dying.

Congratulations for coming this far. You are now in the seventh module of this course on
Behavioural Sciences. In the last six modules of this course, you learnt about the concept of
psychology, emotional states and awareness, foundations of human behaviour change,
sociology, social psychology and anthropology.

In this module, you will learn the link between psychology and physical illness. Examples of
physical illness will be used to illustrate. I hope you will enjoy it.

This module is divided into six units as follows:

Unit 1: Psychological Aspects of Chronic/Terminal Illness

Unit 2: Psychological Aspects of HIV/AIDS

Unit 3: Psychological Aspects of Ageing and Illness

Unit 4: Psychological Factors in Perinatal Mental Health

Unit 5: Psychological Factors in Cardiology

Unit 6: Death and Dying[d1]

Start the module by looking at the module objectives

[d1]This unit has not been discussed

Module Objectives

By the end of this module, you should be able to:

1. Describe the psychological aspects of chronic illness and terminal illnesses.

2. Describe the Psychological Aspects of HIV/AIDS.
3. Describe the psychological Aspects of Ageing.
4. Describe Psychological Factors in Perinatal Mental Health.
5. Describe Psychological Factors in Cardiology.
6. Describe psychological aspects of Death and dying.
Let us now proceed to the first unit.

UNIT 1: PSYCHOLOGICAL ASPECTS OF CHRONIC/TERMINAL ILLNESS

Welcome to Unit 1 of Psychological Aspects of Chronic/Terminal illness. This unit informs

us on the challenges that people with chronic and terminal illnesses go through and finally
guides us through them.

This unit is divided into three sections as follows:

Sections 1: Introductory Concepts of Chronic and Terminal Illness

Sections 2: Living With Chronic Illness-Normalization

Sections 3: Loss Therapy

Start the unit by looking at the unit objectives:

Objectives

By the end of this unit, you should be able to:

1. Outline the introductory concepts of chronic and terminal illness.

2. Describe the psychological adaptation needed to Live with Chronic illness
3. Outline and be able to describe the stages of dealing with loss.

You will now proceed to discuss the first section of this unit in detail.

SECTIONS 1: INTRODUCTORY CONCEPTS OF CHRONIC AND TERMINAL

ILLNESS

Welcome to Section 1 of Unit 1. In this section we will go through the definition of chronic
illness and terminal illness. We will then proceed to discuss uncertainty and stigma as relates
to chronic and terminal illnesses.

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define chronic illness.

2. Define terminal illness.
3. Discuss the uncertainty of chronic and terminal illness.
 4. Describe the stigma of chronic and terminal illness.

1.3 Chronic Illness

In-text Question 1.1

What would you consider to be the minimum period an illness would be present qualify as
chronic?

Hopefully you answered: 3 months.

A chronic illness is a non-curable long term disease. The US Center for National Health
Statistics describes it as an illness lasting more than 3 months. Generally these illnesses cannot
be prevented with vaccines or cured by medications nor do they just disappear. Health
damaging behaviours such as lack of exercise, cigarette smoking, and consumption of alcohol,
poor eating habits such as foods rich in cholesterol, refined sugars and salt contribute
significantly.

1.4 Terminal Illness

A terminal illness is generally an active and progressive illness for which there is no cure and
the prognosis is fatal. It is defined by the American Cancer Society as an irreversibly illness
that without life sustaining procedures, will result in death in the near future or a state of
permanent unconsciousness from which recovery is unlikely. Some examples may include
advanced cancer, some forms of head injury or multiple organ failure. The length of life
expectancy may vary from entity to entity

1.5 Chronic and Terminal Illness and Uncertainty

The course of events is unpredictable in chronic illness. In fact, chronic illness has been
described by Wiener (1975) as an experience of living with chronic uncertainty. Uncertainty
does not represent the total experience of chronic illness, yet it is a constant and most
problematic part of it. Thus, the concept of uncertainty must be addressed in order to understand
the problematic nature of chronic illnesses. Uncertainty is defined as the inability to determine
the meaning of events occurring in a situation where the decision-maker is unable to assign
definite values to objects and events and/or is unable to predict outcomes accurately.

In the illness experience, uncertainty arises when:

1. People lack information about the diagnosis and seriousness of their illness

2. They cannot make predictions as to the course of the illness and its prognosis

3. They have ambiguity concerning the stage of their illness (e.g., how advanced it is),
and
 4. They lack information regarding the best and/or alternate treatments and systems of
care.

1.6 Stigma of Chronic and Terminal Illness

In-text Question 1.2

What are some of the components of stigma?

Hopefully you answered:

a. Intolerance

b. Fear

c. Misunderstanding

d. humiliating and patronizing sympathy

According to Jennings, Callahan, and Caplan ( 1988, p. 6), "Chronic illness and disability are
often stigmatizing; intolerance, fear, and misunderstanding, at one extreme, and well meaning
but humiliating and patronizing sympathy at the other often greet the chronically ill in their
everyday social lives."

In our society, as in most, any illness is negatively valued, and non-curable long-term illnesses
are particularly problematic. The expectation regarding health is the desirability of mastery of
the problems of health. The concept of health is tied to the society's value system, which
emphasizes independence and individual achievement, and the high level of differentiation in
its social structure. Illness is regarded as dysfunctional to the social system because it hinders
individuals and weakens their effective performance of social roles. Society views illness as a
form of deviance that needs to be controlled because it poses problems both for the individual
and society.
Persons who are ill are allowed certain exemptions and privileges denied to healthy individuals
this is also known as the sick role. Lessened and impaired social contact and a sense of social
isolation are among the more detrimental consequences of chronic illness. Social isolation is a
major consequence.

Social isolation refers to a negative state of aloneness or diminished participation in social

relationships. Impaired social interaction relates to the state in which participation in social
exchanges occurs but is dysfunctional or ineffective because of discomfort in social
situations, unsuccessful social behaviours, or dysfunctional communication patterns. Of
course, the worse the illness (and/or its phases), then the more the probability exists that the
ill persons will feel or become isolated. This isolation can happen in two ways: either the ill
person, because of the symptoms, unexpected crises, difficult regimens, and loss of energy,
withdraws from most social contact, or the ill person is avoided or even abandoned by friends
and relatives. In either case, social relationships are disrupted or falter and break down. All
persons with long-term health problems are at high risk for social isolation. Social
relationships are frequently disrupted and usually disintegrate under the stress of chronic
illness and its management because chronic illnesses often involve disfigurement and loss of
both physical and mental health.

1.7 Section Summary

In this section we have defined chronic and terminal illnesses and described psychological
mechanisms underlying chronic and terminal illnesses. We have looked at the concept of
stigma and isolation in relation to chronic and terminal illnesses.

You will now proceed to section two which will take you through adapting to chronic and
terminal illness.

SECTION 2: ADAPTING TO CHRONIC AND TERMINAL ILLNESS

Welcome to Section 2 of Unit 1. In this section you get to understand the process of adaptation,
distinguish it from coping and enumerate factors that influence adaptation in relation to chronic
and terminal illnesses.

Before proceeding, look at the section objectives.

2.2 Section Objectives

By the end of this section you should be able to:

1. Define adaptation.
2. Distinguish between adaptation and coping
3. Name factors affecting adaptation

2.3 Adaptation

In-text Question 2.1

What would you consider to be adaptation?

Hopefully you answered: ‘a balance between demands and expectations of a given situation
and the capacities of an individual to respond to those demands’.

“If you haven't the strength to impose your own terms upon life, you must accept the terms it
offers you.”

-- T. S. Eliot

Life is itself an adaptive process. By adulthood, everyone achieves a certain level of life
adaptation. Chronic illness can disrupt this achievement, because the additional burdens in
dealing with the many problems of chronic illness diminish the capacity of individuals to
respond in satisfactory ways. Adaptation implies a balance between demands and expectations
of a given situation and the capacities of an individual to respond to those demands. Failure to
adapt, then, means that there is a discrepancy between demands and capabilities. It is difficult
to define and operationalize the concept of adaptation for several reasons. First of all,
adaptation is dynamic; it changes as the environment changes. With respect to chronic illness,
there are periods of progress and regress, depending on changes in the illness conditions, and
chronically ill individuals must respond to those changes.

2.4 Adaptation as Distinguished from Coping

Adaptation and coping are often treated as synonymous terms, but they are distinct from each
other. Coping "is the special mobilization of effort and the drawing upon unused resources or
potentials, [and] always involves some type of stress," whereas "adaptation is a broader concept
that includes routine or automatized actions." Adaptation, in a psychological sense, "refers to
individual survival, as well as to the capacity to sustain a high quality of life and to function
effectively on a social level. In this use of the word, the focus is on outcome from an evaluative
perspective -- adaptive or maladaptive", that is, day-to-day symptom management strategies
people employ to adjust to illness demands. It soon became obvious that they were indeed
distinct from each other, although in many cases it is virtually impossible to make a distinction
between these concepts because they are so interrelated. Indeed, while chronically ill
individuals routinely deal with the daily demands of their illness, they are also trying to cope
with sudden and/or unpredictable changes.T0 quote a patient, "I can adjust to it [the illness],
live with it on a day-to-day basis(read adapt) . . . but these damn changes, I can't cope.

2.5 Factors Affecting Adaptation

Some adaptation strategies are mainly illness related and involve dealing with the
incapacitation, discomfort, and symptoms of the illness itself. Depending on the specific
illness, these strategies can involve controlling pain, dizziness, incontinence, extreme
weakness, paralysis, the feeling of suffocation in respiratory ailments, and loss of control in
convulsive disorders. Particularly, the course of illness, type of onset, kinds of limitations, and
changes in physical appearance and functions interacting with situational variables affect the
adaptive responses of individuals with chronic illness. These factors also influence the way
people define the illness and attach meaning to it.

In other words, there are the challenges of the specific illness in question. It has been pointed
out that there are at least three major characteristics of illness that are critical to the long-term
adaptive responses of the chronically ill person. These characteristics are: the type of onset and
expected course of the illness, the nature and extent of limitation, and the type and extent of
changes in physical appearance and bodily functions.

2.6 Section Summary

In this section we have defined adaptation, distinguished between adaptation and coping and
named factors affecting adaptation

Let us now proceed to section three of our discussion.

SECTIONS 3: LIVING WITH CHRONIC ILLNESS

Welcome to Section 3 of Unit 1. In this section you get to understand the process of living with
chronic illness and the strategies involved in normalising life.

Before proceeding, look at the section objectives.

3.2 Section Objectives

By the end of this section you should be able to:

1. Define normalization.
2. Name factors affecting normalization.
3. Describe behavioural strategies of normalisation.
4. Describe cognitive strategies of normalisation.

3.3 Normalization

“When life's terms offer you a lemon, make lemonade!”

-- Popular Folk Saying

Normalization refers to processes a chronically ill person uses to continue what that person
perceives to be a normal life. There is a general presumption that people who work and
participate in social activities lead normal lives; that is, they have the capacity to perform a
variety of physical tasks, including self-care activities. Self-care is defined as the process by
which persons deliberately act on their own behalf for the prevention of illness, health
promotion, and the detection and treatment of health deviations. But with chronic illness, a
person's capacity to perform these tasks becomes limited or activities become restricted as
consequence of the illness. Patient compliance, a concept related to self-care, is defined as the
 extent to which a patient's behaviour coincides with the prescribed treatment recommendations
(Sackett & Snow 1979).

3.4 Factors Affecting Normalization

In-text Question 3.1

What factors might interfere with normalisation?

Compare your answer with the following factors:

a. Upsetting and negative feelings towards the illness

b. Anxiety and apprehension of not knowing what will happen next

c. Apprehension

d. Feelings of inadequacy

e. Self blame

f. Depression.

A primary set of normalization tasks involves preserving a reasonable emotional balance by

controlling upsetting and negative feelings aroused by the illness. Anxiety and apprehension
caused by not knowing the future, feelings of inadequacy, and resentment in the face of difficult
demands are understandable and inevitable, yet these feelings must be managed so that the
more mundane tasks of learning to deal with these demands can be undertaken. The most
common are, having to control negative emotions such as a sense of failure or inferiority,
feelings of self-blame for past wrong doings, being extremely depressed, even suicidal,
particularly at the onset of the illness:

3.5 Behavioural Strategies of Normalization

Chronically ill persons develop a repertoire of behavioural strategies to assist in normalizing

their lives, that is, to continue to live, as much as possible, the way they were living before they
became ill, and to proceed with activities and goals as if the illness did not exist or was not an
important part of their lives. One way they try to accomplish this is by carrying on as usual.
i.e. “ENGAGING IN USUAL ACTIVITIES DESPITE SEVERE LIMITATIONS” Many
chronically ill people keep the same schedule they met before the diagnosis of their illness,
despite exhaustion, the need for extra time for rest to restore energy, and, in many cases leads
to exacerbation of their symptoms. They try very hard to keep up with what they consider
normal activities, such as maintaining a job, taking care of household chores, cooking meals,
and participating in their usual social events

3.6 Cognitive Strategies of Normalization

Minimizing appears to be one of the more common strategies for achieving normalisation. This
occurs when the individuals attempt at arriving at normalcy through behavioural means fails.
By minimizing we mean, the cognitive defense mechanism where the individual tries to avoid
acknowledging and dealing with the seriousness of the illness and the incapacity and
discomfort that may be involved in the treatments and symptoms of the illness particularly. As
an example, a patient in radiotherapy for a pelvic cancer developed rectal bleeding. The patient
described very well but concluded by saying “it is not a problem, it could be worse! I have
heard worse accounts from fellow patients and they still do the things they used to do.” An
almost totally crippled man by a cancerous growth in the spine overheard saying "I just have a
disease, that's all. But it's just, OK, it's a malfunction. That's all it is.

This is of course a dilemma. Patients have to be helped to accept certain realities within reason.

The difference between chronic sufferers and relatively healthy people is that they have more
problems. They have to learn to live with these ever present and often painful, unsightly and
incurable symptoms that are often unpredictable. In addition these illnesses bring with them
the burden of costly and frequently difficult treatment regimes. As a result, the illness becomes
the central focus of chronically ill persons' lives. Thus everything else becomes of secondary
importance, at least initially, in the business of trying to normalize life, to continue to live, to
carry on; as much as possible, the way the chronically ill were living before they became ill.
In fact, it appears that some chronically ill individuals try even harder to carry on than most
so-called healthy people, both because of the threat the illness poses to their self-identity and
because of their sense of impending mortality.

3.7 Section Summary

In this section we have defined normalization, named factors affecting normalization,

described behavioural and cognitive strategies of normalisation.

SECTIONS 4: LOSS THERAPY FOR THE TERMINALLY ILL

Welcome to Section 4 of Unit 1. In this section you get to understand the how the terminally
ill cope with their mortality as relates to loss of health and the anticipated dying process

Before proceeding, look at the section objectives.

4.1 Section bjectives

By the end of this section you should be able to:

1. Define loss.
2. Describe anticipatory mourning.
3. Discuss the concept of normal mourning and prolonged grief disorder (PGD).
4. Describe grief therapy.

4.3 Loss
This is defined as the fact or process of losing something or someone. In the terminally ill it
can be looked at as anticipatory mourning related to anticipated death and loss of health or
normal functioning both at the physical and mental level

In-text Question 4.1

What is mourning?

I hope you answer was:

The expression of sorrow for someone who has died or something that is lost either animate
or inanimate.

Mourning may be expressed in various ways depending on the individual culture such as
dressing in black, crying, wailing, and being sorrowful.

4.4 Anticipatory Mourning

In anticipatory mourning, there is usually a live person who is expected or is expecting to die
due to the nature of their illness or physical state. The person for the most part retains the ability
to communicate and interact with significant others and therefore can have both negative and
positive effects.

In defining anticipatory mourning, it is important to note that it does not replace the post death
grieving process but may lessen the intensity of the post death grief.

Thus, Anticipatory mourning is the form of grief that occurs when there is opportunity to
anticipate the death or loss

4.5 Normal Mourning and Prolonged Grief Disorder

We will now look at each of these two concepts separately to enhance our understanding
starting with normal mourning.

4.5.1 Normal Mourning

There are several stages of normal mourning. The most studied model and in commonest usage
is the Kubler-Ross model which postulates that there are five stages of mourning or
grief. Elisabeth Kubler-Ross in her 1969 book on death and dying postulates
a series of emotional stages experienced when faced with impending death or death of
someone. She was inspired by her work with the terminally ill patients.

The five stages are (Acronym DABDA):

a. Denial,
b. Anger,
 c. Bargaining,
d. Depression and

e. Acceptance.

She made the observation that the stages were not meant to be a complete list of all possible
emotions that can be felt and they can occur in any order. Her hypothesis holds that not
everyone who experiences a life-threatening or life altering event experiences all five of the
stages due to reactions of personal losses differing between people.

Look at each of these stages in detail.

1. Denial – As the reality of the loss is hard to face, the first reaction is that of disbelief and
denial and allows a sense of unreality to take over thus buying time for the news to sink in.

2. Anger- “why me? it’s not fair!” “How can this happen to me?”, “Who is to blame?”, “Why
would God let this happen?” In this second stage, denial is no longer in operation and anger
and rage can be directed to self, others or even higher powers for those who are close to
them.

3. Bargaining- “I’ll do anything for a few more years,” “I will give all my life savings if.....”
This third stage, the hope is that some undoing or avoidance of a cause of grief can be
achieved, e.g. negotiating for extension of life with a higher power in exchange for a
reformed life style. It is believed that what the individual is doing at the psychological level
is saying “I understand I will die, but if I could just do something to buy more time....”

4. Depression- The fourth stage is characterised by an understanding of the certainty of death,

living becomes pointless, “why bother with anything?” “what is the point?” This allows
one to disconnect from things of love and affection. This has been referred to as a kind of
dress rehearsal for the aftermath. It is a kind of acceptance with emotional attachment.
Associated normal emotions would include sadness, regret, fear and uncertainty when
going through this stage.

5. Acceptance- In this last stage, individuals begin to come to terms with their own mortality
or the inevitability of the future of a loved one or other tragic event. Not everyone
experiences this as death may come suddenly and unexpectedly. This phase is marked by
emotional and sometimes physical withdrawal and is not a time of happiness and not
indicative of depression. The terminally ill or ageing may imply that that it is natural to
reach a stage where social interaction is limited. Ultimately, the allowing oneself to
experience the grief as it comes over the individual without resisting it allows the healing
process to progress faster.

4.5.2 Prolonged Grief Disorder

Pathological also known as atypical mourning refers to grief reactions that have now been
described as Prolonged Grief Disorder (PGD) and in the past as complicated grief disorder
(CGD). This is defined as a pathological reaction to loss representing a group of symptoms that
have been recognised over time as associated with long-term physical and psycho-social
dysfunction. Individuals with PGD experience severe grief symptoms for at least six months
and are stuck in a maladaptive state. It is important to distinguish between complicated from
normal grief. In normal grief, the feelings of loss are evident. However in complicated grief,
the feelings of loss become incapacitating and continue beyond 6 months.

Symptoms of complicated grief are:

a. Extreme focus on the loss and reminders of the loved one

b. Intense longing and pining for the deceased

c. Problems accepting the death

d. Numbness or detachment

e. Bitterness about the loss

f. Inability to enjoy life

g. Depression or deep sadness

h. Trouble carrying out normal routines

i. Withdrawing from social activities

j. Feeling that life holds no meaning or purpose

k. Irritability or agitation

l. Lack of trust in others

4.6 Grief Therapy

Treatment of complicated or prolonged grief involves the use of antidepressants of the

selective serotonin reuptake inhibitors such as Paroxetine combined with psychotherapeutic
techniques.
UNIT 2: PSYCHO-SOCIO ASPECTS OF HIV/AIDS

Welcome to Unit 2 where we are going to extensively discuss the psycho-socio aspects of
HIV/AIDS. This unit is divided into two sections as follows:

Section 1: Psycho-socio Impact of HIV/AIDS Diagnosis

Section 2: Common Mental Health issues for people living with HIV/AIDS

Start the unit by looking at the unit objectives:

Unit Objectives

By the end of this unit you should be able to:

1. Describe the psycho-socio aspects of HIV/AIDS diagnosis.

Outline the associated common mental health issues for people living with HIV/AIDS

SECTION 1: PSYCHO-SOCIO IMPACT OF HIV/AIDS DIAGNOSIS

Welcome to Section 1 of Unit 3. In this section you will go through the definition of human
ageing and describe the process of ageing.

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define human ageing.

2. Describe process of ageing.

Welcome to Section 1 of Unit 2. In this section you will go through the definition of Psycho-
socio Aspects of HIV/AIDS and the Impact of the diagnosis.

Before proceeding, look at the section objectives.

1.2 Unit Objectives

By the end of this section you should be able to:

1. Define psycho social.

2. Describe HIV/AIDS.
3. Discuss the impact of the diagnosis.
1.3 Psycho social

In-text Question 1.1

What would you consider to be psychosocial?

Hopefully you answered: Aspects of human development relating to the interrelation of social
factors and individual thought and behaviour.

Psychosocial development relates to how a person’s mind, emotions and maturity develop over
time. It has different components drawn from biological, experiential processes interacting to
complete the psychosocial picture.

1.4 HIV/AIDS

AIDS (Acquired Immune Deficiency Syndrome) is a disease caused by a virus called HIV
(Human Immuno-Deficiency Virus). The illness cause a change in the immune system leading
to an increased progressive vulnerability to infections and other diseases linked to a person’s
immunity.

The HIV virus is found in body fluids of an infected person and is transmitted through blood
to blood and sexual contact. This may also occur in cases of infected pregnant mothers passing
it onto their unborn baby also known as vertical transmission or during delivery or breast milk.

Thus, HIV can be transmitted in many ways including vaginal, oral and anal sex, blood
transfusions and sharing of hypodermic needles.

According to research, the origins of HIV date back to the late 20th century in west-central
Africa. AIDS and its cause, HIV, were first identified and recognized in the early 1980s.

There is currently no cure but there are now medications referred to as HAART (Highly
Active Anti Retro Viral Therapy) capable of slowing progression of the disease compatible
with infected people living longer and with good quality of life. UNAIDS reports that since
2001, HIV infections have dropped by 33%.

1.5 Impact of HIV/AIDS on Infected Individuals

Quality of life is one major area of concern and this can be viewed as follows, diminished
ability to work associated with lowered energy levels, poor diet, loss of social life, disordered
sexuality and poor self-esteem.
Soon after diagnosis, grieving with a sense of profound loss on many levels. (see earlier
description of loss and mourning)

Stigma and discrimination. This has been defined as “the occurrence of labelling, stereotyping,
separation, status loss, and discrimination” in a situation in which power is exercised (Link &
Phelan, 2001, p.363).

The stigma mostly arises out of misconceptions about the condition which include belief that
an individual with this condition is a drug user, gay, has multiple partners, punishment from
god, deserve to get the disease and loose morals. The net consequence is that individuals so
affected may refuse to acknowledge the disease and hence delay seeking counselling, medical
and psychological care and protecting others from getting infected.

Low self-esteem may lead to social isolation with fear of disclosing their status and rejection
by friends and family for fear of death, helplessness, shame and fear of getting infected.

Sexuality is usually impaired because it can be a barrier to intimacy. Confidentiality is another

major concern. Not knowing who to trust with the information. Spirituality may engender hope.
Thus people with HIV/AIDS need to have their spiritual needs addressed.

1.6 Section Summary

In this section we have defined the Psycho-socio Aspects of HIV/AIDS and described the
HIV/AIDS disease concept and the Impact of the diagnosis on quality of life, stigma and
discrimination, grief and mourning, self esteem, spirituality and confidentiality.

You will now proceed to section two which will take you through the psychological
complications and their management.

SECTION 2: COMMON MENTAL HEALTH ISSUES FOR PEOPLE LIVING WITH

HIV/AIDS

Welcome to Section 2 of Unit 2. In this section you will go through the description of common
mental health issues for people living with HIV/AIDS and appropriate psychosocial
interventions.

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of this section you should be able to:

 1. Describe the different psychiatric disorders that may arise as complications of the
HIV/AIDS diagnosis.
2. Describe various management strategies.

2.3 Psychiatric Disorders Associated with HIV Diagnosis

Some of the psychiatric disorders associated with the revelation that one has HIV include:

a. Depression and HIV/AIDS

Depression is a mood disorder characterised by a pervasive low, sad, depressed mood

associated with loss of interest in most things, loss of pleasure, biological shift symptoms of
appetite, sleep, libido and fatigue changes, pessimism, inappropriate guilt, feelings of
hopelessness, worthlessness, helplessness and sometimes suicide. According to the Diagnostic
and Statistical Manual 5th edition (DSM 5) these symptoms need to have been present for at
least 2 weeks. It is believed that depression is much more common among persons with
HIV/AIDS compared to the general population. Rates of depression among people living with
HIV/AIDS are as high as 60% as opposed to 5-10% in the general population. There are a
number of recent studies indicating just how detrimental depression effects are in HIV
infection. Effects are noted on adherence to HAART, quality of life, treatment outcomes and
mortality and disease progression.

Difficulties with diagnosis arise because “Patient has a good reason to be…..” or “Well, you
would be to if you were....” or “It’s reasonable to be depressed…”

Fact: The majority of patients

with chronic medical illness are not depressed.

Another difficulty is overlapping symptoms:

4 out of 9 Symptoms could be
caused by physical illness:
 Appetite changes
 Sleep disruption
 Energy changes
 Slowed motor movement

Associated Psychosocial Stress leading to high suicide rates related to Initial HIV diagnosis &
later stages of illness, presence of multiple comorbid factors:

 Substance abuse
 Poverty
 Homelessness
 Social isolation
The Physical stigma of ART

 Lipoatrophy, lipodystrophy

b. Anxiety Disorders and HIV/AIDS

Anxiety can be a manifestation of the uncertainty surrounding a diagnosis of HIV infection and
the stigma. The symptoms may range from mild anxiety attacks to full blown disorders. The
following anxiety disorders have been associated with the diagnosis.

c. Post-traumatic stress disorder (PTSD)

Greatly increased rates with 42% HIV positive women, 30% pts develop in reaction to HIV
diagnosis, predicts lower CD4 counts and higher levels of pain.

d. Panic Disorder & Generalized Anxiety Disorder

> 4 times more prevalent and affects accessing primary care, adherence to treatment, and
quality of life especially agoraphobic/housebound however responds well to treatment.

e. Social phobia

It is a fear of social situations, scrutiny and criticism by others, inability to eat or speak in
public. Usually relates to internalized stigma of illness and is exacerbated by lipoatrophy and
lipodystrophy caused by ART responds well to psychotherapy & medications.

f. Dementia

Occurs with CNS Infection, 10% AIDS patients present with neurological symptoms. 75% of
AIDS patients will have brain pathology at autopsy consisting of gliosis, white matter pallor &
multinucleated giant cells. HIV-Associated Dementia (HAD)& Minor Cognitive Motor
Disorder (MCMD) predict shorter survival.

The mechanism by which the virus causes dementia and related conditions is believed to be
through HIV-infected macrophages directly entering the CNS early in HIV infection. CNS may
be a sanctuary for HIV replication.

HAART treatment is the most effective and slows progression of dementia.

g. Bipolar Mood Disorder

Prevalence of bipolar disorder in HIV infection is 10 times higher than in general

population. Stress of HIV infection exacerbates pre-existing bipolar disorder – complicating
adherence. New-onset or secondary mania is the result of HIV infection, opportunistic
infections or due to antiretroviral medications. Patients with bipolar disorder (primary) at
increased risk of HIV infection due to Impulsivity, poor judgment, & libido changes all part of
mood episodes. Secondary mania seen in later stages of HIV infection is harder to treat, more
chronic, less episodic course. Medications are the mainstay of treatment
 h. Schizophrenia

Patients with chronic mental illness at increased risk for HIV infection, prevalence rates 2 to
10%. Medical providers often do not test for HIV and incorrectly assume patients not sexually
active. Substance abuse significant co-morbidity. Patients do not implement HIV risk
behaviour knowledge.

• Patients with chronic mental illness at increased risk for HIV infection
– Prevalence rates 2 to 10%
– Medical providers often do not test for HIV
• Incorrectly assume pts not sexually active
• Substance abuse significant co-morbidity
• Pts do not implement HIV risk behaviour knowledge

2.4 Management Strategies

The interventions that you can institute for clients suffering psychology disorders associated
with HIV include:

a. Motivational Interviewing
b. Patient/Family Education
c. Problem Solving
d. Referrals
e. Skills Building
f. Support
g. Medications
h. Psychotherapy

2.5 Section Summary

In this section we have described the different psychiatric disorders that may arise as
complications of the HIV/AIDS diagnosis and described various management strategies.

UNIT 3: PSYCHOLOGICAL ASPECTS OF AGEING

Welcome to Unit 3 Psychological Aspects of ageing. This unit is divided into three sections as
follows:

Sections 1: Concepts of Ageing

Sections 2: Effect of Ageing of the Body Systems

Sections 3: Psychological Features Associated With Ageing

Start the unit by looking at the unit objectives.

 Unit Objectives

By the end of this unit, you should be able to:

1. Describe the concepts of ageing.

2. Outline the effects of ageing of various body systems.
3. Describe the psychological features associated with ageing

You will now proceed to discuss the first section of this unit in detail.

SECTION 1: CONCEPTS OF AGEING

Welcome to Section 1 of Unit 3. In this section you will go through the definition of human
ageing and describe the process of ageing.

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define human ageing.

2. Describe process of ageing.

1.3 Human ageing

In-text Question 1.1

What would you consider to be the age at which we expect to start being senile?

Hopefully you answered: above the age of 65 years

This is described as physiological changes that take place in the human body that lead to
senescence, the decline of biological functions and of the ability to adapt to metabolic stress.
In humans, this is accompanied by psychological and behavioural changes.

Ageing begins as soon as adulthood is attained and can be viewed as a part of the normal human
life cycle that consists of infancy, childhood and adolescence.

The biological-physiological aspects of ageing seem to suggest that that certain changes make
the individual more vulnerable to disease and the probability of death.

1.4 Process of Ageing

Physiologists describe a declining performance of many body organs that is gradual over the
life span. This decline is attributed to a loss of cells from these organs resulting in a reduction
in the reserve capacities of the individual. In addition, the remaining cells have compromised
function with reduced quantities of certain cellular enzymes making them more vulnerable to
death.

1.5 Section Summary

In this section we have defined human ageing and described the process of ageing.

You will now proceed to section two.

SECTION 2: EFFECTS OF AGEING OF VARIOUS BODY SYSTEMS

Welcome to Section 2 of Unit 3. In this section you will go through a description of the effects
of the process of ageing on the various body systems.

Before proceeding, look at the section objectives.

2.2 Section Objectives

By the end of this section you should be able to:

1. Describe the effects of the process of ageing on the various body systems.
2. Outline the physiology of the aging process.

2.3 Biological Aspects of Ageing

There are various biological changes that occur as a result of ageing. We are going to discuss
these changes as they occur in each system in the human body starting with the nervous system.

1. Nervous System

The brain atrophies as a result of aging process. The brain weight decreases, decrease in
enzymes, protein and lipids in brain tissue. There is shrinkage of large neurons resulting in loss
of large neurons with an increase in smaller neurons. There are alterations in the quantities of
some neuro-transmitters.

Clinical changes due to the above are decreased sensation of vibrations (particularly in legs),
less brisk deep tendon reflexes with ankle reflex absent entirely and a decreased ability for
upward gaze. Functional changes include slowing of response to tasks and the increase in time
to recover from physical exertion. Cognitive changes include memory loss, decrease in
perceptual ability and decrease in proficiency.

2. Sensory Changes

The sensory changes include sight, touch, smell, taste and hearing. We need to look at these
sensory changes in their associated organs in detail.

a. Eyes: The eye's external changes give evidence of advancing age. These changes result
from loss of orbital fat, loss of elastic tissue and decreased muscle tone. The skin around
the eyes darkens and wrinkles referred to as "crow's feet" appear. Xanthomas
(cutaneous deposits of lipid material) found at the inner portion of the lid; these may
indicate elevated blood lipid levels.

The cornea flattens which reduces the refractory power. The retina of older individual
becomes thinner because of fewer neural cells and receives only 1/3rd of the amount of
light that of a younger person. Due to this there occurs problem in reading, not able to
see in dim light and also have difficulty in colour perception. The lens of the eye loses
its elasticity and increases in density.

b. Ear: Cerumen glands are reduced in number dry and hard ear wax, along with itching.
Degenerative changes occur in ossicles contributing to hearing loss. Loss of cochlear
hair cells leading to hearing loss; Inner ear changes affect the auditory processing
system leading to auditory processing disorder and a peripheral hearing sensitivity loss.
Presbycusis is the term used to describe hearing loss associated with normal aging.

c. Taste and smell: Very rarely the capacity to smell diminishes. Taste perception and
taste discrimination decreases as the age advances

3. Integumentary System

There is systemic decrease in circulation, loss of cells and loss of elastic collagen fibers and
muscle mass. The number of pressure and light touch sensors decreases with age. Subcutaneous
fat atrophies on the face, hands, shins and soles; whereas it hypertrophies on the abdomen (in
men and thighs (in women). Immune, vascular and thermoregulatory responses of the skin
decrease with age. In addition, there often occurs loss of hair colour and thinning of pubic,
axillary and scalp hair.

2.3 Biological Aspects of Ageing

1. Cardiovascular System
Collagen and lipid deposits increase intercellularity in the heart muscle. Lipofuscin, a yellow-
brown granular material accumulates in the myocardial cell. Valves of the heart become thicker
and more rigid as a result of calcification.

The SA node is infiltrated by fat and connective tissue resulting in a decrease in the heart's
ability to regulate the rate of SA node, also causing a slowing of electrical impulses through
the AV tissue. There is 10% decrease in the number of pacemaker cells in the SA node by age
75 years. Many of the arrhythmias seen in the older person are a result of either the decrease
in pacemaker cells or the infiltration of fat in the SA node.

2. Respiratory System

The trachea and large bronchi are also increased in diameter because of the calcified cartilage
changes. The muscles involved in respiration weaken with age. It results in less forceful
contraction which decreases inspiratory and expiratory effort. The combination of increased
stiffness of the chest wall and decreased muscle strength results in less efficient breathing.

Older people depend more on accessory abdominal muscles to compensate for weakened
thoracic muscles.

3. Musculoskeletal System

There is degeneration of the intervertebral discs leading to development of kyphosis and

scoliosis. Bone resorption takes place without the successful formation of new bone mass
leading to gradual bone loss. Loss of trabecular bone leads to compression fractures in vertebral
column. Reduction in cortical thickness and increased porosity results in progressive cortical
thinning.

In aging, the increased parathyroid hormone, decreased vitamin D and calcitonin also play role
in calcium loss in older people.

In women, estrogen deficiency, calcium malabsorption, lifestyle factors (calcium intake and
exercise) can result in bone loss. Aging brings decline in numbers of muscles resulting in
reduced muscle mass. The muscle strength also reduces especially due to lack of exercise.

4. Urinary System

In men, Benign Prostatic Hypertrophy is associated with aging leads to urinary incontinence
(dribbling). In women, estrogen deficiency causes changes in the squamous epithelium of the
distal urethral and vaginal wall, a decrease in the vaginal muscular tone and vascular profusion.
These changes contribute to urinary incontinence.

Increasing age is also associated with an increase in involuntary bladder contractions, a

reduction in bladder capacity and an increase in residual volume. These contribute to
development of incontinence in older adults. Weak pelvic muscles causes stress incontinence.

5. Gastrointestinal System
Teeth become brittle; there is resorption of bone in the jaw leading to loosening of teeth,
increased infections of teeth and gums and eventual loss of teeth. There is difficult to chew
food because of loose teeth.

Common bile duct undergoes progressive dilatation with age. Presence of gall stones increases
with age. Liver weight and size decreases with age. There is decrease in number of hepatic
cells and as a result, a diminished capacity for metabolism of drugs and hormones.

6. Reproductive System

a. Changes in women

Menopause begins between the ages of 45 to 50 years. The cessation of ovarian secretion
of estrogen and progesterone is the major physiologic event of menopause. Women may
experience hot flashes due to vasomotor instability. Also another associated feature of
menopause is bone loss leading to osteoporosis.

Decrease in estrogen production leads to reduced vaginal lubrication, the vaginal mucosa
becomes thin and the vagina shortens in length and width. Due to this reason, the sexual
arousal is reduced which results in painful intercourse and vulvo-vaginitis.

b. Changes in men

Erectile ability undergoes changes. Takes longer time for erection, amount of semen is
reduced and the intensity of ejaculation is lessened. It is not clear that whether the increase
in impotence is age related.

2.4 Section Summary

In this section we have described the effects of the process of ageing on the various body
systems.

Let us now proceed to section three where we are going to discuss the psychological features
associated with ageing.

2.4 Section Summary

In this section we have described the effects of the process of ageing on the various body
systems.
Let us now proceed to section three where we are going to discuss the psychological features
associated with ageing.

SECTION 3: PSYCHOLOGICAL FEATURES ASSOCIATED WITH AGEING

Welcome to Section 3 of Unit 3. In this section you will go through a description of the
psychological features associated with ageing.

Before proceeding, look at the section objectives.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the psychological features associated with ageing.

2. Outline the socio-cultural aspects of ageing.
3. Discuss the sexual aspects of ageing.

3.3 Psychological Aspects of Aging

The psychological features affected by ageing in a human being include:

1. Memory functioning

Short term memory deteriorate with age, long term memory does not show similar changes. A
well educated and mentally active person does not exhibit such changes in faster rate. The time
required for memory scanning is longer for both recent and remote recall among older people.
This can be attributed to social or health factors (stress, fatigue, illness), but it can also occur
with certain physiological changes due to aging (decreased blood flow to the brain).

2. Intellectual functioning

Fluid abilities or abilities involved in solving novel problems, tend to decline from adult period
to old age. There is a high degree of regularity in intellectual function present on most of the
old age people. Intellectual abilities of older people do not decline, but do become obsolete.
Their formal educational experience is reflected in their intelligence performance.

3. Learning ability

The ability to learn does not decline by age. The slowing of reaction time with age and over
arousal of central nervous system are noted in old age. It may lead to lower level of
performance in tasks which requires high efficiency. Ability to learn continues throughout the
life, although strongly influenced by personal interests and preferences. Accuracy of
performances diminishes.
4. Adaptation to the tasks of ageing

These include the following:

a. Loss and grief

By 60-70 years of age, most have experienced numerous losses, and mourning has
become a life long process and because grief is cumulative, this can result in
bereavement over load.

b. Maintenance of self-identity

Self-concept and self-identity appears to remain stable over life time and good psycho
social adjustment equals sustained family relationships, maturity of the ego defenses,
absence of depressive disorder and absence of alcoholism.

c. Attachment to others

The need for attachment is consistent throughout the life span and hence the need for
socialization and companionship for seniors as well.

d. Dealing with death

e. Death anxiety among the elderly is more of a myth than reality, however, the feeling
of abandonment, pain and loss may lead to fear or anxiety.

5. Psychiatric disorders

The later life constitute a time of especially high risk for emotional distress and dementia,
depressive disorders, delirium, sleep disorders etc are the most common psychiatric illness seen
among elderly.

3.4 Socio-cultural Aspects of Aging

Old age brings many important socially induced changes, some of which have the potential for
negative effect on both the physical and mental well-being of older persons. They want
protection from hazards and weariness of everyday tasks. They want to be treated with respect
and dignity and also want to die with respect and dignity.

In developing countries and Asian countries the aged are awarded a position of honor, that
place emphasizes on family cohesiveness. In industrialized countries many negative
stereotyped perspectives on aging still persist, aged are always tired or sick, slow and
forgetful, isolated and lonely, unproductive etc. Employment is one of the areas where the
aged face discrimination.

3.5 Sexual Aspects of Ageing

In this aspect we are going to discuss the physical sexual changes and the effects of ageing to
the elderlies’ sexual behaviour.
1. Physical Changes

These changes occur differently in women and men and therefore we will look at each
separately as follows:

a. Changes in female

Menopause may begin anytime during the 40’s or early 50’s. Gradual decline in the
functioning of the ovaries and subsequent reduction in the production of estrogen. The
walls of the vagina become thin and inelastic and vaginal lubrication decreases.

Orgasmic uterine contractions become spastic. All these changes result in vaginal
burning, pelvic aching, irritability etc. In some women these changes result in
avoidance of sexual intercourse. These symptoms are more likely to occur with
infrequent intercourse of only one time a month or less. Regular and more frequent
sexual activity result in a greater capacity for sexual performance.

b. Changes in male

Testosterone production decline gradually as the age increases. As a result of these hormonal
changes the erection takes place slowly and requires more genital stimulation to achieve. The
volume of ejaculate decreases and the force of ejaculation lessens. The testis become smaller,
but most men continue to produce viable sperm well in to old age.

3.6 Sexual Behaviour in Elderly

Sexual activity can continue and well preserve till the age of late 70s and 80s for both males
and females who have regular opportunities for sexual expression. As the sexual practices
continue frequently, the sexual capacity can prolongs.

Studies reveal that for healthy men and women with healthy partners, sexual activity will
probably continue throughout life if they had a positive attitude about sex when they were
young.

3.7 Section Summary

In this section we have described the psychological features associated with ageing.

UNIT 4: PSYCHOLOGICAL ASPECTS OF CARDIOLOGY

Welcome to Unit 4 psychological aspects of cardiology. This unit is divided into four sections
as follows:

Section 1: Psychosocial factor and the link to coronary heart disease

Section 2: Evidence linking specific psychosocial factors to coronary heart disease

Section 3: Relation between depression and anxiety and coronary heart disease

Section 4: Modification of psychosocial factors

Start the unit by looking at the unit objectives.

Unit Objectives

By the end of this unit you should be able to:

1. Describe the link between psychosocial factors and coronary artery disease.
2. Examine the evidence linking specific psychosocial factors to coronary heart disease.
3. Relate depression, anxiety and other psychosocial factors with coronary heart disease.
4. Describe how modification of psychosocial factors influences outcomes in heart
disease.

You will now proceed to discuss the first section of this unit in detail.

SECTION 1: PSYCHOSOCIAL FACTOR AND THE LINK TO CORONARY HEART

DISEASE

Welcome to Section 1 of Unit 4. In this section you will go through the definition of a
psychosocial factor and describe the link between psychosocial factors and coronary artery
disease.

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of this section you should be able to:

1. Define a psychosocial factor.

2. Describe the link between psychosocial factors and coronary artery disease.

1.3 Psychosocial Factors

A psychosocial factor may be defined as a measurement that potentially relates psychological

phenomena to the social environment and to patho-physiologic changes.

In-text Question 1.1

What would be the biggest aetiologic contributor to heart disease?

Hopefully you answered: life style

The evidence of mechanisms linking psychosocial factors with coronary heart disease is
important in making causal inferences and therefore in designing preventive interventions.

1.4 Psychosocial Factors and Coronary Heart Disease

Psychosocial factors may act alone or combine in clusters and may exert effects at different
stages of the life course. Broadly, three interrelated pathways may be considered.

Firstly, psychosocial factors may affect health related behaviors such as smoking, diet,
alcohol consumption, or physical activity, which in turn may influence the risk of coronary
heart disease and finally access to and content of medical care may plausibly be influenced
by, for example, social supports. It has been observed that socioeconomic status is inversely
associated with coronary heart disease and certain psychosocial factors, and it has been
proposed that psychosocial pathways may play a mediating role

1.5 Section Summary

In this section we have defined a psychosocial factor and described the link between
psychosocial factors and coronary artery disease.

You will now proceed to section two which will take you through.

SECTION 2: THE EVIDENCE LINKING SPECIFIC PSYCHOSOCIAL FACTORS TO

CORONARY HEART DISEASE

Welcome to Section 2 of Unit 4. In this section you will go through a description of the specific
psychosocial factors that have been linked to heart disease and the research evidence

Before proceeding, look at the section objectives.

2.2 Section Objectives

By the end of this section you should be able to:

1. Describe the link between psychosocial factors and coronary heart disease
2. Cite the research evidence linking psychosocial factors with coronary heart disease

2.3 The evidence for Psycho social factors and coronary heart disease

Largely on the basis of studies in middle aged men four groups of psychosocial factors were
identified by using the predefined quality filter consisting of:
 1. Psychological traits (type A behavior, hostility),
2. Psychological states (depression, anxiety),
3. Psychological interaction with the organization of work (job control-demands-
support) and
4. Social networks and social support.

In simple terms this corresponds to a spectrum with mainly psychological components at one
end and a stronger social component at the other.

In healthy populations, prospective cohort studies suggest a possible aetiological role for:

a. Type A/hostility (6/14 studies)

b. Depression and anxiety (11/11 studies)
c. Psychosocial work characteristics (6/10 studies)
d. Social support (5/8 studies)

In coronary heart disease patient populations, prospective studies suggest a prognostic role
for:

a. Type A/hostility (0/5 studies)

b. Depression and anxiety (6/6 studies)
c. Psychosocial work characteristics (1/2 studies)
d. Social support (9/10 studies)

Although there exist a possible bias based on publication needs, prospective cohort studies
provide strong evidence that psychosocial factors, particularly depression and social support,
are independent aetiological and prognostic factors for coronary heart disease.

Type A behavior pattern—is characterized by hard driving and competitive behavior, a

potential for hostility, pronounced impatience, and vigorous speech stylistics. The instruments
for measurement of Type A behavior and hostility—the Jenkins activity scale, the structured
interview, the Minnesota multiphasic personality inventory (MMPI), the Bortner hostility
scale.

Unlike other psychosocial factors, Type A is distinguished by being the subject of numerous
intervention trials. The National Institutes of Health declared type A an independent risk factor
for coronary heart disease. However, with the publication of negative findings it was proposed
that a more specific component of type A, namely hostility, might be aetiological, although
there are conflicting studies.

2.4 Depression and Anxiety

The relation between depression and anxiety and coronary heart disease differs from those of
other psychosocial factors for several reasons. Firstly, unlike other psychosocial factors,
depression and anxiety represent well defined psychiatric disorders, with standardized
instruments for measurement. Secondly, depression and anxiety are commonly the
consequence of coronary heart disease, and the extent to which they are also the cause poses
important methodological issues. Thirdly, the ability to diagnose and treat such disorders
makes them attractive points for intervention. Finally, depression and coronary heart disease
could share common antecedents—for example, environmental stressors and social supports.
Results from the 11 prospective studies that investigated depression or anxiety in the aetiology
of coronary heart disease, were all positive. All three of the prospective studies examining the
effect of anxiety in the aetiology of coronary heart disease had positive results, this effect is
strongest specifically for phobic anxiety and sudden cardiac death.

Wassertheil-Smoller reported the effect of depression in relation to cardiovascular events

among 4367 healthy older people. An increase in depression symptoms predicted events. Such
findings are compatible with the hypothesis that premonitory signs of coronary heart disease
such as angina or breathlessness may have led to the increase in depression.

Depression in patients after myocardial infarction seems to be of prognostic importance

beyond the severity of coronary artery disease. Depression is a continuously distributed
chronic psychological characteristic.

2.5 Other Psychosocial Factors

The longstanding observation that rates of coronary heart disease vary markedly among
occupations. This is more than can be accounted for by conventional risk factors for coronary
heart disease. This has generated a quest for specific components of work that might be of
aetiological importance.

The dominant “job strain” model proposes that people in jobs characterized by low control
over work and high conflicting demands might be high strain. A subsequent addition to the
model was that social support might buffer this effect. The advantage of the model is that it
generates specific hypotheses for testing. Prospective cohort studies that have examined the
relation between job strain and coronary heart disease found:

Six of the 10 studies had positive results.

There is growing emphasis on the importance of low job control rather than on conflicting
demands. Social supports and networks relate to both the number of a person’s social contacts
and their quality (including emotional support and confiding support).

Marital status—information routinely sought in clinical practice—is a simple measure of social

support, and the ability of low social support to predict all causes of mortality has long been
recognized. It has been proposed that social supports may act to buffer the effect of various
environmental stressors and hence increase susceptibility to disease, but most of the evidence
supports a direct role.

Five of the eight prospective cohort studies that investigated aspects of social support in
relation to the incidence of coronary heart disease were positive.

Nine of the 10 prognostic studies were positive, and the relative risks for three of these studies
exceeded 3.

2.6 Psychosocial Interventions

A recent study found that psychosocial interventions are associated with improved survival
after myocardial infarction. However, two recent large randomized controlled trials of
psychological rehabilitation after myocardial infarction found no difference in anxiety and
depression, and this may in part explain the lack of effect on mortality.

Randomized controlled trials of modification of social supports after myocardial infarction

show a decrease in cardiac death or re-infarction rates. A patient’s social circumstances should
be elicited as part of the history, and the doctor may have a role in mobilizing social support.

Psychosocial components of secondary prevention clinicians should consider:

1. Detecting and treating depression

2. Mobilizing social support

2.7 Modification of Psychosocial Factors

Using socioeconomic status and psychosocial factors to risk stratify patients. The potential for
primary prevention in relation to psychosocial factors lies largely outside the remit of
clinicians. Psychosocial factors themselves are determined largely by social, political, and
economic factors and it is therefore policy makers who influence the structure and function of
communities—in the public and private domains—who may have scope for primary
prevention.

Of the large number of psychosocial factors that have been studied, only four met the quality
filter:

1. Type A/hostility,
2. Depression and anxiety,
3. Work characteristics, and
4. Social supports.
5. 2.8 Section Summary
6. In this section we have concluded that the prospective observational studies show
aetiological roles for social supports, depression and anxiety, and work characteristics
and prognostic roles for social supports and depression.

UNIT 5: PSYCHOLOGICAL FACTORS IN PERINATAL MENTAL HEALTH

Welcome to Unit 5 Psychological factors in perinatal mental health. This unit is divided into
three sections as follows:

Section 1: Definition of perinatal mental health

Section 2: Description of the various mental health issues

Section 3: Strategies in managing these issues

Start the unit by looking at the unit objectives:

Unit Objectives
By the end of this unit you should be able to:

1. Define and describe perinatal mental health

2. Describe the various mental health issues associated with the perinatal period
3. Outline strategies in managing these issues

You will now proceed to discuss the first section of this unit in detail.

SECTION 1: DEFINITION OF PERINATAL MENTAL HEALTH

Welcome to Section 1 of Unit. In this section you will go through the definition of perinatal
mental health

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of this section you should be able to:

1. Define perinatal mental health.

1.3 Perinatal Mental Health

In-text Question 1.1

What would be the perinatal period?

Hopefully you answered: The period between conception and birth through to the age of 1
year.

Mental health is dependant on factors such as hormonal (biological), psychological and social
(Bio-Psycho-Social).

Perinatal mental health covers the baby, mother, partner and families.

1.4 Section Summary

In this section we have defined perinatal mental health.

You will now proceed to section two which will take you through
SECTION 2: MENTAL HEALTH ISSUES ASSOCIATED WITH THE PERINATAL
PERIOD

Welcome to Section 2 of Unit 5. In this section you will go through a description of the specific
psychological disorders that may arise during the perinatal period.

Before proceeding, look at the section objectives.

2.2 Section Objectives

By the end of this section you should be able to:

1. Describe specific psychological disorders that may arise during the perinatal period

2.3 Common Psychiatric Disorders Associated with the Perinatal Period

Some of the common disorders that you will see in your clients during the perinatal period
include:

1. Maternity Blues

85% of women will develop mood changes in the period after delivery lasting approximately
2weeks.

2. Abortion

Induced abortion is the surgical or medical intervention in a pregnancy for the purpose of
causing the death of the embryo or fetus. (If the procedure results in a live birth, the outcome
is a preterm delivery, not an abortion). Every abortion, then, is an iatrogenic death. Every post-
abortion woman has undergone a real death experience - the death of her child.

Grief is a natural consequence of death. Current obstetrical and psychiatric literature abounds
with articles about grief following perinatal death - death due to spontaneous abortion,
premature birth, stillbirth, and Sudden Infant Death Syndrome.

In addition to the 20 to 30 percent of pregnancies thought to end in spontaneous abortion in the

USA, there is now one elective abortion for every three live births. Evidence is mounting that
the reaction to the loss of a child from induced abortion is part of the same continuum of grief
the profession, led by society, more readily accepts that miscarriage, termination, stillbirth, and
neonatal death lie in a spectrum of the same grief.

Grief after induced abortion is often more profound and delayed than grief after other perinatal
losses because it is largely hidden. The post-abortion woman's grief is not acknowledged by
society because the reality of her child's death is not acknowledged. Society offers her no
support in grieving. She is typically alone, without her partner during the procedure. There is
 no dead child to hold, no photographs, no funeral, burial, or grave to visit, no consolation from
friends, relatives or clergy

The psychological defense mechanisms of denial and repression are massively in effect pain,
bleeding, unnatural endocrine changes remind her of the physical assault on her body,
obsessive thought, "I killed my baby!"

May then resort to

Intense activity -work or study

Attempts to repair her intimate relationships or to develop new ones

Reminders e.g. the expected date of delivery, children the same age that their children would
have been, a visit to the gynecologist, the sound of the suction machine in the dentist's office,
a baby in a television ad, a new birth, another death experience. Each of these may trigger a
breakthrough of guilt, grief, anger, and even despair.

Use of alcohol or sleeping pills to deal with feelings of grief and guilt are some of the
maladaptive coping mechanisms employed

Risk factors for the development of pathological grief Include:

Pre-existing high dependency on the deceased

Pre-existing frustration or anxiety in relating to the deceased,

Unexpected or tortuous deaths,

Sense of alienation from or antagonism to others,

History of multiple, simultaneous, unintegrated earlier losses.

Real or fantasized responsibility for the suffering or the death itself.

Could lead to:

a. Anxiety (including PTSD)

b. Mood disorders

c. Adjustment disorder

d. Psychosis

e. Worsening of personality disorder."

2.3 Common Psychiatric Disorders Associated with the Perinatal Period

3. Antenatal and Postnatal Depression

The most common perinatal mental health problem is postnatal depression with rates ranging
between 13% and 20%. A significant number of women will become depressed in the antenatal
period.

Depression is likely to be worsened by abortion because it increases guilt and causes another
loss.

Depressive disorders are the most common reason for psychiatric referral of post-abortion
women the significance of the early pregnancy loss through abortion as a causative factor is
often overlooked.

This may occur for a number of reasons:

a. The patient may not volunteer her abortion history,

b. A long time may have passed since her abortion,
c. other negative factors in the history
d. Society's "blind spot" regarding the significance of perinatal loss

A number of studies have documented the negative impact that depression can have on
relationships, families and children. This ranges from depression in partners, divorce, less
strong bonding with the infant and reduced emotional adjustment and cognitive development
among children.

Perinatal mental health is closely connected to infant mental health, so looking after the mother
means looking after the baby too.

Working with mothers and infants to improve their interaction and attachment may be seen as
prevention of the development of mental health problems in children.

Help should be sought as early as possible, as this is likely to be most effective in providing
optimal outcomes for the mother, infant and family. However, it is never too late to seek help.

4. Suicide

There is low risk of suicide during pregnancy and first year after delivery" suicide rate after
stillbirth is six times that for all mothers after childbirth.

Elective abortion is anything but a minor event in the lives of young women and their partners.

5. Postpartum psychosis

This serious but rare condition arises early in the postnatal period, and is characterised by
severe mood swings, loss of touch with reality, distractibility, and inability to function. It
requires urgent admission for treatment. Although the symptoms of postpartum psychosis can
be dramatic and frightening, this condition is usually rapidly responsive to treatment.

6. Relapse of other conditions

The postnatal period is associated with increased likelihood of relapse of pre-existing mental
health conditions.

7. Antenatal and Postnatal Anxiety

Anxiety often goes hand-in-hand with depression during pregnancy and the postnatal
period. Worrying thoughts around the progress of the pregnancy or the health of the mother
or baby are normal and usually settle in response to reassurance.

However 10-15 per cent of childbearing women show symptoms that are more clearly due to
an anxiety disorder rather than to depression and treatment needs to take this into account.

Women who have had previous pregnancy, labour or delivery complications; miscarriages or
experienced the death of a baby are more likely to show increased levels of anxiety during
subsequent pregnancies. A history of phobia, generalised anxiety disorder or obsessive
compulsive disorder increases the risk of anxiety symptoms in pregnancy and after the birth.

8. Post-Traumatic Stress Disorder

This disorder has the following triad of symptoms:

a. re-experiencing
b. avoidance and numbing
c. Hyperarousal

The most common traumata involve either a serious threat to one's life or to physical integrity.
The disorder is apparently more severe and longer lasting when the stressor is of human
design."

9. Anniversary Suicide Attempts and Anniversary Mourning

Physical symptoms most commonly involving the reproductive system - abdominal pain and
dyspareunia, headaches, chest pain, eating irregularities and increased drug and alcohol abuse.

2.4 Section Summary

In this section we have described specific psychological disorders that may arise during the
perinatal period.

SECTION 3: STRATEGIES IN MANAGING PERINATAL MENTAL HEALTH ISSUES

Welcome! In this section we are going to discuss various strategies of managing perinatal
mental health issues.

Before proceeding, acquaint yourself with the objectives of this section.

 3.2 Section Objectives

By the end of this section you should be able to:

1. Outline strategies in managing these issues.

3.3 Management of perinatal health issues

Grief is the subjective experience which follows the death of a loved one mourning after a
significant loss normally continues for at least a year.

Horowitz divides normal grief into four stages:

1. Outcry

2. Denial Phase

3. Intrusion Phase

4. Working Through

Pathological Grief

Uncomplicated Bereavement (Normal Grief) Horowitz gives the following examples of

pathological grief.

The OUTCRY may be intensified into a panic state where behavior is erratic, and self-
coherence is lost in a flood of uncontrolled fear and grief, dissociative state or even a reactive
psychotic state.

DENIAL PHASE may occur and complicate with "overuse of alcohol or drugs to anesthetize
the person from pain.

Depression

a. Safety and physical well-being

b. Anti-depressants
c. Allowing guilt, sorrow, anger and self-hate thus enabling working through
d. Acknowledging fantasies about her dead child.
e. Prayers and/or a memorial service for her baby

3.4 Section Summary

In this section we have Defined and described perinatal mental health, described the various
mental health issues associated with the perinatal period and outlined strategies in managing
these issues.
\

UNIT 6: DEATH AND DYING

Welcome to Unit 6 of Death and Dying. The goal of this unit is to provide an understanding of
the spiritual, psychological, social, and physical aspects of the dying experience.

This unit is divided into 5 sections as follows:

Section 1: The nature of care and the needs of the dying

Section 2: Needs of caregivers and the needs of individuals at the end of life

Section 3: Supportive aspects of care for the dying

Start the unit by looking at the unit objectives:

Unit Objectives

By the end of this unit you should be able to:

1. Describe the nature of care and the needs of the dying

2. Explain the needs of caregivers and the needs of individuals at the end of life
3. Outline the supportive aspects of care for the dying

You will now proceed to discuss the first section of this unit in detail.

SECTIONS 1: THE NATURE OF CARE AND THE NEEDS OF THE DYING

“Do individuals become more religious as they die? This question has often been debated
among academics who study death. Such debate avoids the central issue that the dying process
raises profound spiritual concerns of meaning and connection for individuals. Whether those
who are dying reconnect, review, or renew prior religious beliefs (or are even open to new
religious experiences) they are likely to engage in some form of spiritual searching” (Doka,
2013).

Each dying person and each of his or her family members may cope with the dying process in
a different way. Past losses, educational level, spiritual beliefs, and the individual’s philosophy
may all affect how he or she reacts to the dying process. To die peacefully and to die knowing
that life has had meaning are important to the dying person. The goal at the end of life is a
healthy death, which is defined as a death that has positive benefits for the dying person and
for his or her family, caregivers, and friends (Dossey & Keegan, 2013).
Health care professionals can assist individuals at the end of life and their families by providing
compassionate care that incorporates the physiological, psychosocial, and spiritual
considerations that are most relevant to the dying person and his or her family.

Loss, and the grief that often accompanies that loss, is a normal part of the human experience.
A healthy response to loss is the goal. That healthy response, and the healing process, is only
achieved when individuals give attention to, and achieve a balance between their physical,
psychological, emotional, and spiritual needs.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the nature of dying

2. Outline the spiritual aspects in dying

3. State the psychological aspects associated with dying

4. State the physical aspects associated with dying

1.3 The Nature of Dying

Dying individuals are usually the best qualified to help others understand what is best for them
in this process. It is important for dying individuals to communicate their needs related to the
place of their death, pain management concerns, the specific roles of health care providers
during the dying process, the type and level of involvement of family members throughout the
process, specific funeral arrangements required, and important rituals requested during the
process. None of these is as important, however, as the care, trust, compassion, acceptance,
and love that are provided and shared in the dying process (Dossey & Keegan, 2013). It is
important to listen to the dying person's needs and not impose one's own fears, beliefs, or biases
on that person (Doka, 2013).

The nature of dying and the dying process include spiritual, psychological, social, and physical
aspects common to both dying individuals and their families. Although these aspects are
discussed individually, each aspect rarely occurs without impacting the others (Kuebler,
Heidrich, & Esper, 2006; Meiner & Lueckenotte, 2006).

1.4 Spiritual Aspects in Dying

Most people have done little to prepare emotionally, psychologically, or spiritually for their
deaths. Some may be afraid of death and the possibility of pain during the dying process. Some
deny their mortality. Others may not have a religious foundation that explains or prepares them
for the hereafter. Still others may not have adequate coping skills to deal with the profound
questions surrounding death and the dying experience.

With the knowledge of impending death, individuals often seek to find or make sense out of
their lives. As they go through this important life transition, their most deeply held beliefs are
challenged and opportunities for growth are experienced. (Meiner & Lueckenotte, 2006).
 Spirituality is an integral part of dying. It is usually a component of religion, but a person need
not be religious to be a spiritual being. Through transitions such as dying and death, an
individual’s most deeply held beliefs are challenged, and opportunities for growth (or
regression and despair) are presented. Dying is a profound process of spiritual transformation.
It is a spiritual event of enormous importance. Often, attention is turned away from the outer
distractions in the world and turned inward, toward a greater peace and comfort in spiritual
fulfillment. Spirituality and religion are deeply personal issues

(National Cancer Institute, 2013).

To support individuals during this time of transition, the health-care provider can help
incorporate spiritual and religious care into the plan of care. For example, if the hospitalized
client is a practicing Buddhist with a fear of dying, providing quiet time and space for
meditation could be a helpful intervention. If the person is a practicing Roman Catholic,
experiencing the Sacraments is essential to maintaining strength in the face of loss. If the person
is a fundamental Christian, prayer and Bible quotations might speak to his or her soul. If the
person is Jewish, providing foods that are appropriate to his or her traditions could perhaps
give as much support as a half-hour of counseling (Collins, 2002).

If an individual is nonreligious, agnostic, or even atheist, discovering the central guiding

principle for his or her life can be essential when providing quality care. Health-care and
spiritual care providers can use that knowledge to provide support and guidance.

It is not important to agree with the beliefs or values, but it is important to recognize that a
specific principle, reading, practice, or perspective is important and meaningful to that client.
Since all persons are spiritual beings, it is only a matter of discovering what spirituality, life
perspective, and self-transcendent resources make sense to the person receiving the care, and
creatively and humbly using that perspective to bring healing and hope to the individual.

When family members struggle to assimilate and understand the dying process, they may find
it helpful to seek as much information about the illness or condition of the dying person as
possible. If they see the illness or condition as part of the person’s life, they may find meaning
in the person’s life and in the illness or condition, be successful in maintaining family roles
and relationships, address unfinished business, and advocate for appropriate treatment. The
result of these tasks is a sense of peace and closure for the family (Burkhardt & Nathaniel,
2013).

As part of the holistic process, health-care and spiritual care providers should also come to
terms with death as they assist families and clients in the dying process. The ability to respond
to the many aspects of suffering creates a variety of situations for those providing spiritual care.

For example, a provider’s own experiences of death and dying, questions of meaning, and
feelings of vulnerability may cause suffering as well. To further complicate the situation, the
repeated attachment, detachment, and reattachment to new clients may be very distressing to
caregivers. Closure is a vital component of spiritual care for the provider as well as the client.

The health-care team may help provide for a patient’s spiritual needs by the following (National
Cancer Institute, 2013).

 Suggest goals and options for care that honor the patient’s spiritual and/or religious views.
 Encourage the patient to speak with a religious or spiritual leader.

 Provide information regarding other adjunct therapies that have been shown to increase
spiritual well-being, such as mindfulness meditation, art and music therapy, and journaling.

 Research addressing spiritual dimensions of individuals offers an opportunity to expand the

horizons of contemporary palliative care, thereby decreasing suffering and enhancing the
quality of time remaining to those who are nearing death (Chochinov & Cann, 2005).

Spirituality has been defined as (Reddeer Hospice, 2013)

 Pertaining to one’s inner resources, especially one’s ultimate concern;

 The basic value around which all other values are focused;

 The central philosophy of life—religious, non-religious or antireligious—

 That guides conduct; and

 The supernatural and nonmaterial dimensions of human nature.

Religion is usually recognized as the practical expression of spirituality: the organization,

rituals, and practice of one’s beliefs. Religion is a personal way of expressing spirituality
through affiliations, rites, and rituals based upon creeds and communal practices (Burkhardt &
Nathaniel, 2013). While religion includes specific beliefs and practices, spirituality is much
broader. Spirituality is about existence, about the individual’s relationship with him- or herself,
with others, and with the universe. Spirituality extends beyond the physical, material, and self
to a state called transcendence (Eliopoulos, 2013).

Both spiritual and religious beliefs give meaning and purpose to life, and they play an important
part in an individual’s ability to make sense of his or her existence.

1.5 Psychological Aspects Associated with Dying

At the end of life, people may experience a variety of psychological symptoms such as sadness,
depression, and anxiety.

Feelings of sadness are usually the result of the many losses experienced by the dying person—
loss of energy to work, loss of hobbies or interests, loss of the ability to participate in future
events, among many other losses.

Depression is often under diagnosed and undertreated due to a lack of knowledge regarding
depression, a low priority given to psychological symptoms, time constraints, and concern
about adverse reactions to medications used to treat depression. Normal criteria for diagnosing
depression may not be useful for the dying person. In the terminally ill, feelings of helplessness,
 hopelessness, worthlessness, guilt, and suicidal ideation are better indicators of depression than
the typical diagnostic criteria.

Anxiety, another symptom experienced by individuals at the end of life, is often affiliated with
feelings of fear, worry, uneasiness, and apprehension. Anxiety may also be associated with
concerns about being a burden to others, worries about being separated from loved ones, and
fears about a painful death.

Age, sociocultural factors, religious background, physical status, social isolation, loneliness,
and the meaningfulness of everyday life are other important factors in determining an
individual’s attitude and approach to impending death (Kuebler, Heidrich, & Esper, 2006;
Meiner & Lueckenotte, 2006).

1.6 Social Aspects

Social aspects at the end of life involve both the patient and the family. Once the term dying is
applied to an individual, role changes often occur.

 Changes in all of life’s activities can be affected.

 The individual may no longer be able to work, may not be able to drive, may be unable to
engage in hobbies, may lose financial resources, and may experience a change in personal roles
and relationships.

 Social isolation frequently results as friends and sometimes even family members seemingly
abandon the dying person.

The individual’s role within the family may also change as the family attempts to take on new
roles once assumed by the dying person. This can lead to feelings of distress, loss, frustration,
and depression. If an individual is elderly and family members have the attitude that the person
is “ready to die” and therefore has less of a need to interact with others, this, too, can foster
feelings of social isolation, fear, and anxiety (Kuebler, Heidrich, & Esper, 2006; Meiner &
Lueckenotte, 2006).

1.7 Physical Aspects Associated with Dying

Alleviating physical symptoms has been the main focus in end-of-life care. The multiple
physical symptoms of pain, dyspnea, gastrointestinal disturbances, delirium, agitation, fatigue,
and anorexia require care that aims to control or relieve these symptoms to provide the patient
with as much function as possible (Ferrell& Coyle, 2002; Kellehear, 2000; Meiner &
Lueckenotte, 2006). Palliative care providers provide both the patient and the family with help
in dealing with side effects of therapies.

One of the most confusing questions for people working with the dying is when to consider a
person to be dying. Does the person need to be diagnosed with a terminal illness before this
occurs? Must certain physical signs be present?

Usually, the length of time before death occurs or the certainty of a fatal illness determines
whether one is defined as dying. However, there is no clear definition of the stage of dying for
people who are not diagnosed with a terminal illness.
Further discussion of the physical aspects of dying is covered in the section on imminent death
(Meiner & Lueckenotte, 2006; Eliopoulos, 2013).

1.8 Section Summary

In this section we have explained the spiritual, psychological, social, and physical aspects of
the process of dying.

SECTION 2: NEEDS OF CAREGIVERS AND THE NEEDS OF INDIVIDUALS AT THE

END OF LIFE

In caring for the dying, caregivers and health professionals must face their own issues of loss
and bereavement. Not only do patients and their families suffer distress, so too do the people
who care for them. To function effectively in a healing role with others, health care providers
and caregivers must nurture themselves as well as their clients (Dossey & Keegan, 2013). The
caregiver needs to be able to recognize symptoms of unhealthy stress in themselves.

Integrating good nutrition, exercise and meditation into daily life helps control symptoms of
stress. Establishing a spiritual belief system and allowing oneself time to grieve losses both
personally and as a member of the care team is crucial as well (Palmer, 2008).

1.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the needs of caregivers at the end of life

2. State the needs of individuals at the end of life

2.3 The Caregiver’s Needs

Taking care of their spirit is not only a benefit to health care providers, it is their
responsibility in providing ethical, competent, compassionate health care (Dossey & Keegan,
2013). By attending to their own spiritual needs, health care providers and caregivers can live
in a healing way, a key ingredient in integrating spirituality into health care practices for
patients at the end of their lives.

The growing public demand for more holistic, spiritual approaches to health care, along with
an increasing interest in this kind of care on the part of health care professionals themselves,
has led to an increase in the provision of spiritual care.

To determine how they can best meet their patients’ needs, health care providers now assess
their patients’ spiritual needs as well as their medical needs, refer them to clergy or other
spiritual care providers as needed, and pray with them.

2.4 The Dying Individual’s Needs

Dying is a profound process of spiritual transformation, a spiritual event of enormous
importance. Often, attention is turned away from the outer distractions in the world and turned
inward toward a greater peace and comfort in spiritual fulfilment.

There are three distinct spiritual needs that arise as individuals become aware of their finitude,
or the sense that their life is now severely limited. Doka (2013) identified these three spiritual
needs of the dying:

1. The need to search for the meaning of life

2. The need to die appropriately

3. The need to find hope that extends beyond the grave

Spiritual or religious beliefs can be crucial in helping individuals meet these needs. As
individuals search for meaning in their own death or in the death of a loved one, spiritual issues
may surface. During this experience, bereaved people may ponder the existential issues of life,
not only with regard to the loss of a loved one, but for themselves as well.

Sometimes the dying person, as well as his or her family, will be angry with God and may
experience a crisis of faith and meaning. Finding meaning is individual and personal and has
relevance to the person’s experiences, events, expectations, belief systems, and core values
(Dossey & Keegan, 2013).

Finding meaning in life is especially difficult during the dying process. What each individual
finds meaningful is not as important as the ability to look back on life, see what has been
meaningful, and realize that life can continue to be meaningful even in the last stages.

At least five elements of spiritual care can be helpful to the dying person (Olson,

2001):

1. Engaging in prayer or meditation with or for the dying person

2. Including the presence of loved ones in the provision of spiritual care and rituals

3. Providing a time to share feelings and thoughts

4. Assisting the person to complete any unfinished business

5. Giving the person permission to die

Health care providers or caregivers who share these experiences with a dying individual share
in his or her spirituality and the healing comfort of the special relationship they have established
with that individual.

You will now proceed to section three which will take you through the supportive aspects of
care
2.5 Section Summary

In this section we have explained the spiritual, psychological, social, and physical aspects of
the process of dying.

SECTION 3: SUPPORTIVE ASPECTS OF CARE

Ultimately, all individuals must ask themselves what role spirituality plays in their perception
of the dying experience (Moyers, 2013). Dying is one of the great mysteries of life. However,
most health care professionals tend to regard dying as a failure, and they use phrases like
“fighting the battle,” or “lost the battle” (Kessler, 2001).

Few health care professionals are comfortable with the subject of death or the dying process.
Fewer still have received any training on the subject or on how to assist dying patients and their
families.

Dying is so much more than just a medical event; it is a life event that everyone will experience
at some time or another. Each person’s death is as unique as his or her birth. For all involved,
it is a time for exchanging love, for reconciliation, and for transformation. The dying person’s
loved ones can become compassionate companions during the experience and can help the
dying person through this journey.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Outline the interactions with the dying person

2. Describe the healing strategies

3. Outline the concept of imminent death

4. State nutrition and hydration as supportive care in dying

5. Explain healing from loss and grief

3.3 Interactions with the Dying Person

No one guide fits every situation, but the following suggestions are intended to provide health
care professionals with ways to help family members and the dying person achieve a sense of
peace during the final days of life (Kessler, 2001; Meiner & Lueckenotte, 2006; Mayo Clinic,
2011).

Relate to the Person: Health care providers must relate to the person, not the illness. In the
process, they serve as a role model for both the individual and the family members to do the
same. People who are dying need intimate, natural, and honest relationships. It is important to
see all people as the unique individuals they are, right up to the moment of death.
Be Attentive: Undivided attention is the greatest gift a health care provider can offer to the
dying person. Family members and health care providers must listen without judgment, pay
attention to nonverbal cues, and respect the personal truths the dying person may be
discovering. Allowing individuals to express their thoughts about dying can make the last
chapter of their lives profoundly meaningful.

Demonstrate Compassion: Individuals want and deserve to be cared for by compassionate,

sensitive, knowledgeable people who will attempt to understand their needs. Placing a cool
cloth on a perspiring brow, holding the hand of a frightened, dying person, and listening to a
lifetime of stories conveys caring and acceptance of that individual.

Create a Calm Environment: The human presence can be very healing, particularly in the
final days of a dying person’s life. Leaving room to allow silence and reducing distractions
creates a calm and receptive environment that may be important to the dying person and his or
her family.

Attend to Spiritual Needs: As people approach death, their quest for spirituality may involve
a search for peace and safety. Some individuals practice a religion while others do not practice
religion but do consider themselves spiritual. No matter the path, individuals should be allowed
to seek their answers in their own way.

3.4 Healing Strategies

It is important for dying individuals to spend their final months, weeks, or days in a way that
best suits them and their family and friends. Some people may want to spend time talking or
simply being together with those who mean the most to them. Others might find it helpful and
rewarding to work on some of the following activities.

Some people may just need time alone and to be by themselves. Some family members and
friends may feel driven to fill the dying person’s every waking moment with activities; perhaps
they are trying to take the person’s mind off their impending death, but they may also be doing
the same thing for themselves. The needs of the dying person are the priority (Bone, 2013).

The role of the health care professional is to assist dying patients and their families in
participating in these healing strategies so that a healthy death can be achieved (Dossey &
Keegan, 2013; Seaward, 2012).

Journal Writing: Journal writing can be an extremely effective healing technique to use
during the grieving process. It can be done as a family or individually. For families,
recollections, family stories, and thoughts about time spent together can be written down.
Adding pressed flowers, photos, small mementos, and other items to a special book will help
memorialize the life that is passing. For dying individuals, the healing effect may come from
the process of writing their innermost thoughts and feelings.

Family Photos: Family members can select photos to put in a special album and write captions
next to each photo. Younger family members may enjoy recapturing memories and appreciate
learning about their family’s history.
A Collection of Favorite Things: Encourage the family to organize a collection of the dying
person’s special recipes, books, or other collectibles. They can add personal notes to any books
or recipes to keep a record of memories about the collection.

A Memory Garden: Planting a tree or memory garden is a special way to make a living
memorial. As the plants grow, family and friends will be reminded of the loved one.

Pets: Depending on individual preference and specific life situations, animals may provide
comfort to the dying person. This decision must be considered carefully, however, since the
needs of the pet and the care of the pet after the individual’s death must also be well thought
out.

Short Trips: If the person has the strength, going to a favorite place or a special restaurant
may be therapeutic and can take the focus off the illness.

Music Therapy: Music therapy helps promote a patient’s physical, mental, and spiritual well-
being. Music therapy is especially useful at the end of life when communications often break
down and a sense of isolation sets in. Gentle environmental sounds like ocean waves, wind,
rain, birds, and music from harps, flutes, or stringed instruments may provide a sense of peace.
Not everyone likes music, so it is important to pay attention to the dying person’s likes and
dislikes and provide music that will help the dying person feel a sense of relaxation and a sense
of peace.

Art Therapy: Art therapy is based on the principle that individuals project their internal world
into visual forms. Drawing, painting, or making a collage can be a way for the dying person to
express his or her feelings about the end of life.

A Spiritual Assessment: Many terminally ill people find it helpful to take a spiritual
assessment of their life as they move closer to dying. A spiritual assessment involves asking
some of the following questions:

What do I need to do, or let go of, in order to be more peaceful? What am I grateful for? What
have I learned about courage, strength, power, and faith? How am I handling my suffering?
What will give me strength as I die?

3.4.1 Involving the Senses in Rituals for the Dying

Every culture since the beginning of time has used rituals and ceremonies.

Music, art, reading, praying, and meditating may help dying individuals become more in touch
with their spiritual aspects. When creating rituals and ceremonial acts for the dying,
incorporating the senses of touch, smell, taste, sight, and hearing is important (Dossey, &
Keegan, 2013). Rituals may help to promote a sense of peace and comfort for the dying person.

Touch: Touching is a powerful way to break the isolation, loneliness, and fear of dying. The
health care professional should first assess the situation, then guide family members in the use
of appropriate touch (e.g. the patient may be in great physical pain and touch may be
unwelcome). In most cases, touching can bring a sense of peacefulness.
Smell: The sense of smell can elicit powerful emotions. Illness will probably change the types
of fragrances that can be tolerated, but the dying person may be able to tolerate mild-smelling
lotions and colognes. Natural scents like rosemary or vanilla, a fragrant plant, or a mildly
scented candle are usually tolerated the best. Use caution when incorporating fragrances into
end-of-life care, since some odors may cause nausea or unpleasant feelings in the dying person.

Taste: The sense of taste varies for each individual and usually remains until the end of life.
When creating rituals for the dying person, provide foods that he or she desires. Tasting and
eating have symbolic meanings for the patient and the family. If the dying person no longer
wishes to eat, this can be normal and can be supported since it probably will not cause undue
suffering.

Sight: Arrange objects that have meaning to the dying person within easy view; these objects
should symbolize positive people, places, and events in the patient’s life. A room lit by soft,
subdued sunlight can provide a sense of serenity to surroundings. Light colors are usually more
soothing to the dying person than bright or dark colors.

Hearing: The sense of hearing is often sharp even to the end of life, so special words at death
can be heard. It can also be comforting to simply sit in silence and hold the hand of the dying
person.

3.4.2 The Choice to Die at Home

Home deaths do not occur as often as possible because of the lack of awareness of hospice
programs by both patients and health care professionals, psychosocial issues, economic factors,
and the continued use of high-technology interventions in patients with incurable illnesses.

However, many dying individuals choose to spend their remaining days at home for a variety
of reasons (Caregiving Resource Center, 2002):

The home setting may offer a better environment for maximizing the life that remains and for
achieving personal closure.

Individuals and their families are free to do what they wish because their routines and schedules
can be altered as needed.

Dying persons often are psychologically more comfortable in a familiar environment with
continuous support of family, friends, and pets.

1. The ability to prepare meals makes it easier to offer what the individual likes.
2. The stress of traveling to and from the hospital or hospice facility is eliminated.
3. The unique beauty of familiar surroundings provides comfort to the dying person.
4. The individual and the family experience feelings and emotions in a different way
because of fewer interruptions.
5. The dying person and the family can make the most of decisions regarding care,
medication, and treatments.

The choice to die at home may, however, present specific disadvantages (Caregiving Resource
Center, 2002):
 1. There may be inadequate support for, or difficulty in coping with, care needs.
2. There may be competing needs for care by small children, older adults, or other sick
or disabled family members.
3. The stress of caring for a dying person might be overwhelming.

The choice to die at home is a deeply personal one that only dying individuals and their families
can make. Individuals may refuse any type of medical care, including hospitalization, even if
that decision results in physical harm or death.

Individuals can refuse to stay in hospitals and choose to return home even against medical
advice. The health care provider should furnish patients and their families with information
about the possible consequences of each decision and then support that decision in the best way
possible.

3.5 Imminent Death

With a few exceptions, there are predictable signs and symptoms that death is near. Although
distressing to family members, normal changes, in addition to the death rattle, occur as death
is imminent (expected to occur within 24 to 48 hours). These signs and symptoms include
profound weakness, gradual hypoxia, irregular breathing, drowsiness, difficulty concentrating,
slow and gasping respiration, respiratory acidosis, difficulty swallowing, and renal failure. In
addition, the extremities usually become cold, mottled, blue, and swollen.

©Mike Koopsen. Used with Permission.

Often, patients become less responsive and many become completely unresponsive. They are
often bedbound, require assistance with all or most of their care, and have difficulty
cooperating with caregivers. This is a time when family members must decide if they will be
present, say everything they wish to say to the dying person, and say a final good-bye. It is
important to remember that individuals die in their own way and sometimes at the time of their
choosing (such as when a family member is present or absent) (Kuebler, Heidrich, & Esper,
2006; Pantilat, 2002).

3.6 Nutrition and Hydration

For patients who are imminently dying, ceasing to eat and drink is a normal part of the process.
The family is the most often disturbed when the patient stops eating and drinking. They often
want artificial nutrition and hydration provided in the hopes of prolonging life and promoting
comfort. However, in some cases this may cause other problems and make the dying person
more uncomfortable.

Moistening the patient’s mouth with a swab or rubbing petroleum jelly on dry lips may be
comforting to the patients as they take in less fluids and become more dehydrated. Fluids
should not be routinely administered to dying patients nor should they automatically be
withheld from them. Decisions about whether or not to provide fluids and nutrition should be
based on a careful assessment of the person’s comfort, overall condition, and underlying
disease processes, and a discussion of the risks and benefits of artificial hydration (Kuebler,
Heidrich, & Esper, 2006; Pantilat, 2002).
The Death Rattle

A distressing sound to families and loved ones is the “death rattle” in people who are
imminently dying. The sound is made by air passing over the thin layer of saliva and mucus
that forms in the back of the throat when secretions can no longer be cleared by the patient.
Suctioning is not recommended because it can increase discomfort. Sometimes medication
given sublingually or in a patch is used (Pantilat, 2002). However, the process is a normal part
of dying.

The Moment of Death

It is important to prepare rituals for the moment of death. If healing rituals have been performed
prior to death, the dying person usually has a sense of serenity and inner calm (Dossey &
Keegan, 2013).

The caregiver, health care professional, hospice professional, family member, or friend might
notice that before the person’s eyes finally close, tight brow muscles may become relaxed and
a sense of peace may appear on the face. In addition, the caregiver, health care professional,
hospice professional, family member, or friend of the dying person may help the person have
a “peaceful crossing” into death by touching, holding, talking, and being with the dying person
in ways that deepen hope and faith.

The health care provider can continue to communicate with others who are there to support the
dying person, shut the half-closed eyes of the dying person and adjust the head on the pillow
for the last time. Depending on the dying person’s beliefs, it may be helpful to give him or her
permission to leave and to meet others who have died before (Dossey & Keegan, 2013).

At the moment of death, family and friends of the dying person often need time to be alone and
to say good-bye to their beloved spouse, child, friend, or family member. The removal of the
body should not be rushed. The family and friends must be allowed adequate time to express
their grief. The moment of death is a sacred time and should be respected. Cultural or religious
rituals that occur after death (e.g., body preparation) and various types of gatherings (e.g.,
wakes) should be encouraged and supported (Kuebler, Heidrich, & Esper, 2006).

3.7 Healing from Loss and Grief

Healing originates from the Anglo-Saxon word haelan, which means “to become whole.”
Wholeness often incorporates a state of harmony between the mind, body, and spirit. It
involves a state of perfect balance in the structural, physical, emotional, psychological, and
spiritual dimensions of an individual. Healing is a process rather than a static state (Dossey
& Keegan, 2013).
3.7.1 The Healing Process
Healing from a major loss can take from three to five years or more. Difficult, violent, or
unexpected deaths are usually the most difficult types of losses. While the American culture
does not recognize the formal mourning period observed by many more traditional
societies, healing from a loss can be a challenge from which intense personal growth occurs.
When people begin to heal from grief and loss, they will experience the following (Dossey &
Keegan, 2013):
1. The healing of cells and tissues
2. A shift from resentment to forgiveness, a release of old hurts, and new energy for
growth and an expanded consciousness
3. A feeling of being loved unconditionally and for all time so there is no separation
between a feeling of oneness with a higher power and a oneness with all creation
Healing from grief and loss can occur in many ways. Grieving individuals may find the
following helpful:
a. Talking to family and friends
b. Reading poetry or books
c. Listening to music
d. Exercising
e. Seeking spiritual support
f. Joining a support group
g. Being patient with themselves
h. Seeking counseling
i. Participating in social activities
j. Taking a trip
k. Eating healthy, tasty foods
l. Taking time to relax
m. Letting themselves grieve
n. Caring for themselves in their own unique way
This list is by no means conclusive, since each individual grieves in his or her own unique
way and time. It is important to experiment with a variety of ideas to determine what fits
best with an individual lifestyle and personality. Talking to others who have also
experienced loss will provide ways of coping with the emotional and physical pain of loss.
Healing can progress when friends and family support grieving individuals. This can be done
in any of the following ways:
a. Being a good listener
b. Sitting quietly with them
c. Asking about the loss
d. Calling on the telephone
e. Letting them feel sad
f. Asking about their feelings
g. Sharing similar feelings
h. Remembering the loss
i. Acknowledging the pain
j. Being available whenever possible
According to Doka (2002), “When grief is characterized as something people will get over,
that time will heal, the choice of language implies that grief is an illness and with the proper
treatment its consequences can be expunged. This rarely parallels the experience of the
bereaved and they often feel disenfranchised when they cannot find ‘closure’ and ‘get
better’ in a limited period of time” (p. 174).
It would be very simple if grief were an illness and people could simply “get over it.” In
essence, people learn how to deal with the pain and acknowledge the disappointments, the
sad moments in life, and the stressors that cannot be avoided. They learn to move forward
in life with all its challenges, and a new sense of self emerges (Doka, 2002).
The healing process is an intensely personal one. The characteristics of the journey, the
length of time involved, and the outcome are determined by the unique aspects of the loss
and the griever. Attention to the needs of the physical, emotional, psychological, and
spiritual self ensure the best chances for a positive outcome.
3.7.2 Coping Strategies
Coping strategies are important in adapting to grief. Coping with grief is uniquely individual,
with each person finding his or her own sources of comfort through support groups and
activities such as journaling, or through spiritual and religious support. Experiencing grief
can be very stressful, so it is important to encourage the grieving individual to eat well,
sleep well, seek appropriate support, and engage in adequate exercise (Doka, 2013).
Grief is experienced as an individual reaction. However, the first two years after a loss are
the most intense time (Doka, 2013). Low periods tend to be less frequent after two years,
but even then people may still experience a sense of grief when attending special events,
listening to a song, or looking at pictures of the deceased. It can take a long time to recover
from a major loss.
3.7.3 Grief Counselling
A grief counsellor may help individuals understand their reactions to grief. Seeing a
counselor is advised if the expressions of grief are destructive to the self or to others, or in
situations where grief makes it difficult for individuals to care for themselves or others or to
function in normal life roles such as a job. Seeking professional assistance to come to terms
with a loss and work through grief is a sign of strength, not a sign of weakness (Doka, 2013).
3.8 Section Summary

Death, dying, and grief experiences are unique for each individual. As knowledge of the
issues involved in death and dying increases and positive attitudes are promoted, the care and
support for dying individuals will improve.

Knowledgeable, caring health care professionals can help dying individuals find or create
spiritual meaning in the last stage of their lives and help them through the transition that leads
to the ultimate peaceful moment of death.

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Retrieved March 20, 2013 from http://www.mayoclinic.com/health/grief/CA00041

McBride, J. L. (2002). Spiritual component of patients who experience

psychological trauma: Family physician intervention. Journal of the American

Board of Family Practice, 15 (2), 168–169.

HCH100: BEHAVIOURAL SCIENCES - HEALTH PROMOTION

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

UNIVERSITY OF NAIROBI DEPARTMENT OF PSYCHIATRY

In collaboration with

CENTRE FOR OPEN AND DISTANCE LEARNING

HCH 100: BEHAVIOURAL SCIENCES

MODULE 8: HEALTH PROMOTION

vCopy Right Page

Behavioural Sciences Course to Undergraduate Students in the College of Health
Sciences

by Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

© University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced
in any form or by any means without permission in writing from the Publisher.

Writer: Dr. Anne W Mbwayo PhD Clinical Psych

Reviewer:

Chief Editor: Joshua M Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

List of Abbreviations

AIDS Acquired Immunodeficiency Syndrome

HBM Health Belief Model

HIV Human Immunodeficiency Virus

PHC Primary Health Care

WHO World Health Organization

Module Introduction

Welcome to Module 8 on Health Promotion. Health promotion seeks to improve the health of
individuals and communities through education, behavioural change and environmental
improvement. As a doctor to be, it is important that you know how you can empower your
patients to promote their health as this would help them respond quickly to the treatment that
you recommend. This module will take you through some of the ways through which health
promotion is done. We start by defining of health promotion give you an outline to the
principles of health promotion and take you through the various ways involved in health
promotion. This module will comprise of four Units, namely:

UNIT 1: Fundamentals of Health Promotion

UNIT 2: ........................................

Sections 1: Compliance with medical Regimens

Sections 2: Health Beliefs in consultation

UNIT 3: .......................................

Sections 1: Accidents and injury prevention

Sections 2: Crisis and Crisis Intervention

UNIT 4: ..........................................

Sections 1: Mental Health in Primary Health Care

Objectives

By the end of this module you should be able to:

1. Describe Health promotion.

2. Explain the Health Belief Model
3. Explain the Bio-Psychosocial Model in Medicine
4. Demonstrate the importance of compliance with medical Regimens
5. Discuss Crisis and Crisis Intervention
6. Explain the importance Mental Health in Primary Health Care
7. Outline causes and prevention of Accidents and related injury
8. Discuss the role of Health Beliefs in consultation
At the end of each unit, there a multiple choice questions to test your knowledge of the unit. I
hope that you will enjoy the module as you learn ways of health promotion hoping you
become great health promoters. As you go through the module, I wish you good luck and I
hope that you will not only learn but will also enjoy the model.

UNIT 1

Unit Introduction

I would now like to draw your attention to this first unit of this module on health promotion.
In this unit we are going to discuss the overview of health promotion and its fundamental
concepts, followed by the health belief model and finally look at the bio-psychosocial model
in medicine.

This unit is divided into three sections as follows:

Sections 1: Health promotion: An overview

Sections 2: Health Belief Model

Sections 3: Bio-Psychosocial Model in Medicine

Familiarize yourself with the unit objectives before proceeding to the specific sections

Objectives

By the end of this unit you should be able to:

1. Describe Health promotion.

2. Explain the Health Belief Model
3. Explain the Bio-Psychosocial Model in Medicine

Let us now look at the first section.

SECTION 1: HEALTH PROMOTION - AN OVERVIEW

Welcome to Section 1 of Unit 1of Module 8. In this section you will go through the overview
of health promotion. You will then proceed and explain the various concepts of the health
promotion.

Before proceeding, look at the section objectives.

1.2 Objectives

By the end of this section you should be able to:

 1. Explain the overview of health promotion.
2. Discuss the concepts of health promotion.
3. Describe the Ottawa Charter for Health Promotion

1.3 Health Promotion

Health promotion is probably the most ethical, effective, efficient and sustainable approach to
achieving good health. WHO defines health promotion as ‘The process of enabling people to
increase control over the determinants of health and thereby improve their health' (WHO,
1986). This definition is about making a difference to people's health and the conditions that
support their health. It is a way of thinking and doing.

Activity 1.1
In groups of three, list what health means to each one.

Did you come up with definition of WHO meaning of health? Do you wholly agree with it or
does your list have more than the WHO definition? Were there social -cultural influences on
your definitions?

Hope your definition incorporated the following:

"a state of complete physical, mental, and social well-being and not merely the absence of
disease or infirmity." (WHO, 1948

1.3.1 Historical Development of Health Promotion

Health promotion has evolved from health education. Health education in its early days was to
make people aware of the health consequences of their behaviour. It was assumed that people
were “empty vessels” that process information in a logical manner and subsequently act
accordingly. Changes in individual opinion, attitudes and behaviours were seen to be as a result
of information and knowledge, that is, if you provide people with knowledge, they will make
good decisions regarding their health. Later, it was discovered that providing knowledge alone
was not enough and that for people to be able to live a health life, an individual’s motivation,
skills and the influence of the social environment were important determinants as well.
Informing people alone is not enough but they have to be encouraged, educated, trained and
facilitated in order to be able to improve their health and change the environment they live in.

In the next section in our discussion we will go through the concepts of Health Promotion.

1.4 Concepts of Health Promotion

The health promotion principles are based on human rights, seeing people as active
participating subjects - professionals and people are mutually engaged in an empowering
process. The role of the professionals is to support and provide options that enable people to
make their own choices and to make people aware of determinants of health and able to use
them. World Health Organization has come up with the following Principles of Health
Promotion

a. Empowerment - a way of working to enable people to gain greater control over

decisions and actions affecting their health.
b. Participative - where people take an active part in decision making.
c. Holistic - taking account of the separate influences on health and the interaction of
these dimensions. It involves all aspect of the individual that is physical, social,
spiritual and mental health.
d. Equitable - ensuring fairness of outcomes for service users.
e. Intersectoral - working in partnership with other relevant agencies/organisations.
f. Sustainable - ensuring that the outcomes of health promotion activities are
sustainable in the long term.
g. Multi Strategy - working on a number of strategy areas such as programmes, policy.

1.5 The Ottawa Charter for Health Promotion

The first International Conference on Health Promotion was held in Ottawa in November
1986. The Ottawa Charter, has defined health promotion action in many countries since this
time (WHO, 1986b). It presents a CHARTER for action to achieve Health for All by the year
2000 and beyond. The charter views health promotion as implying strengthening people's
health potential and that good health is a means to a productive and enjoyable life. Human
rights are fundamental to health promotion and a concern for equity, empowerment and
engagement. In addition, health promotion is seen as having the following characteristics:

a. It is a process - a means to an end

b. It is enabling - There is need to achieve equity in health, and so health promotion focuses
on achieving this equity. This also means that actions are to be done by, with and for people,
not impose anything upon them

The Ottawa Charter has identified a set of five mechanisms of health promotion:

a. building healthy public policy

b. creating a supportive environment

c. strengthening community action

d. developing personal skills

e. Re-orientating health services.

These were updated in the Jakarta Declaration (WHO, 1997), which focused on creating
partnerships between sectors, including private-public partnerships. The priorities for the
twenty-first century were to:
 a.
a. promote social responsibility for health
b. increase investment in health development
c. consolidate and expand partnerships for health
d. increase community capacity and empower the individual
e. secure an infrastructure for health promotion

More recently WHO, through the Bangkok Charter (2005) has reviewed the strategies for
health promotion in a globalised world as the context for health promotion has changed
markedly since the Ottawa Charter.

1.5 The Ottawa Charter for Health Promotion

In particular, increasing health inequalities, environmental degradation, new patterns of

consumption and communication, and increasing urbanisation. Priorities for health promotion
in the 21st century have been outlined as follows:

1. Promote social responsibility for health

Decision-makers must be firmly committed to social responsibility. Both the public and
private sectors should promote health by pursuing policies and practices that: avoid harming
the health of individuals; protect the environment and ensure sustainable use of resources;
restrict production of and trade in inherently harmful goods and substances such as tobacco
and armaments, as well as discourage unhealthy marketing practices; safeguard both the
citizen in the marketplace and the individual in the workplace; include equity-focused health
impact assessments as an integral part of policy development.

2. Increase investment for health development

In many countries, current investment in health is inadequate and often ineffective.

Increasing investment for health development requires a truly multi-sectoral approach
including, for example, additional resources for education and housing as well as for the
health sector. Greater investment for health and reorientation of existing investments, both
within and among countries, has the potential to achieve significant advances in human
development, health and quality of life. Investments for health should reflect the needs of
particular groups such as women, children, older people, and indigenous, poor and
marginalized populations.

3. Consolidate and expand partnerships for health

Health promotion requires partnerships for health and social development between the
different sectors at all levels of governance and society. Existing partnerships need to be
strengthened and the potential for new partnerships must be explored. Partnerships offer
mutual benefit for health through the sharing of expertise, skills and resources. Each
partnership must be transparent and accountable and be based on agreed ethical principles,
mutual understanding and respect. World Health Ogarnization guidelines should be adhered
to.
4. Increase community capacity and empower the individual

Health promotion is carried out by and with people, not on or to people. It improves both the
ability of individuals to take action, and the capacity of groups, organizations or communities
to influence the determinants of health. Improving the capacity of communities for health
promotion requires practical education, leadership training, and access to resources.
Empowering individuals demands more consistent, reliable access to the decision-making
process and the skills and knowledge essential to effect change. Both traditional
communication and the new information media support this process. Social, cultural and
spiritual resources need to be harnessed in innovative ways.

5. Secure an infrastructure for health promotion

To secure an infrastructure for health promotion, new mechanisms for funding it locally,
nationally and globally must be found. Incentives should be developed to influence the
actions of governments, nongovernmental organizations, educational institutions and the
private sector to make sure that resource mobilization for health promotion is maximized.
‘Settings for health' represent the organizational base of the infrastructure required for health
promotion. New health challenges mean that new and diverse networks need to be created to
achieve inter-sectoral collaboration. Such networks should provide mutual assistance within
and among countries and facilitate exchange of information on which strategies have proved
effective and in which settings.

Training in and practice of local leadership skills should be encouraged in order to support
health promotion activities. Documentation of experiences in health promotion through
research and project reporting should be enhanced to improve planning, implementation and
evaluation. All countries should develop the appropriate political, legal, educational, social
and economic environments required to support health promotion.

1.6 Section Summary

Summary
You have seen how the World Health Organization has developed the concept of health
promotion since the 1970s through a series of international meetings and declarations. These
have helped provide support to individuals and organizations in nation-states to develop
health promotion.

You will now proceed to section two which will take you through the Health Belief Model.

SECTION TWO: HEALTH BELIEF MODEL (HBM)

Welcome to Section 2 of module 8. In this section we will go through the Health Belief
Model. We will look at its history and its concepts. This model will help understand why
patients behave in certain ways regarding their illness, for example coming early or late for
treatment.
Before proceeding, look at the section objectives.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the historical background of HBM.

2. Explain the HBM concepts.

We shall now go ahead and discuss this section in detail.

2.3 History and Orientation of HBM

The health belief model (HBM) is a psychological model that explains and predicts health
behaviours. It focuses on the attitudes and beliefs of individuals towards health. The HBM
was originally developed in the 1950s by social psychologists Hochbaum, Rosenstock and
Kegels working at the U.S. Public Health Service to explain why many people did not
participate in public health programs such as TB or cervical cancer screening. Subsequently,
it was extended by Leventhal, Rosenstock, Becker and others to explain differing reactions to
symptoms and to explain variations in adherence to treatment. It has been adapted to explore
a variety of long- and short-term health behaviours, including sexual risk behaviours and the
transmission of HIV/AIDS. It has subsequently been used to guide the design of interventions
to enhance compliance with preventive procedures.

2.4 HBM concepts

The HBM breaks down health decisions into a series of stages and offers a list of variables
that influence health action. In the HBM, the likelihood that a person will follow a preventive
behaviour is influenced by their subjective weighing of the costs and benefits of the action;
the perception involves the following elements:

2.4.1 Perceived susceptibility

This is the person's judgment of his or her risk of contracting the condition. This might be
measured by questions such as "Taking all factors into account, what do you think are your
chances of getting the disease?"

2.4.2 Perceived seriousness of the condition

The severity of the condition (its clinical consequences, disability, pain or death) and its
impact on life style (working ability, social relationships, etc.). Questions might include "If
you got [the disease], how serious would that be?" Or, more objective indicators might be
used, such as the number of days off work or in bed.
The combination of perceived susceptibility and seriousness is termed perceived threat (see
Figure 1 below). The perceived threat has a cognitive component and is influenced by
information. It creates a pressure to act, but does not determine how the person will act. How
the person will act is influenced by the balance between the perceived efficacy and cost of
alternative courses of action:

2.4.3 Perceived benefits of an action

Will the proposed action be effective in reducing the health risk? Does this course of action
have other benefits? Again, it is the person's beliefs, rather than factual evidence, that is
influential. The beliefs will reflect social and cultural influences. Assessments might include
"Do you think there is anything that could be done to prevent this condition? How effective
would that be?"

2.4.4 Perceived barriers to action

How do these benefits compare to the perceived costs of action? Are there barriers to action?
Will it involve expense, pain, or embarrassment? This can be assessed via questions such as
"What difficulties do you see in undertaking this action?"

The balance between benefits and costs may suggest the person's likelihood of acting and
their preferred course of action, but do not necessarily determine that they will act. Indeed, if
benefits are closely balanced against costs the person may vacillate, perhaps experiencing
anxiety.

2.4.5 A stimulus or cue to action

When a person is motivated and can perceive a beneficial action to take, actual change often
occurs when some external or internal cue (e.g., a change in health, the physician's advice, or
a friend's death) triggers action. As cues may be fleeting events they are elusive to record.
The magnitude of the cue required to trigger action would depend on the motivation to
change and the perceived benefit to cost ratio for the action.

2.4 HBM concepts

Activity
Do you agree with the HBM?
Figure 1: Health Belief Model

Activity 2.1
In groups of 2, each role play being a patient and the other a doctor and you present a case
scenario of a particular illness and use the HBM to see how you will seek help from a health
provider.

2.5 Section summary

2.5 Section Summary

In this section, we have looked at HBM and how it influences health seeking behaviour and
the application of the model.

Next, we are going to discuss the Bio-Psychosocial, Spiritual Model in Medicine in section 3
SECTION THREE: BIO-PSYCHOSOCIAL, SPIRITUAL MODEL IN MEDICINE

Welcome to Section 3 of Unit 1. In this section we will go through the definition of bio-
psychosocial, spiritual model in medicine and then look at the role of bio-psychosocial,
spiritual model in medicine.

Before proceeding, look at the section objectives.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Explain the development of bio-psycho-social-spiritual model in medicine.

2. Describe the importance of bio-psycho-social-spiritual model in medicine.

Let us now look at the first subsection in detail.

SECTION THREE: BIO-PSYCHOSOCIAL, SPIRITUAL MODEL IN MEDICINE

Welcome to Section 3 of Unit 1. In this section we will go through the definition of bio-
psychosocial, spiritual model in medicine and then look at the role of bio-psychosocial,
spiritual model in medicine.

Before proceeding, look at the section objectives.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Explain the development of bio-psycho-social-spiritual model in medicine.

2. Describe the importance of bio-psycho-social-spiritual model in medicine.

Let us now look at the first subsection in detail.

3.3.2. Background

The bio psychosocial-Spiritual approach started as the bio psychosocial model which was
developed at Rochester by Drs. George Engel and John Romano. The late George Engel
believed that to understand and respond adequately to patients' suffering-and to give them a
sense of being understood-clinicians must attend simultaneously to the biological,
psychological and social dimensions of illness. He offered a holistic alternative to the
prevailing biomedical model that had dominated industrialized societies since the mid-20th
century. His new model came to be known as the bio psychosocial model.

He formulated his model at a time when science itself was evolving from an exclusively
analytic, reductionistic, and specialized endeavor to become more contextual and cross-
disciplinary. Engel did not deny that the mainstream biomedical research had fostered
important advances in medicine. However, he criticized its excessively narrow (biomedical)
focus which lead clinicians to regard patients as objects and for ignoring the possibility that
the subjective experience of the patient was open to scientific study. Engel championed his
ideas not only as a scientific proposal, but also as a fundamental ideology that tried to reverse
the dehumanization of medicine and disempowerment of patients. His model struck a
resounding harmony with those sectors of the medical profession that wished to bring more
empathy and compassion into medical practice. However, the Engel Biomedicine model has
been criticized as follows:

1. A biochemical alteration does not translate directly into an illness.

 The appearance of illness results from the interaction of diverse causal factors,
including those at the molecular, individual and social levels.
 On the other hand, psychological changes may, under certain circumstances, manifest
as illnesses or forms of suffering that constitute health problems, including, at times,
biochemical link.

2. The presence of a biological disturbance does not shed light on the meaning of the
symptoms to the patient, nor does it necessarily assume the attitudes and skills that the
clinician must have to gather information and process it well.

3. Psychosocial variables are more important determinants of susceptibility, severity and

course of illness than had been previously appreciated by those who maintain a biomedical
view of illness.

4. Adopting a sick role is not necessarily associated with the presence of a biological
problem.

5. The success of most biological treatments is influenced by psychosocial factors, for

example, the so-called placebo effect

6. The patient-clinician relationship influences medical outcomes, even if only because of its
influence on adherence to a chosen treatment

7. Unlike inanimate subjects of scientific scrutiny, patients are profoundly influenced by the
way in which they are studied and the scientists engaged in the study are influenced by their
subjects.

The model implies that treatment of disease processes, for example type two diabetes and
cancer, requires that the health care team address biological, psychological and social
influences upon a patient's functioning. The bio psychosocial model therefore states that the
workings of the body can affect the mind, and the workings of the mind can affect the body.
This means both a direct interaction between mind and body as well as indirect effects
through intermediate factors.

Activity 2.1
In groups of 3, come up with ideas of how you think you can apply the model in your clinical
practice.

Did you come up with some of the points listed below?

3.3.3 The Bio-psycho-social- spiritual model

George Engel model was criticized for failing to take into account the patient's spirituality.
Spirituality has to do with an individual's or a group's relationship with the transcendent,
however that may be construed. Spirituality was added to biopsychoscial model. Illness
disturbs relationships not just in the body- whose homeostasis is disturbed, but relationship
with others- It disrupts families and workplaces. It shatters preexisting patterns of coping. It
raises questions about one's relationship with the transcendent. Thus illness disturbs
relationships both inside and outside the body of the human person. Healing therefore means
the restoration of right relationships. What genuinely holistic health care means then is a
system of health care that attends to all of the disturbed relationships of the ill person as a
whole, restoring those that can be restored, even if the person is not thereby completely
restored to perfect wholeness.

3.4 Importance of Bio-Psychosocial, Spiritual Model in Medicine

Holistic healing requires attention to the biological, psychological, social and spiritual
disturbances as well. To apply the bio psychosocial-spiritual approach to clinical practice, the
clinician should:

a. Recognize that relationships are central to providing health care

b. Use self-awareness as a diagnostic and therapeutic tool

c. Elicit the patient's history in the context of life circumstances

d. Decide which aspects of biological, psychological, and social domains are most
important to understanding and promoting the patient's health

e. Provide multidimensional treatment. The model therefore suggest the integration of

professional services through integrated disciplinary teams, to provide better care and address
the patient's needs at all three levels. The integrated teams may comprise physicians, nurses,
health psychologists, social workers and other specialties eg a chaplain to address all the
aspects of the above framework.
In terms of disease predisposition, psychosocial spiritual factors can cause a biological effect
by predisposing the patient to risk factors. For example, depression by itself may not cause
liver problems, but a depressed person may be more likely to have alcohol problems and
therefore liver damage. Thus, this increased risk-taking leads to an increased likelihood of the
disease.

To remember that in the model, the biological, the psychological, the social and the spiritual
are only distinct dimensions of the person and no one aspect can be disaggregated from the
whole Therefore as a doctor, you must always respect the patients spiritual needs and if you
can accelerate the help the better, letting the spiritual matters be addressed. You won't belief
in them but respect them. Nonetheless, if patients do not have spiritual or religious concerns
or do not wish them to be addressed in the context of the clinical relationship, the clinician
must always respect the patient's refusal.

Finally it is important to note that the biopsychosocial spiritual model does not provide a
straightforward, testable model to explain the interactions or causal influences. Rather, the
model has been a general framework to guide theoretical and empirical exploration.

3.5 Section Summary

3.5 Section Summary

In this section, we have looked at Bio psycho social spiritual model and how it influences
treatment of various diseases, and what you as a doctor needs to remember as you treat
your patients.

We shall now move to unit 2 but before that, attempt the following review questions.

UNIT 2

Welcome to Section 1 of Unit 2. In this section, we shall look at the beliefs that individuals
have as they consult a doctor and also those beliefs that the doctor has. For the patient, the
beliefs could be about the illness and doctor, while the doctor has beliefs about his/her
expectations on the patients and the treatment expectations. These beliefs could hinder or
promote treatment.

Before proceeding, look at the section objectives.

1.2 Section Objectives

By the end of the section you will be able to:

 1. the beliefs in consultation.
2. Outline the barriers to effective consultation.
3. Outline how doctors can do to address the patient's negative health beliefs.
4. Outline how to improve consultation.

Well then with the objectives stated; let us now proceed to discuss this section in details.

SECTION 1: HEALTH BELIEFS IN CONSULTATION

1.3 Health beliefs in consultation

I am sure that at one time you had consulted a doctor. I am sure you had certain beliefs that
you had with you. You are training to be a doctor. Let us explore whether the beliefs you had
as a patient and those of a doctor for the patient will fit in your previous beliefs.

1.3.1 What is consultation?

Medical consultation is a two-way encounter between a doctor or a practitioner and a

patient. This may be initiated by a patient when they are ill or by a doctor when instituting
preventive medicine or screening.

The consultation is the central act of medicine. As the “central act of medicine”, the
consultation is the place where patients and healthcare professionals interface. It is where
therapeutic relationships are formed and when conducted well, where information is
exchanged and patients' needs and concerns are recognised and addressed. Consultations
are part of the “cycle of care” where patients learn about their disease, come to terms with
their condition and are given the ability to share in its management.

1.3.2 Beliefs in Consultation

Patient beliefs and expectations are at the heart of the consultation process, providing an
insight into physician and patient interactions. The consultation process is influenced by the
patient’s beliefs and expectations, which in turn influences adherence, behaviour change and
mediates the outcome. Their identification and management can be understood and
addressed only within the overall context of the consultation itself.
1.3.3 What are Health Beliefs?

They refer to beliefs held by individuals about health, illness and diseases. They are shaped
by people’s wider setting such as their structural location, cultural context, personal
experiences and social identity. These beliefs are brought to the consultation room.

1.3.4 Importance of Knowing the Patients Health Beliefs

It is important because:

1. A patient’s beliefs about health (e.g. cause of disease, controllability of a condition, value
of different remedies) predict health behaviours such as medication adherence, utilization of
health care services and lifestyle decisions. For example:

a. The patient might belief that he/she is the one to blame for their disease
b. The Patients’ health beliefs may play a big role in deciding whether to start a new
medication or undergo an invasive test or procedure.
c. Some patients are more willing to endure potentially risky procedures in order to learn
their diagnosis quicker, while others prefer "watchful waiting,” or monitoring
symptoms that are unlikely to be a sign of anything serious.

2. A better awareness of a patient’s health beliefs could help physicians identify gaps between
their own and the patient’s understanding of his or her health situation and lead to treatment
decisions better suited to the patient’s expectations and needs.

3. The physicians’ skill at hearing and understanding patients’ perspectives is also a key
component of empathy.

4. Research has also shown that patient satisfaction, commitment to treatment, and
perceived outcomes of care are higher when physician and patient achieve a shared
understanding on issues such as the patient’s role in decision-making, the meaning of
diagnostic information and the treatment plan.
1.4 Barriers to Effective Consultation

It is important for the doctor to understand some of the reasons why the patients might not
open up to them. Key among them is your attitude. What is your attitude towards the patient?
Are the doctor know it all, the one who lords over every person? Are your health beliefs such
that your word is final? Trust. Does the patient trust you? Can they confide in you? What can
you do to win their trust? Another reason is communication? How do you communicate to
the patient? Effective communication between doctor and patient leads to improved
outcome for many common diseases.

1.4 Barriers to effective consultation

These are some of the ways. Let us discuss them and add others.

Let us now see what you can do.

Encourage the patients to:

a. Ask questions,
b. express their worries,
c. state preferences and opinions during the consultation.

All these provide the doctors explicit information on their beliefs, needs and concerns and
therefore be able to address them

Unfortunately, in a typical consultation, which might last for about 15-minutes office visit only,
a doctor barely has enough time to establish a friendly rapport with patients, much less probe
them deeply about their beliefs. As a result, the doctor often find him/herself making
assumptions about the care the patient prefers. Thus, the physicians' understanding is better the
more patients are involved by asking questions, expressing concerns, and stating their beliefs
and preferences for care.

Related to communication is style with which a doctor listens to a patient this will influence
what they say. Research into doctor–patient communication has established a number of key
tasks of the consultation including –

a. Eliciting patients’ problems and concerns,

 b. Giving information,
c. Discussing treatment options
d. Being supportive

1.5 What the doctors can do to address the patient’s negative health beliefs

In text Question 1.1

As a doctor, how do you think you can address the patient’s beliefs?

Did you come up with some of the following answers?

a. Listening attentively
b. Asking appropriate questions
c. Showing empathy
d. Answering the patients questions
e. Communicating clearly to the patient
These are some of the ways. Let us discuss them and add others.

Let us now see what you can do.

Encourage the patients to:

a. Ask questions,
b. express their worries,
c. state preferences and opinions during the consultation.

All these provide the doctors explicit information on their beliefs, needs and concerns and
therefore be able to address them

Unfortunately, in a typical consultation, which might last for about 15-minutes office visit only,
a doctor barely has enough time to establish a friendly rapport with patients, much less probe
them deeply about their beliefs. As a result, the doctor often find him/herself making
assumptions about the care the patient prefers. Thus, the physicians' understanding is better the
more patients are involved by asking questions, expressing concerns, and stating their beliefs
and preferences for care.
Related to communication is style with which a doctor listens to a patient this will influence
what they say. Research into doctor–patient communication has established a number of key
tasks of the consultation including –

a. Eliciting patients’ problems and concerns,

b. Giving information,
c. Discussing treatment options
d. Being supportive

1.6 How to improve consultation

1) Clarify of the patient's objectives for the consultation.

a. It is sensible to begin every clinical encounter with a determination of the patient's

beliefs/ expectations.
b. Patients consult for a variety of reasons, of which four are particularly common:
c. to obtain cure or symptomatic relief;
d. to seek diagnostic clarification;
e. to seek reassurance and
f. to seek ‘‘legitimisation of their symptoms.''

Often, patients will have a clear and explicit reason(s) for consultation, but sometimes they
just seem to wish to express distress, frustration or anger.

2) To enable and encourage the patient to express his/her expectations and concerns, try to
establish a therapeutic climate encouraging self-disclosure, adopt an appropriate
communication style using appropriate language and attend both to the verbal and non-verbal
aspects of communication.

1.7 Section Summary

1.7 Section Summary

We looked at the beliefs that the patients bring to the consultation room, how they affect
consultation treatment and finally how we can try and address the beliefs

SECTION 2: COMPLIANCE WITH MEDICAL REGIMENS

Welcome to Section 2 of Unit 2 of this module on health promotion. In this section we will
go through the issue of compliance with medical regimens, why patients do not comply, risks
for failure to comply and the relevance of epidemiology in public health. We will also
describe the importance of complying.
Before proceeding, look at the section objectives.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Explain the concept of compliance to medical regimens

2. Outline reasons patients don’t comply with medical regimens
3. Describe the importance of compliance.

Let us now look at the first subsection in detail.

2.3 Concept of Compliance to Medical Regimens

Under this section, we shall look at a few concepts that include:

1. Compliance to medical regimens

2. Factors influencing medical regimens compliance

Let us discuss each of these concepts in detail.

2.3.1 Compliance to Medical Regimens

In text Question 2.1

What is your understanding of the term compliance?

I hope your answers had the following:

1. Adherence
2. Conform
3. Obedience
4. Act in accordance

In your medical profession you will expect the patients you see to comply with the instructions
that you give them regarding the management of their problems. This introduces us to the
concept of medical regimens compliance. Compliance can be defined as “the extent to which
a person’s behaviour coincides with medical advice”. We expect our patients to comply with a
number of things which include among others: taking of medication the right way, coming for
follow-ups if there is need, going for various investigative procedures, eating the recommended
diet, doing exercises among others.

2.3.2 Factors Influencing Medical Regimens Compliance

Compliance to medical regimens is influenced by a number of factors which can be divided

into two: those that influence compliance positively and those that influence negatively.

Those that have a positive influence are:

a. Patient viewing disease as serious;

b. Family stability;

c. Patients satisfaction and expectations met;

d. Favourable doctor-patient relationship in which patient is involved in the decision-making

process;

e. Private doctor (vs clinic) and seeing same doctor consistently (vs different doctor);

f. Mental stability.

g. Spirituality

Those that have a negative influence are:

a. Complexity of the regimen especially when four or more drugs are involved

b. Unfavourable doctor-patient relationship;

c. Psychological problems (especially mental illness).

d. Poverty

e. Distance to the health facility/doctor

f. Traditional and religious beliefs

g. Competing alternative practices

Reflection 2.1
In a group of four or five discuss the times you have not complied with medical regimens?
List at least 5 reasons why you did not comply

Many doctors expect their patients to be "flexible" enough to accept their advice and carry out
their suggested treatments without any objections and therefore get surprised when patients fail
to do so and are left feeling angry, and tend to react in a critical, threatening and even scornful
way. Doctors will often classify their patients as" good" or "bad" according to whether they
experienced hem as "compliant" or not.

2.5 Importance of compliance with medical regimens

Compliance to medical regimen is important for both the doctor and the patient. For the
doctor there is satisfaction as the patient gets well. For the patient, there are many benefits of
getting well as this was the goal of getting to see a doctor. Alternatively the patient will have
quality life even as they continue with condition irrespective of how long they will be alive.

The doctor has to help the patient comply to the medical regimen by:

a. Simplifying drug regimens as much as possible e.g. prescribing as few drugs as

possible and as simple a dosage schedule (e.g. once or twice daily) as possible;
b. To involve patients in the decision-making process as much as possible. This way
they will be able to carry out activities they participated in charting out. This will
mean that you must psycho-educate them on the importance of following the medical
regimen that you want them to follow.

Behavioural interventions can also be carried out on patients really having difficulties. This
could include counselling or the various psychotherapeutic approaches.

2.6 Section Summary

Summary
Finally in this section, we have looked at the meaning of compliance to medical regimens,
factors associated to compliance and failure to comply and the importance of compliance and
how to improve compliance to medical regimen.

You have come to the end of Unit 2. You will now proceed to unit 3 of this module. Attempt
the following review questions to see how best you have understood this unit.

UNIT 3

UNIT 3:…………………………………

Unit Introduction
SECTION 1: ACCIDENTS AND INJURY PREVENTION

1.1 Section Introduction

Welcome to Section 1 of Unit 3. This section deals with accidents and injury prevention. It's
going to help you understand what causes accidents in all the environments of an individual
and how you can help people avoid injury. As a doctor, you will come across patients who
have experienced all sorts of accidents and have all sorts of injuries, minor or serious. You
need to know how to deal with it.

You will begin the unit by first looking at the section objectives.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Outline the causes of accidents and injuries.

2. Describe methods of injury prevention.

Next, you will go into sub-section one and look at it in detail.

1.3 Causes of Accidents and Injuries

An accident can be looked at as mishap, a calamity a disaster, etc. It is unintentional.

Accidents can occur anywhere and anytime and can occur to anybody and of any age.
Accidents lead to injury and the injury can be minor or serious and can even lead to death.
Accidents have various causes which we shall now explore.

1.3.1 Accidents

In text Question 1.1

What are some of the causes of accidents that you know?

Did you mention any of the following?

1. Vehicle/car accidents
2. Industrial accidents
3. Home accidents
4. A school accident
In other words, accidents can be caused by virtually anything. Imagine tripping on your
classmate’s leg, you fall and you break your leg. The breaking of your leg is the injury. Some
types of accidents can be avoided for example motor vehicle accidents caused because the
driver was either driving under the influence of alcohol or was overspending; having one’s feet
being cut by carelessly thrown broken glass, leaving sharp objects in the homestead anywhere
etc.

1.3.2 Injury

Injuries include all the ways people can be physically hurt, impaired or killed, involving
unintentional or intentional damage to the body. However WHO has defined injury in the
following way:

"Injuries are caused by acute exposure to physical agents such as mechanical energy, heat,
electricity, chemicals, and ionising radiation interacting with the body in amounts or at rates
that exceed the threshold of human tolerance. In some cases, for example drowning and
frostbite, injuries result from the sudden lack of essential agents such as oxygen or heat"
Baker et al 1992.

This definition takes into account only the physical damage to a person, but recently many
injury definitions have started to include psychological damage as well. Public Health science
divides injuries into two categories: intentional and unintentional injuries. Injuries and
accidents are also categorized according to the environment they take place in, e.g. traffic,
work, home and leisure time accidents and injuries, and according to the severity of the
injury: fatal, need for hospital treatment, health centre, or home treatment.

Who gets injured? Injuries can happen to anyone. Injuries present a significant risk to our
health and well-being regardless of our age, gender, race, income or where we live. However,
the burden of injury is greater for some groups than others. In particular, children,
adolescents and the elderly are at risk.

1.4 Methods of Injury Prevention

Since injuries result from accidents, it is then possible that injuries are predictable&
preventable. Injuries result from unsafe environments, conditions and behaviours. By
recognizing, changing, and controlling these factors, most injuries can be prevented. Injuries
need to be prevented because:

a. The impact of injuries to health and on society is great in terms of mortality, morbidity,
disability and cost. Every year, more than five million people in the world die as a result of
some kind of injury. This accounts for nine percent of all deaths, placing injuries in the top
three causes of death.

b. Injuries also lead to suffering, grief and disability. The burden of injury is felt not only by
those who are injured, but also by their families, caregivers and employers.
c. Many people especially in the developing countries do not receive requisite treatment for
their injuries leading to many of the injured people suffering long-term or permanent
disabilities.

d. Injuries also cause a major loss of human resources and productivity for the societies and
pose a great social and economic burden to them.

e. The treatment and rehabilitation of injured persons often accounts for a large proportion of
national health budgets.

The burden of injury is unequally distributed. It is particularly heavy on low-income families

and communities as they are more prone to injury and less likely to survive or recover from
disability

Despite the magnitude, the injury problem was neglected for a long time because of the
traditional view of considering injuries as random unavoidable events. However, better
understanding has changed the attitudes and injuries are now known to be largely
preventable.

There is also a growing evidence base of effective prevention strategies for injuries, whatever
their cause.

Injury prevention includes a wide range of methods to address the issue, including data
gathering and research; creating networks and coalitions of common interest; promotion of
media and educational campaigns to raise public awareness.

The public health approach to injury control includes:

1. identification of the problem;

2. identification of risk factors and target groups;
3. implementation of countermeasures;
4. Evaluation of effectiveness; and dissemination of results.

In order to prevent injuries effectively, accurate information on the number of injuries, their
types and victims is needed. This kind of information gives an indication on the seriousness
of the injury problem so that the cases where prevention measures are mostly needed can be
identified. Injury data is also needed for evaluating the effectiveness of injury prevention
practices.

Injury prevention can include the following approaches:

1. Aim to decrease just a single type of injury, such as drowning, or target all types of
injuries.

2. In a similar manner, injury prevention can use just one method (e.g. promote the use of life
jackets in order to prevent drowning), or several methods or a comprehensive approach.
Those that support a comprehensive approach argue that behaviour and objects within any
environment are interrelated and can strongly influence one another. Therefore, to address
one and not the other results in a less effective approach
3. Injury prevention can also target specific groups of the population. As an example, we can
take the injuries among the elderly, which are becoming a growing concern for health and
social care in several countries. The main reason is that the proportion of the aged population
is growing rapidly.

The government can help in injury preventions through:

1. Creating a climate of social cohesion and peace as well as of equity, protecting human
rights and freedoms, at a family, local, national or international level.
2. The prevention and control of injuries and other consequences or harms caused by
accidents.
3. The respect of the values and the physical, material and psychological integrity of the
individuals.
4. The provision of effective preventive, control and rehabilitation measures to ensure
the presence of the three previous conditions.

1.5 Section Summary

Activity
In summary have looked at causes of accidents and the results of accidents that is injury. We
have also looked at how injuries can be prevented.

We shall now move to section 2 on crisis and crisis intervention. An accident and injury is one
of the causes of a crisis in an individual’s life.

SECTION 2: CRISIS AND CRISIS INTERVENTION

Welcome to Section 2. This section deals with Crisis and Crisis intervention. It’s going to help
you understand what a crisis is and how you intervene in times of crisis. As a doctor, you might
come across a crisis in the course of your work. You need to know how to deal with it.

You will begin the unit by first looking at the section objectives

2.2 Section Objectives

By the end of this unit, you shall be able to:

1. Explain the meaning of a crisis.

2. Outline the characteristics of a crisis.
3. Explain how a Crisis intervention is carried out.

Next, you will go into Section 2 and look at it in detail.

2.3 Crisis

Let us start with a question to you.

In text Question 5.1

What is a crisis? Have you ever experienced a crisis? What was it?

Did the answers to the first question comprise of:

a. A time of intense difficulty, trouble, or danger;

b. A critical point, a turning point, being at a crossroad or other related answers

In mental health terms, a crisis can be defined as an individual's reaction to an event, situation,
or stressor. A crisis is a very individual reaction to an event or experience. One person may be
extremely affected by an event, while someone else experiencing the same event is not affected
by it, in fact that person would be wondering what is wrong with the other person. For the
person experiencing the crisis, if it is not handled in an appropriate and timely manner (or if
not handled at all), may turn into a disaster.

2.4 Characteristics of a Crisis

When an individual registers an event as a crisis, it will have the following characteristics:

1. Time limited: Generally lasting no more than six weeks.

2. Individual goes through the following typical phases :

a. Traditional attempt to problem solve

b. Attempts to try alternative methods

c. Disorganization

d. People are more open to change

e. Opportunity to resolve previously unresolved issues

f. Successful experience

2.5 Crisis Intervention

The goal of intervention is to stabilize the individual/family situation and restore to the
person’s/families’ pre-crisis level of functioning. The intervention provides an opportunity for
one to develop new ways of perceiving, coping, and problem-solving. The intervention is time
limited and fast paced, with the worker taking an active and directive approach.

2.5.1 Crisis Intervention Process

The process of interventions involves the following:

1. Assessment
2. Intervention
3. Termination

Assessment includes: the stressor event; the person experiencing the crisis; and the meaning of
the event to the person in crisis. It is important to assess risk factors. The risk factors include:
a. Suicide or homicide
b. Risk of physical or emotional harm to self or others
c. Risk of break from reality (psychosis)
d. Risk of client fleeing the situation.

Let us discuss the three (3) crisis intervention activities in detail.

1. Assessment

When an individual who has undergone a crisis is being assessed, that assessment involves:

a. Conducting the interview

i. History: personal and familial of risk behaviour
ii. Any means and plans the client may have about carrying out the risk behaviour
iii. Controls: internal and external that is stopping the client from undertaking the risk
behaviour.

b. Observations during the interview

 Level of anxiety; desperation; despair; sense of hopelessness; contact with reality.

 The skill and technique most essential at this stage is that of focusing while allowing
the client to ventilate and express the overwhelming flood of emotions.
 c. Focusing technique can elicit more coherent information for assessment as well as help
the client pull themselves together cognitively and emotionally.
d. A focused interview can serve as an instrument of both assessment and intervention.

2. Intervention

The person making an intervention needs to bear in mind the following:

a. Planning occurs simultaneously as assessment is made about how much time has
elapsed between the occurrence of the stressor event and this initial interview.
b. How much the crisis has interrupted the person’s life;
c. The effect of this disruption on others in the family;
d. Level of functioning prior to crisis and what resources can be mobilized.
e. The goal of intervention is to restore the person to pre-crisis level of equilibrium, not
of personality changes.
f. Worker attempts to mobilize the client’s internal and external resources.
g. Exact nature of the intervention will depend on the client’s pre-existing strengths and
supports and the worker’s level of creativity and flexibility.

Three approaches to intervention are:

a. Affective:
– Expression and management of feelings involving techniques of ventilation;
psychological support; emotional catharsis.

b. Cognitive:
– Helping the client understand the connections between the stressor event and their
response. Techniques include clarifying the problem; identifying and isolating
the factors involved; helping the client gain an intellectual understanding of the
crisis
– It also involves giving information; discussing alternative coping strategies and
changing perceptions.

c. Environmental modification:
– Pulling together needed external, environmental resources (either familial or
formal helping agencies)
Any and all three approaches may be used at any time depending on where the client is,
emotionally and cognitively. The goal is to help the client restore pre-crisis levels of
functioning.

Activity 5.2
Let’s go back to our question 2 at the beginning of the session. How did you go about solving
your crisis? Did you use any of the method discussed above?

2.5.2 Critical Incident Stress Management - Defusing

A defusing session is a short (30–45 minute), non-judgmental session where one or more
workers affected by the incident meets a trained leader (defuser). Defusing should be held
within 6 to 8 hours of the event

The defuser will:

a. Explain to workers the physical, emotional & mental reactions that they are, or may
soon be experiencing.
b. provide information on how workers can take care of their emotional and physical
health and the resources that are available to workers who require more assistance

This may also be an opportunity for the defuser to determine the need for a debriefing session.
Defusings are conducted where the incident is particularly distressing, complex or protracted.

2.5.3 Debriefing

Debriefing is the process in which the staff who have been working with an individual(s) who
have undergone a traumatic event are able to talk to another person. The express what they
have experienced and in the process helps not to get traumatized. A debriefing is provided later
than defusing (ideally 12–72 hours post-incident) when staffs have recovered enough and have

 begun to assimilate the experience,

 a range of reactions and responses to be understood

Debriefing should include further information on recovery, stress and self-management

When conducting a debriefing, a trained debriefer will:

 a. Introduce the session; outline the rules of confidentiality, non-judgement and freedom
to talk.
b. Invite the group to give an account of the incident, which is then clarified and
completed.
c. Invite participants to share their thoughts at the time of incident or in the time since it
occurred. These indicate important meanings that will be significant factors in the
development of stress.
d. Review staff reactions, should indicate other aspects of the meaning and significance
of the events, and account for the development of symptoms.
e. Review stress symptoms as these form the basis for the following stage
f. Provide focused education, advice and information to assist in understanding and
managing the symptoms.
g. Undertake problem solving for issues arising in the course of the session and prepare
for the recovery process or return to work. Requirements for continuing the integration
of the incident are discussed
h. 2.6 Section Summary
i. You will now proceed to Unit 4 of module eight which deals with Mental Health in
Primary Health Care. Before that, let us see how much you have understood from this
unit by doing the following review questions.

UNIT 4

UNIT 4:…………………………………….

Unit Introduction

SECTION 1: MENTAL HEALTH IN PRIMARY HEALTH CARE

1.1 Section Introduction

Welcome to Section 1 of Unit 4. This section deals with mental health in primary health care.
It's going to help you understand what mental health services can be offered in the primary
care setting, the need for it and the barriers. You will begin the section by first looking at the
unit objectives.

1.2 Unit Objectives

By the end of this section, you shall be able to:

1. Describe mental health in primary care.

2. Outline reasons for having mental health in health care

Describe the challenges to mental health in primary care

Next, you will go into section one and look at it in detail.

1.3 Meaning of Mental Health in Primary Health Care Setting

Primary health care is about providing 'essential health care' which is universally accessible to
individuals and families in the community and provided as close as possible to where people
live and work. It refers to care which is based on the needs of the population. It is decentralized
and requires the active participation of the community and family (WHO, 1978: Declaration
of Alma-Ata).

Therefore providing mental health services in primary health care involves diagnosing and
treating people with mental disorders; putting in place strategies to prevent mental disorders
and ensuring that primary health care workers are able to apply key psychosocial and
behavioural science skills, for example, interviewing, counselling and interpersonal skills, in
their day to day work in order to improve overall health outcomes in primary health care
(WHO, 1990).

In text Question 1.1

What are some of the reasons why we should have mental health services in the primary
health care?

Did your answers include some of the following?

1. Reducing Stigma
2. Cutting cost by going to hospital near you
3. Saving on time

4. Improved access to care as there is overall treatment of the person among other
Let us discuss some of these reasons in detail.

1.4 Reasons for Having Mental Health in Primary Health Care Setting

There are a number of reasons why mental health services should be provided in the
primary health care. These reasons include:

1.4.1 Reduced Stigma for people with mental disorders and their families

Unlike a mental health facility known for provision of mental health care, primary health care
services are not associated with any specific health conditions therefore stigma is reduced
when seeking mental health care from a primary health care, making this level of care far
more acceptable - and therefore accessible - for most users and families.

1.4.2 Improved Access to Care

Mental health in the primary health facility care to improve access to mental health services
and treatment of co-morbid physical conditions. This is improved through:

1. Treating Co-morbidities

Mental health is often co morbid with many physical health problems such as cancer,
HIV/AIDS, diabetes and tuberculosis, among others. The presence of substantial comorbidity
has serious implications for the identification, treatment and rehabilitation of affected
individuals. When primary health care workers have received some mental health training
they can attend to the physical health needs of people with mental disorders as well as the
mental health needs of those suffering from infectious and chronic diseases. This will lead to
better health outcomes.

2. Improved Prevention and Detection of Mental Disorders

Primary health care workers are frontline formal health professionals, “the first level of
contact of individuals, the family and community with the national health system" (Alma Ata
Declaration, 1978). Therefore, equipping these workers with mental health skills promotes a
more holistic approach to patient care and ensures both improved delivery and prevention of
mental disorders.

3. Treatment and Follow-up of Mental Disorders

People who are diagnosed with a mental disorder are often unable to access any treatment
for their mental health problems. By providing mental health services in primary health care,
more people will be able to receive the mental health care they need because of:

a. Better physical accessibility: primary health care is "the first level of contact (the
closest and the easiest to access) of individuals, the family and community with the
national health system" (Alma Ata Declaration, 1978);
b. Better financial accessibility: When consulting in hospitals, indirect health
expenditures (transportation, loss of productivity related to the time spent in
accompanying the patient to hospital, etc) add to the cost of consultation and
medications. If mental health services are integrated into primary health care, health
care costs are greatly reduced or are minimal.
c. Better acceptability linked to reduced stigma and easier communication with health
care providers (e.g. reduced language and cultural barriers, better knowledge of the
user's personality and personal and familial background/history)
1.4.3 Reduced Chronicity and Improved Social Integration

Both for the people with mental disorders and his/her household. When people are treated
far from their homes, it disrupts normal daily life, employment and family life; it removes
individuals from their normal supports, essential to recovery, and it imposes more burden on
families and care givers. By providing services in primary health care the burden on
individuals, families and society will be reduced, household productivity and social integration
will be maintained, resulting in better chances of recovery.

1.4.4 Human Rights Protection

This is achieved through:

a. Providing treatment at primary health care, backed by secondary health care and
informal community care can prevent people from being admitted into psychiatric
institutions which in many countries are often associated with human rights
violations.
 b. The reduced stigma associated with receiving care in primary health care settings can
also mean people with mental disorders and their families are less likely to experience
discrimination within society.
1.4.5 Better Health Outcomes

For people treated in Primary Health Care. In terms of clinical outcomes it has been found
that, for most common mental disorders, primary health care can deliver good care and
certainly better care than that provided in psychiatric hospitals.

1.4.6 Improving Human Resource Capacity for Mental Health

Integrating mental health services into primary health can be an important solution to
addressing human resource shortages to deliver mental health interventions.

Activity 1.1
In groups of three discuss how easy it is to implement mental health in primary health care.

1.5. Challenges of Having Mental Health in Primary Health Care Setting

Having mental health services in the primary health care requires a lot of careful planning and
there are likely to be several issues and challenges that will need to be addressed. These include:

1. Investment in the training of staff to detect and treat mental disorders. This could be a
challenge as many countries might not have these investments or are not willing to invest.

2. Lack of skills to identify mental health disorders. Within the context of training, primary
health care workers may be uncomfortable in dealing with mental disorders and may also
question their role in managing disorders. Therefore, in addition to imparting skills, training
also needs to address the overall reluctance of primary health care workers to work with people
with mental disorders.

3. The issue of availability of time also needs to be addressed. In many countries primary health
care staff is overburdened with work as they are expected to deliver multiple health care
programs. Governments cannot ignore the need to increase the numbers of primary health care
staff if they are to take on additional mental health work.

4. Issue of adequate supervision of primary care staff is another key issue which needs to be
addressed. Mental health professionals should be available regularly to primary care staff to
give advice as well as guidance on management and treatment of people with mental disorders.
Furthermore the absence of a good referral system between primary and secondary care can
severely undermines the effectiveness of mental health care delivered at primary health care
level.

5. Finally, governments must pay attention to key human resource management issues in
primary health care – adequate working conditions, payment, resources and support to carry
out demanding work.

1.6 Section Summary

Summary
We have discussed the meaning of mental health in primary health care setting, the reasons
why mental health should be integrated in this setting and some challenges faced in
integrating mental health in primary health care settings.

REFERENCES

REFERENCES

WHO, 1978. Declaration of Alma-Ata. International Conference on Primary Health Care,

Alma-Ata, USSR, 6-12 September 1978.
url:http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf

HCH100: BEHAVIOURAL SCIENCES - : NEUROSCIENCES

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY
 ANTHROPOLOGY

FOR

BACHELOR OF MEDICINE AND SURGERY STUDENTS

HCH 100: BEHAVIOURAL SCIENCES

MODULE 9: NEUROSCIENCES

2014

Copy Right

Behavioural Sciences Course to Undergraduate Students in the College of Health Sciences by

Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

© University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced
in any form or by any means without permission in writing from the Publisher.

Writer: Prof. Wangari Kuria MBCHB, MMED (Psych), PhD Psych.

Reviewer:
Chief Editor: Joshua M Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

The University of Nairobi (UoN), College of Health Sciences wish to acknowledge the
contribution of the Department of Psychiatry and PRIME-K whose financial assistance made
the development of this e-learning course possible.

Module Introduction

Welcome to this module on neurosciences. It introduces you to basic neurosciences and its
relevance to behaviour. This is the approved course outline for this module (link). This module
is an important basis for understanding anatomy, biochemistry and physiology as related to
human behavior. You will also understand the neurophysiological aspects of sleep and other
physical disorders like memory loss and pain. You are expected to carefully read the e-content,
complement these with the recommended reference books and other reading material. The
text-tasks included in the modules are important and you should carefully go through them to
enable you understand the module content. It is also crucial that you take time to reflect on the
posed questions and complete the assignments and activities suggested. You are advised to
discuss the module and assignments with other students and consult the module teacher if
necessary.

The module consists of 3 units as follows;

Unit 1: Fundamentals of Neurosciences and behaviour

Unit 2: Endocrinology and physiology of psychiatric disorders

Unit 3: Physiology of Sleep and memory

Module Objectives

By the end of this module, you should be able to:

1. Understand fundamentals of neurosciences and behaviour

2. Describe the endocrinology and physiology of psychiatric disorders.
3. Describe physiology of sleep and memory.

Let us proceed to discuss the first unit of this module.

UNIT 1: FUNDAMENTALS OF NEUROSCIENCES AND BEHAVIOUR

Welcome to this unit that will teach you on what neurosciences are and how they are related to
human behaviour. The pathophysiology of majority of behavioural disorders is now better
understood following many advances made in the fields of neuroanatomy, brain imaging,
neurochemistry and neurophysiology. It is therefore important to understand the neurosciences
because they form the biomedical foundation of psychiatry and psychology. They help us to
understand human experiences and behavior. In this unit, we will emphasize the relationship
between anatomy, biochemistry and physiology of the body affect human behaviour. In your
training as medical doctor you will need to understand why a patient behaves in a particular
way when they suffer certain disorders. This information will be very useful to you as you
rotate through the various medical disciplines (internal medicine, surgery, paediatrics and
public health).

Welcome to Unit 1, I hope you will enjoy the topic and learn from it.

Unit 1 consists of 3 sections as follows:

Section 1: Introduction to Neurosciences

Section 2: Neuro Anatomy and Behaviour

Section 3: Neuro Chemistry/Neuropsychology and Behaviour

Unit Objectives

By the end of this unit, you should be able to:

1. Describe the introductory concepts of neurosciences.

2. Discuss Neuro anatomy and behaviour.
3. Discuss neuro chemistry/neuro physiology and behaviour.

We shall now begin with the introduction to neurosciences

SECTION 1: INTRODUCTION TO NEUROSCIENCES

Welcome to this section on the introduction to neurosciences. Neurosciences will be defined

and you will also learn the various divisions in neurosciences. You will also learn about the
organization of the nervous system and finally the importance of neurosciences in the discipline
of medicine will be explained. This section will prepare you to understand the other sections
of this unit. I hope you will enjoy the section. Welcome to Section 1.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define neuroscience.
2. Understand the divisions in neuroscience.
3. Describe the organization of the nervous system.
4. Discuss the importance of neurosciences in the discipline of medicine.

1.3 Definition of Neurosciences

The human is the most complicated organization of matter we know of. Neuroscience is the
umbrella term for the multi-disciplinary study of the nervous system. The nervous system is
the body’s electrochemical communication circuitry. Neurons (nerve cells) are nervous system
basic units. The nervous system is made up of billions of neurons. The brain is the central
command center of the nervous system and Controls all thoughts, movements.

1.4 Divisions in Neuroscience

Not long ago the disciplines that study the nervous system were virtually separated from each
other. There are 4 divisions in neuroscience as listed below:

a. Neuroanatomy- studies the neurons physical structure

b. Neurophysiology- studies the function of the neurons
c. Neurochemistry- analyses neurons chemical activity
d. Behavioral neuroscience- focuses on nervous system connection and behavior

Today these disciplines overlap and for two of them (neurophysiology and neurochemistry) it
is difficult to discuss them as separate entities. In this unit the 2 will be discussed under the
same subheading.

1.4 Divisions in Neuroscience

Not long ago the disciplines that study the nervous system were virtually separated from each
other. There are 4 divisions in neuroscience as listed below:

a. Neuroanatomy- studies the neurons physical structure

b. Neurophysiology- studies the function of the neurons
c. Neurochemistry- analyses neurons chemical activity
d. Behavioral neuroscience- focuses on nervous system connection and behavior

Today these disciplines overlap and for two of them (neurophysiology and neurochemistry) it
is difficult to discuss them as separate entities. In this unit the 2 will be discussed under the
same subheading.

1.5 Organization of the Nervous System

The human nervous system is highly organized and it processes everything we do. It is
divided into two parts;

1. Central Nervous System (CNS)

2. Peripheral Nervous System (PNS)

1.5.1 Central Nervous System

The central nervous system is made up of 2 components

a. Brain
b. Spinal cord

More than 99% of all neurons (nerve cell) in our body are located in the CNS.
1.5.2 Peripheral Nervous System

This is the network of nerves that connects the brain and spinal cord to other parts of the
body

It brings information to and from the brain to other parts of the body and carries out
commands of the CNS to execute various muscular and grandular activities. The peripheral
nervous system (PNS) has two major divisions;

1. Somatic nervous system

This consists of Sensory nerves, which conveys from the skin and muscles to the CNS about
such matters as, pain, temperature, and motor nerves which inform muscles when to act.

2. Autonomic nervous system

This system takes messages to and from body's internal organs and monitors such processes
as breathing, heart rate, and digestion. It is divided into 2 parts

a) Sympathetic nervous system. This system arouses the body

b) Para Sympathetic nervous system. This system Calms the body

Let me explain how the central nervous system works by giving an example of a lecturer who
is preparing lecture notes:

The PNS carries information about the notes to the CNS, which in turn interprets and
memorizes key points. The PNS then conveys to the muscles of the arm and hand to write

The somatic nervous system transmits information from the eyes to the brain and from brain
to your hand. While the sympathetic systems arouse anxiety about the quality of the lecture
notes, the parasympathetic system causes relaxation, calm the person.

1.6 Importance of Neuroscience in Medicine

The pathophysiology of majority of psychiatric disorders is now better understood following

many advances made in the fields of neuroanatomy, brain imaging, Neurochemistry and
neurophysiology. The study of neurosciences gives us understanding in the aetiology of neuro
psychiatric disorders, neurophysiological and neurochemical causes of disorders. The brain
and nervous system are central to understanding behaviour, thought and emotion. It is therefore
very important for doctors to understand neurosciences to enable them be effective clinicians.

1.7 Section Summary

Neuroscience is an umbrella term for the multidisciplinary study of the central nervous
system. The central nervous system is composed of the central nervous system and the
peripheral nervous system. The CNS has 2 components namely the brain and the spinal cord.
The PNS has 2 components the sympathetic and parasympathetic nervous system. The 2
components of the CNS and PNS are well coordinated in function to ensure that the body
functions well. It is difficult to understand the discipline of medicine without understanding
neurosciences.

Activity 1.8

Form a discussion group consisting of student(s) in your class and discuss :

1. What are neurosciences

2. How important is this topic to you as health professional to be?

In section 2 you will learn on neuroanatomy as relates to the human behavior.

SECTION 2: NEUROANATOMY AND BEHAVIOUR

Welcome to this section on neuroanatomy and behaviour. As a learner you may have been
wondering why the lecturers teach you anatomy and expects you to dissect the human body.
Similarly you may be wondering why neuroanatomy and behaviour should be taught to you as
a clinician to be. This section will answer these questions by laying a foundation for you to
understand how neuroanatomical abnormalities results to abnormalities in behaviour and body
functioning. Many of the abnormalities mentioned in this chapter may appear difficult to
pronounce at the moment but in due course they will be the disorders you see during your ward
rotations on a day to day basis. Hope you enjoy the section.

Section Objectives

By the end of this section, you should be able to:

1. Outline the anatomy of the brain.

2. Describe neuro anatomical abnormalities and how it affects behaviour.

2.3 Anatomy of the Brain

The brain consists of two hemispheres, which are connected by the corpus callosum and other
smaller commissural tracts. The brain has an extension called the spinal cord. The spinal cord
and the brain constitute the central nervous system (CNS). The brain has gray and white
mater. The three areas of the gray mater are; cerebral cortex, cerebellar cortex, and the sub-
cortical cerebral and cerebellar nuclei.

The cerebral cortex has four lobes frontal, parietal, temporal and the occipital lobe. The
cerebral cortex is heavily folded with convolutions (gyri) fissures (sulci or grooves) and
contains about 70 percent of the nerve cells in the CNS. The part called the brain stem
comprises the medulla oblongata, pons and mesencephalon.

The ventricular system consists of;

 a. Two lateral ventricles each with an anterior and posterior horn,
b. Third and fourth ventricles all located within the depth of the brain mass.
c. The central part of the ventricular system is located between the two lateral ventricles.

Cerebral spinal fluid (CSF) circulates within these ventricles.

The following are important structures of the brain that may affect behaviour.

2.3.1 Basal Ganglia

The Basal ganglia consist of a group of nuclei that contain cholinergic neurons. It has

a. Corpus striatum
b. Substantia nigra and innominata and
c. Subthalamic nuclei.

2.3.2 Meninges

The brain is covered by layers of tissue referred to as meninges in the following order from
without,

1. dura mater which is attached to the skull,

2. the arachnoid mater is beneath the dura mater

The space between the dura mater and arachnoid is called the sub-dural space. The 3rd layer is
known as the pia mater and is attached to the cerebral cortex. The space in- between the
arachnoid and pia mater is called the subarachnoid space and is filled with Cerebro-Spinal
Fluid (CSF).

2.3.3 Neurons and Glia

A neuron is the basic functional unit of the nervous system. Neurons are also called nerve cells.
Glial cells (neuroglia) are a class of neuronal cells in CNS. There are four types of glial cells,
the astrocytes, oligodendrites, ependymal and microglia cells. Ependymal and microglia cells
line the brain ventricles and the central canal of the spinal cord. They facilitate the flow of the
CSF.

The glial cells also contribute to blood brain barrier (BBB), a semi-permeable membrane
between blood vessels and the brain. The ability of compounds to pass from the blood into the
brain and vice versa depends on their molecular size, electrical charge, solubility, and specific
transport system. The BBB is important in regulating the brain chemistry.

2.3.4 Thalamus, Hypothalamus and Pineal Body

Thalamus is located above the hypothalamus and consists of various nuclei. It is an integral
part of the limbic system. Thalamus is involved with perception of pain. The nociceptors (pain
receptors receive nerve impulses from the peripheral organs that are relayed and eventually
ascend along spinothalamic and reticulothalamic tracts to the thalamus. from where the
impulses are relayed to the somatic sensory cortex. The Thalamus is a relay station for all of
the sensory messages that enter the brain. It is this area that the conscious awareness of
messages as sensations such as temperature, pain and touch probably begin. The hypothalamus
is located beneath the thalamus and on either side of the third ventricle. It has many nuclei and
those relevant to psychiatry include: mamillary, supra-chiasmatic, optic and paraventricular
nuclei.

The hypothalamus has several connecting pathways to other parts the brain. It is a major
integrating and output system of the entire CNS. It controls biological rhythms and regulates
the immune systems. It is also involved with appetite and sexual regulation, since it is a part of
the limbic system.

The pineal gland secretes melatonin which is useful in sleep regulation and also secretes
various peptides.

2.3.5 Brain Stem

The brain stem comprises three parts: the mesencephalon, pons and medulla oblongata.

Functions of the brain stem are control of cardiovascular activity, sleep and levels of
consciousness. It is also involved in respiratory activities. All these physiological activities are
under involuntary control. The Brain Stem contains nerve fibres (neurons) which transmit
information from the spinal cord to the brain. Higher concentrations of serotonin and
norepinephrine binding sites may be present in these areas. The second important function of
the brain stem is hosting of the medial forebrain bundle, the nuclei of ascending biogenic-
amine pathways. Thus, there are high concentrations of dopamine, noradrenalin and serotonin
levels in the brain stem

2.3.6 Cerebellum

Consist of cerebellar cortex, the middle cerebellum vermis and deep cerebellar nuclei. There
are projections to the cerebral cortex and other brain areas such as the limbic system, brain
stem and the spinal cord.

2.3.7 Reticular Activating System

This is a system of loosely organised network of neurons located in the brain stem, which
receive input from cerebellum, basal ganglia, hypothalamus and cerebral cortex. The reticular
activating system also sends projections to the hypothalamus, the thalamus and the spinal
cord.

2.4 Abnormalities of the Nervous System and How it Affects Behaviour Body Function

2.4.1 Cerebrospinal Fluid

Neurotransmitter metabolites contained in the CSF can be biological markers and a measure
of response to pharmacological treatment. Blockade in CSF drainage causes CSF pressure to
rise within the ventricles resulting in hydrocephalus. Computed tomography (CT) scan of
such brains

2.4.2 Basal Ganglia

The basal ganglion is involved in initiation of movement. This anatomic area is associated
with a number of clinical disorders such as Parkinson's disease, Huntington's chorea Wilson's
disease and Fahr syndrome. These are neurological disorders mostly associated with
symptoms of psychosis, depression and dementia. The disorders present with abnormal
movements of limbs and body. You will study these disorders further in your clinical years of
medicine. Untreated schizophrenics ( a form of mental illness)show many movement
disorders eg, extreme opening & closing of eyes, flaring of the nose, grimacing, protrusion
of the tongue, and shaking of head, all of which imply an involvement of the basal ganglia.

2.4.3 Meninges

1. Sub-dural haematoma: A subdural haematoma is due to "slow" blood accumulation

beneath the dura mater caused by ruptured veins

2. Epidural haematoma: An epidural haematoma is due to "rapid" accumulation of blood

between the dura mater and skull caused by rupture of an artery. An epidural haematoma is a
life threatening condition

3. Meningitis: This is a viral or bacterial infection or inflammation of one of the meningial

layers.

In all the above conditions patient may show signs and symptoms of delirium, behaviour and
psychological symptoms. It is therefore important to rule out brain meningeal abnormalities
in who present with behaviour problems.

2.4.4 Frontal Lobe

There may be changes in the frontal lobes, the part of the brain concerned with emotional and
some higher mental functions. The hippocampus and adjacent regions may show some
reduction in size. This can affect the "sensory filtering" that takes place in this region of the
brain. The ventricles (fluid-filled spaces) may be larger than normal. This may put pressure
on surrounding brain tissue. Patient with frontal lobe disorders will present with emotional
and behavioural problems including disinhibition.

2.4.5 Thalamus and Hypothalamus

Dysfunctions of the thalamus are due to many factors including tumours which produce
severe pain syndrome Pain transmission to the thalamus can be inhibited by projections from
periaqueductal region of the midbrain and the nucleus raphe of the medulla. These regions
have high concentrations of opiate receptors and these endogenous opiates (endorphins
enkephalins) play a role as neurotransmitters for the control of pain. Tumours of the thalamus
may present with extreme pain.

Disorders of the hypothamus will affect appetite, sleep and sexual behaviour

2.4.6 Cerebellum

Functions of the cerebellum are control of movement and posture and therefore its lesions
will cause loss of balance. It is also involved in higher mental functions resulting to abnormal
behaviour.
2.4.7 Reticular Activity System

Since the reticular activating system is responsible for the state of alertness and wakefulness,
those psychiatric disorders where motivation and arousal are affected, may be due to
pathology within the reticular activating system.

2.5 Section Summary

Abnormalities of the brain may result to behaviour problems. It is therefore important to rule
out brain pathology in patients who present with behaviour problems.

2.6 Activity
Identify the anatomical structures discussed in this section during your cadaver dissection
practical

Let us now look at section3 in which you will learn about human behaviour as related to
neurochemistry and neurophysiology

SECTION 3: NEUROCHEMISTRY/NEUROPHYSIOLOGY AND BEHAVIOUR

3.1 Section Introduction

Welcome to this section on neurochemistry/ neurophysiology and behaviour. In this section

you will learn about the brains neurochemistry. You will also learn how abnormalities in the
neurochemicals can result to disorders that affect behaviour. This understanding will help you
in the future to evaluate patients holistically having in mind that the aetiology of some of the
behavioural disorders may be neurochemical abnormalities. Hope you will enjoy the learning.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Outline neurochemistry and neurophysiology.

2. Describe neurochemical-neurophysiological abnormalities and how it affects
behaviour.

3.3 Outline of Brain Neurochemical and Neurophysiological System

Behavioural students can approach the study of the brain on many conceptual levels. While in
neuro anatomy section the subject was approached at the level of the whole brain and
individual brain areas for the neurochemistry and neurophysiology we will approach study of
the neuron level. Just as a whole brain or a single brain area can be seen as performing an
integrating function, so can an individual neuron be seen as performing an integrating
function. An individual neuron receives diverse incoming information, integrates that
information and responds by modulating how often it generates an action potential and how
much of which neuro-transmitter molecules it releases from its axon terminals. Most neurons
receive synaptic input, an individual neuron can be affected by hormones, the immune
system, and chronobiological rhythms of the organism. There are integrating mechanisms
with the neurons. This includes regulation of protein function and regulation of gene
function. Many important molecules within the neuron are proteins including
neurotransmitters receptors, enzymes and cytoskeletal elements. In as much as the function of
its shape and electrical charge, biochemical processes such as protein phosphorylation, that
can affect the shape and charge of a protein can affect its function. Specifically an individual
protein molecule may have its function regulated by several reversible, post-translation
modifications, initiated by a different source e.g. synaptic input hormal effects and
chronobiological rhythms.

The human brain is made up of cells called neurons. These cells comprise four parts:

a. Cell body,
b. Dendrites,
c. Axon,
d. Pre-synaptic terminal.

A gap called the synapse exists between a pre-synaptic terminal and the next neuron. There
are several millions of these neurons in the brain whose main function is information
processing following either excitation or inhibition. Neurons communicate to and with each
other through; signal transduction chemical neurotransmission. Signal transduction refers to
the general process by which electrical signals (the nerve impulse) are converted into
chemical signals (neurotransmitter release) by the pre-synaptic neuron and the process by
which the chemical signals are converted back into electrical signals by the post-synaptic
neuron.

Chemical neurotransmission refers to the release of a neurotransmitter by the pre-synaptic

neuron and the detection of the neurotransmitter by the receptor proteins (synaptic
connection) leading to activation of post-synaptic neuron causing membrane depolarization
(excitation) or hyperpolarization (inhibition). The activities that take place in the synapse are
important in the understanding of many physiological changes that are relevant to psychiatry.
The synapse is the major site of action for neuro-messengers and drugs used in psychiatry.

There are three types of synapses- chemical (humoral), electrical (gap junctions) and
conjoint. Chemical synapses use neurotransmitters to send messages while electrical synapses
use electric current and flow of charged ions to relay messages. Conjoint synapses contain
both chemical and electrical synapses. Synapses can either be excitatory or inhibitory,
depending on whether they induce membrane depolarization (excitation) or membrane
hyperpolarization (inhibition), following release of the neuro-messengers and its effect on the
post-synaptic neuron. Neuro-messengers, also known a neuro-transmitters or neuro-
modulators are grouped into;

1. Biogenic amines (5-10%) - include cate-cholamines (dopamine, epinephrine and

norepinephrine); indole amines (serotonin, also called 5-hydroxy tryptamine),
quaternary amines (acetyl-choline) and ethyl amines (histamine).
2. Amino acids, (60%)
3. Peptides
4. Endocannabinoids ( this group is the least understood)
All neurotransmitter play a role in behaviour regulation. neurotransmitter synthesizing
enzymes, quantities of neuro-transmitters and neuro-transmitter metabolites that are found in
samples of blood, urine and cerebrospinal fluid can be measured in research techniques. Clear
understanding of the nature of receptors allows the neuroscientists and clinicians to
appreciate the mechanisms involved in the actual disease pathology and what remedies to
develop.

Receptors are made up of proteins and are found in neuronal membranes. They are located on
both the pre-synaptic and post-synaptic neurons. Receptors are configured in such a way that
each receptor only recognizes a specific neurotransmitter. They are designed in the key and
lock format where a lock will only accept the correct key for the locking or unlocking
operation to occur. The following neuro chemicals are some of the important ones

1. dopamine
2. Nor epinephrine and epinephrine
3. serotonin
4. acetylcholine

Dopamine-containing neuronal cell bodies are located in the Nigrostriatal, Mesolimbic,

Mesocortical and Tubero-infundibular pathways. There are 5 major types of dopamine
receptors. D1 and D5 receptors are members of the D1 like family of dopamine receptors,
whereas the D2, D3, D4 receptors are members of the D2-like family. Activation of the D1-
like family receptors is typically excitatory, while D2-like activation is typically inhibitory.
The D2 family of receptors is the most relevant in behavior and in psychiatry. The function of
dopamine involves the initiation and co-ordination of movements.

3.3.1 Basic Electrophysiology

In the resting state the intracellular compartment of a neuron is negatively charged in

comparison with the extracellular compartment. The difference in electrical potential is
produced and maintained by the neuronal membrane itself and by the ion pumps and channels
contained in the membrane. The principal ion pump is the energy-requiring sodium-potassium
exchange pump; the principal ion channels are the sodium, potassium, calcium and chloride
ion channels. The membrane is said to be semipermeable because it is selective regarding
which ions can pass through it. The semipermeable property of the membrane is the source of
its functional role, which is similar to the role of a capacitor. The electrical potential of the
membrane follows the equation of Ohm’s Law, E=IR. In that equation, E is the transmembrane
potential, I is the current and R is the resistance.

3.3.2 Neuronal Membrane

Phospholipids, organized as a bilayer with the hydrophobic ends of the molecules pointing
toward each other, make up the neuronal membrane. Cholesterol and protein molecules can be
found within the sea of phospholipids. The cholesterol is believed to regulate membrane
rigidity. The major types of proteins found in the membrane are neurotransmitter receptors,
their related proteins e.g. adenyl cyclase and ion channels.

3.3.3 Action Potentials

In the resting state the intracellular compartment of the neuron is negatively charged, but during
an action potential the neuron is positively charged. For an action potential to be generated by
a neuron, the inside of the neuron has to become less negatively charged than the outside.

3.3.4 Synapse

The components of the synapse are the axon terminal of the presynaptic neuron, the synaptic
cleft, and the dendrite of the post synaptic neuron. When a cation potential develops in
presynaptic neuron, the action potential; moves down the axon to the axon terminalor to other
functionally similar regions of the axons called axional varicosities. The action potential causes
calcium ions to enter the anon terminal.

3.3.5 Receptors

Neurotransmitter receptors are the sites of action for virtually all the psychotherapeutic and
psychoactive drugs used today. There are many types of receptors. In a synapse receptors can
be on both the presynaptic and postsynaptic neuron. Fundamentally there 2 types of receptors;
receptors linked to the G protein and receptors located directly on ion channels.

UNIT 2: ENDOCRINOLOGY AND PSYCHIATRIC DISORDERS

Psychiatric disorders may be secondary to endocrine disorders. if the endocrine organ

produces to little or too much of the concerned hormone, may result to psychiatric
manifestation that may be mistaken as mental illness. Treatment of the endocrine disorder
results alleviation of the psychiatric symptoms. Making the proper diagnosis of these disorders
is important since if untreated this conditions may lead to complications including death.
Proper evaluation of each case is important to avoid misdiagnosis. You will now learn about
some of this endocrine disorders and the psychiatric presentation. Welcome to unit 3, I hope
you will enjoy the topic and learn from it.

Unit 2 consists of 5 sections as follows:

Section 1: Thyroid disorders and the physiology of psychiatric disorders

Section 2: Adrenaline disorders and the physiology of psychiatric disorders

Section 3: Pituitary disorders and the physiology of psychiatric disorders

Section 4: Parathyroid disorders and the physiology of psychiatric disorders

Section 5: Pancreatic disorders and the physiology of psychiatric disorders

Unit Objectives

By the end of this unit, you should be able to discuss:

1. Thyroid disorders and psychiatric disorders

2. Adrenaline disorders and psychiatric disorders
3. Pituitary disorders and psychiatric disorders
 4. Parathyroid disorders and psychiatric disorders
5. Pancreatic disorders and psychiatric disorders.

We shall now begin with a discussion of thyroid disorders and psychiatric disorders

SECTION 1: THYROID DISORDERS AND PSYCHIATRIC DISORDERS

1.1 Section Introduction

The thyroid gland produces the thyroid hormones that are responsible for the regulation of
important body functions including, blood pressure, heart rate body temperature and rate of
conversion of food to energy. Thyroid hormones are essential for the function of every cell in
the body. They help regulate growth and the rate of metabolism in the body. It also helps in
growth and development of children. The thyroid stimulating hormone which is produced by
the pituitary gland is responsible for the stimulation of the thyoid gland in order to produce
the hormones. The thyroxine (T4) and triiodothyronine (T3) are important thyroid
hormones. It also produces calcitonin, which is involved in calcium metabolism and
stimulating bone cells to add calcium to bone.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss hyperthyroidism and psychiatric disorders

2. Discuss hypothyroidism and psychiatric disorders.

1.3 Hyperthyroidism and Psychiatric Disorders

Hyperthyroidism results from an increase of the thyroid hormones with the resulting medical
condition that is referred to as thyrotoxicosis. An elevated level of the thyroid hormones results
to symptoms of what may appear like an anxiety disorder, including restlessness, irritability,
distractibility and anxiety. To differentiate the between symptoms of thyrotoxicosis and
anxiety disorder, it is important to take proper history and examination. The discriminating
symptoms of thyrotoxicosis include; preference of cold weather, weight loss despite increased
appetite, palpable thyroid gland, sleeping pulse rate of above 90/min and tremors.
Measurement of the T3 and T4 shows elevated levels.

1.4 Hypothyroidism and Psychiatric Disorders

Hypothyroidism is the lack of thyroid hormones and invariably results to psychiatric

symptoms. If it happens in early life it leads to retardation of mental development. In adults,
lack of thyroid hormones results to poor memory, slowness, apathy akin to depression and
dementia. The symptoms of hypothyroidism are less distinctive than those thyrotoxicosis
including; poor appetite, constipation, generalized aches and sometimes angina. In making a
diagnosis it is important to measure not only the T3 and T4 but also the TSH to help
distinguish between primary thyroid diseases from pituitary cause. In pituitary causes the
TSH is usually low

1.5 Section Summary

In this section, we have so far seen that abnormalities of the thyroid hormone may cause
psychiatric symptoms.

1.6 Activity
List 2 psychiatric disorders that may result from abnormalities of the thyroid hormones

SECTION 2: ADRENALINE DISORDERS AND THE PHYSIOLOGY OF PSYCHIATRIC

DISORDERS

2.1 Section Introduction

The suprarenal gland (adrenal gland) is located at the top of each kidney. These glands are
critical in creating numerous hormones that are necessary for a healthy life. The suprarenal
glands are divided into two parts. The outer portion of the gland is called the adrenal cortex.
The adrenal cortex is responsible for creating three different types of hormones:
mineralocorticoids which conserve sodium in the body, glucocorticoids which increase blood
glucose levels and gonadocorticoids which regulate sex hormones such as estrogen. Death
would result if the adrenal cortex were to stop functioning as it controls metabolic processes
that are essential to life. The inner medulla is the inner portion of the suprarenal gland
(adrenal gland). This portion secretes epinephrine and norepinephrine in times of stress.

Let us familiarize ourselves with the section objectives.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss hypo adrenalism and psychiatric disorders

2. Discuss hyper adrenalism and psychiatric disorders
3. Discuss phaeochromocytoma and psychiatric disorders.

2.3 Hyperadrenalism and Psychiatric Disorders

Addison's disease also referred to have hypoadrenalism is caused by low levels of adrenaline.
Addison's disease may present with psychological symptoms that may be mistaken as
psychiatric illness. This symptom includes: withdrawal, apathy, fatigue mood disturbance and
memory loss. This may be mistaken be mistaken for dementia, a disorder that presents with
memory loss. A patient in Addisonnian crises (when the levels of adrenaline are too low)
may present in an acute confusion. Occasionally Addison's disease may coincide with
depression or schizophrenia

2.4 Hypoadrenalism and Psychiatric Disorders

Cushing syndrome is also referred to as hyperadrenalism and results from too much adrenaline.
As described by Cushing’s, it is usually associated with emotional disorder. Depressive
symptoms are the most frequent manifestation in these patients. Paranoid symptoms are less
common and appear mainly in patients with severe physical illness. Discuss
phaeochromocytoma and the physiology of psychiatric disorders.

2.5 Phaeochromocytoma and Psychiatric Disorders

Phaeochromocytoma are tumours usually benign arising from the chromaffin cells of the
adrenal medulla or ectopically in relation to the sympathetic ganglia. They secrete adrenaline
and nor adrenaline either continuously or paroxysmally. It is associated with headaches,
anxiety attacks and occasionally episodes of confusion. Increased catecholamine’s in urine is
an important diagnostic finding.

The depression improves once the cushing syndrome is treated is treated

2.6 Section Summary

Addison’s disease and Cushing’s syndrome are abnormalities of adrenaline gland that may
present with psychiatric symptoms.

2.7 Activity
What is phaecromocytoma and what are the psychiatric manifestations of the condition.

SECTION 3: PITUITARY HORMONES AND PSYCHIATRIC DISORDERS

3.1 Section Introduction

The pituitary gland rests at the base of the brain in the bony sella turcica near the optic
chiasma and the cavernous sinuses. The pituitary consists of an anterior lobe
(adenohypophysis) and a posterior lobe (neurohypophysis). It is connected to the
hypothalamus by a stalk of neurosecretory fibres and blood vessels. The anterior pituitary
produces growth hormone, prolactin, thyroid stimulating hormone, follicle stimulating
hormone, luteinizing hormone and adrenocorticotropic hormone. The posterior pituitary
produces oxytocin and vasopressin (antidiuretic hormone). Welcome to section 3, hope you
will enjoy it.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss acromegaly and psychiatric disorders

2. Discuss hyper pituitarism and psychiatric disorders.

3.3 Acromegaly and Psychiatric Disorders

Acromegaly is a disorder resulting from hyper secretion of hormones from the pituitary
gland. The psychiatric symptoms in acromegaly include apathy and lack of initiative.
Depression sometimes occurs which may be a psychological reaction to physical symptoms
rather than direct effect of the hormone disturbance.

3.4 Hypopituitarism and the Physiology of Psychiatric Disorders

Hypopituitarism is due to reduction in hormones produced from the pituitary gland. The
psychiatric manifestations of this disease include; depression, apathy, lack of initiative,
somnolence, and cognitive impairment similar to that found in patient with dementia.
Psychological symptoms usually respond well when hypopituitarism is treated by replacement
therapy.

3.5 Section Summary

Abnormalities of the pituitary gland may cause psychiatric symptoms.

3.6 Activity
List 2 psychiatric disorders that may result from abnormalities of the pituitary hormones

SECTION 4: PARATHYROIDISM AND PSYCHIATRIC DISORDERS

4.1 Section Introduction

The parathyroid glands, as the name suggests, are situated close to the thyroid gland. They
are usually four in number and can also be situated outside their normal anatomical site,
residing anywhere between the hyoid bone in the neck and the mediastinum. These glands
produce the parathyroid hormone which serves as one of the principle regulators of calcium
and phosphate homeostasis. Welcome to section 4, hope you will enjoy it.

4.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss hypo parathyroidism and psychiatric disorders

2. Discuss hyper parathyroidism and psychiatric disorders.

4.3 Hyperpitutarism and Psychiatric Disorders

Hyper parathyroidism is due to increased hormones of the parathyroid gland. In this condition
psychological symptoms are common and apparently related to the raised blood level of
calcium. The psychiatric symptoms include; depression anergia (lack of energy), irritability
and cognitive impairment. In cognitive impairment the patient has poor concentration,
memory, orientation, attention and judgment.

4.4 Hypoparapiturism and Psychiatric Disorders

Hypoparathyroidism is usually due to removal or damage to the parathyroid glands after

thyroidectomy but a few cases are idiopathic. Psychiatric symptoms in this disorder include
depression, irritability, nervousness, manic depressive and schizophrenic symptoms. Patients
may also present with epilepsy.

4.5 Section Summary

Abnormalities of the parathyroid hormone may cause psychiatric symptoms.

4.6 Activity
List 2 psychiatric disorders that may result from abnormalities of the para thyroid hormones

SECTION 5: CORTICOSTEROID TREATMENT AND INSULINOMAS

Welcome to Section 5. In this section we are going to cover corticosteroid treatment and
insulinomas in relation to psychiatric disorders.

Before proceeding further, go through the objectives of this section.

5.2 Section Objectives

By the end of this section, you should be able to:

1. Discuss corticosteroid treatment and psychiatric disorders

2. Discuss insulinomas and psychiatric disorders.
5.3 Corticosteroid treatment and Psychiatric Disorders

Patients on corticosteroid treatment may develop psychological problems. These psychological

symptoms are more likely if the patient has used the corticosteroids for a prolonged period.
Psychological symptoms may include; euphoria, mild manic syndrome, depressive
disorder.

5.4 Insulinomas and Psychiatric Disorders

Insulinomas usually present between the ages of 20 and 50 years. The patient gives a long
history of transient but recurrent attacks in which the patient behaves out of character, often in
an aggressive and uninhibited. A low blood glucose concentration either during the episode or
immediately after helps in diagnosis.

5.5 Section Summary

Patients with abnormalities of the insulin hormone and corticosteroids may cause psychiatric
symptoms.

5.6 Activity
List 2 psychiatric disorders that may result from abnormalities of insulin and corticosteroids

UNIT 3: PHYSIOLOGY OF SLEEP AND MEMORY

In section 1 you will learn the physiology of sleep and the basic understanding of sleep needs
pattern and how this is dependent on physiological state of the body. In section 2 you will learn
about memory. Both the sections are useful for every human being and it is necessary to have
a good understanding.

This unit has 2 sections namely:

Section 1: Physiology of sleep

Section 2: Memory

Objectives

By the end of this unit, you should be able to:

1. Describe the physiology of sleep.

2. Discuss memory.

Next, we shall now tackle section one of this unit.

SECTION 1: PHYSIOLOGY OF SLEEP

In section 1 you will learn the physiology of sleep and the basic understanding of sleep needs
pattern and how this is dependent on physiological state of the body. In section 2 you will
learn about memory. Both the sections are useful for every human being and it is necessary to
have a good understanding.

This unit has 2 sections namely:

Section 1: Physiology of sleep

Section 2: Memory

Objectives

By the end of this unit, you should be able to:

1. Describe the physiology of sleep.

2. Discuss memory.

Next, we shall now tackle section one of this unit.

SECTION 1: PHYSIOLOGY OF SLEEP

1.1 Section Introduction

Welcome to section 1 of this unit. This is a very interesting section where you will learn on
the various psychology aspects of sleep. You will learn why you need to sleep, how much
sleep you need in 24hrs and the sleep rhythms. You will also learn the consequences of sleep
deprivation.

I hope you will enjoy this section

1.2 Section Objectives

By the end of this section, you should be able to:

1. Understand the purpose of sleep

2. Describe sleep requirements
3. Understand normal sleep rhythm
4. Describe the consequences of sleep deprivation.

1.3 Purpose of Sleep

Sleep serves a restorative, homeostatic function and appears to be crucial for normal
thermoregulation and energy conservation. Prolonged periods of sleep deprivation sometimes
lead to the following:

a. Disorganization
b. Hallucination
c. Delusions

In studies with rats, sleep deprivation produces a syndrome that includes:

a. Debilitated appearance
b. Skin lesions
c. Increased food intake, weight loss, increased energy expenditure, decreased body
temperature and death

The neuroendocrine changes resulting from sleep deprivation includes increased plasma
norepinephrine and decreased plasma thyroxine.

1.4 Normal Sleep Rhythm

Without external clues, the natural body clock follows a 25 - hour cycle. However with
influence of external factors such as light-dark cycles, daily routines, meal periods train persons
to 24-hour clock. Biological rhythms influence sleep. Within a 24 hour period, adults sleep
once or twice. This rhythm is absent at birth and develops over the first 2 years of life.

Sleep is made of two physiological states:

a. Non rapid eye movement (NREM) sleep

b. Rapid eye movement (REM) sleep.

Non rapid eye movement sleep is characterized by:

a. Slowed pulse rate but regulars (5-10 beats below level of restful waking)

b. Respiration is slow

c. Blood pressure is lower than normal

d. Involuntary body movements are present

e. Blood flow through most tissues including cerebral blood flow is reduced.

f. Pulse, respiration and blood pressure are all high during REM sleep

g. Brain oxygen use increases during REM sleep

The NREM has 4 stages with stage 3 and 4 being the deepest portion of NREM. The
percentage of time spent in each of the stages is as follows:
 a. Stage 1 - 5%

b. Stage 2 - 45%

c. Stage 3 - 12%

d. Stage 4 - 4 -13%

e. Stage 3 & 4 are the deepest portions of NREM sleep.

1.4.1 Rapid Eye Movement (REM) Sleep

Almost every REM period is accompanied by partial or full penile erection. This finding is of
significant clinical value in evaluating the cause of impotence. There is almost total paralysis
of skeletal (postural) muscles - as a result:

a. Body movements are absent during REM sleep

b. Dreams occur commonly in REM (Dreams do occur in NREM but are typically lucid
and purposeful). The cyclical nature of sleep is regular and reliable.
c. A REM period occurs about every 90-100mm during the night.
d. The first REM period tends to be short usually less than 10 minutes.
e. The latter REM periods may last 15-40 minutes.
f. Most REM periods occur in the last third of the night.
g. Sleep patterns change of over life span in neonates 50% of sleep is REM
h. While in adults only 25% of sleep is REM.
i. Newborns sleep about 16 hrs a day.
j. In adulthood the distribution of sleep stages is as follows;-
k. Sleep patterns change of over life span in neonates 50% of sleep is REM
l. While in adults only 25% of sleep is REM.
m. Newborns sleep about 16 hrs a day.

In Reduction of REM sleep occurs in the elderly.

1.5 Sleep Requirements

There are 2 groups of persons as far as sleep requirements is concerned.

a. Short sleepers who require fewer than six hours of sleep each night and who function
adequately.

b. Long sleepers - who require more than nine hours each night in order to function
adequately.

Short sleepers are generally efficient, ambitious, and content and socially outgoing. Long
sleepers tend to be mildly depressed, anxious and socially withdrawn. However increased
sleep needs occurs with:

a. Exercise
 b. Physical work
c. Illness
d. Pregnancies
e. General mental stress
f. Increased mental activity
g. 1.6 Section Summary
h. Sleep is biologically controlled. Adequate and quality sleep is necessary for normal
functioning of the body. Some medical and psychological disorders will change sleep
quantity, quality and pattern.

i. 1.7 Activity
j. In a group of classmates, discuss your individual sleep requirements
k.

l. Review Question
m. Describe the consequences of sleep deprivation
n.

SECTION 2: MEMORY

Memory is an important function in every human being. Remembering helps us relate with
what has been encountered. This is an important function even for you as a student who is
expected to remember what you have been taught in class and retrieve the same during
examination. In this section you will learn about memory processes, memory encoding and
types of memory. You will also learn about forgetting and why people forget. This topic is not
just important for you as a clinician but also as a student. Hope you enjoy the session.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Define memory processes

2. Discuss memory encoding
3. Outline types of memory
4. Discuss forgetting and reasons

2.3 Introductory Concepts of Memory Processes

Memory is the retention of information over time. The following are the memory processes:

1. Registration

This is ability to add new material to existing store of memories.

2. Retention

This is the ability to retain memory.

3. Recall

This is the ability to bring it back to awareness. Recall is the process by which material
previously learned is retrieved into remembrance.

4. Recognition

Recognition is a feeling of familiarity indicating correct, that a particular person, object or

event has been encountered before.

Memory may be divided into:

a. Working (recall) memory: also called short term retained for as long as 30 secs unless
information is rehearsed.
b. Recent memory: holds recent information
c. Long term memory: a relatively permanent type of memory that holds huge amounts of
information for a long time.

2.4 Memory Encoding

Encoding involves how information gets into memory. Storage consists of the retention of
information over time and retrieval takes when information is taken out of storage.

In everyday experiences, encoding has much in common with learning. When you are listening
to a lecture, watching a movie, listening to music or talking with a friend, you are encoding
information into memory. Some information gets into memory virtually automatically, while
getting other information in takes effort.

Some of the encoding processes that require effort are:

a. Rehearsal
b. Deep processing
c. Elaboration
d. Imagery
e. Organization

2.4.1 Rehearsal

Rehearsal is the conscious repetition of information that increases the length of time that
information stays in memory. Rehearsal works best when we need to remember a list of
numbers or items for a brief period. It is not efficient to remember information over a long
time.

2.4.2 Deep processing

Fergus Craik and Robert Lockhart (1972) proposed that people process information at different
levels. Their theory, levels of processing theory, states that memory is on a continuous from
shallow to deep, with deeper processing producing better memory.
At the shallow level only the sensory of physical features of the stimuli are analyzed while at
the intermediate level the stimulus is recognized and labeled while at the deepest level
information is processed semantically in terms of its meaning. A number of studies have shown
that people’s memories improve when they make association to stimuli as opposed to physical
aspects. They are more likely to remember something in the deep rather than a shallow level.

2.4.3 Elaboration

Cognitive psychologists soon recognized that there is more to a good memory than just deep
processing. Within deep processing the more extensive the processing the better the memory.

Elaboration is the extensiveness of processing at any given depth in memory e.g. rather than
memorizing the definition of memory, you would do better to learn the concept of memory by
coming up with some examples of how information enters your mind, is stored, is retrieved,
until to understand it.

2.4.4 Imagery

How many windows are in your apartment or house. If you live in a single room the answer is
easy but few of us have memorized that information but may believe we can get a correct
answer if we use imagery to ‘reconstruct’ each room.

Studies by Allan Palvio (1977, 1986) document how imagery can improve memory. Palvio
argues that memory is stored in one of 2 ways as verbal code or as image code e.g. a picture
can be remembered by a label (verbal code) or mental image (image code). Palvio believes that
image code, which is highly detailed and distinctive produces better memory.

The dual-code hypothesis claims that memory images is better because the memory for concept
image is stored both as an imaginal code and verbal code thus providing 2 potential avences
by which information can be retrieved.

Although imagery is widely accepted as an important aspect of memory, there is controversy

over whether we have separate codes for words and images.

2.4.5 Organization

Researchers have found that if people simply are encouraged to organize materials, their
memory of the maternal improves even if no warning is given that their maternal will be tested.
In many instances we remember information better when we organize it hierarchically. A
hierarchy is a system in which items are organized from general to specific classes.

Chunking is another beneficial organization memory strategy that involves grouping or

“packing” information into higher order units that can be remembered as a single unit e.g. O L
D H A R O L D A N DYO UNGBEN. It’s easier when chunked as Old Harold and young
Ben.

2.5 Forgetting

To retrieve something from your mental data bank, you search your store of memory to find
the relevant information. There are various concepts on retrieval.
 1. Tip of the tongue phenomenon. (TOT state)

It is a type of “effortful retrieval” that occurs when people are confident they know
something but just can’t quite seem to pull it out of memory.

2. Serial position effect – that recall is superior for items at the beginning and at the end
of list e.g. giving direction, turn left then right on central, keep straight then right on
park side.

2.5.1 Retrieval Cues and Retrieval Task

Two other factors involved in retrieval are

a) The nature of the cues that can prompt your memory

b) The retrieval task that you set for yourself.

Cues help you remember e.g. going through the alphabet generating names that begin with
each letter may help you stumble on the right name. While cues help, your success in
retrieving information also depends on the task you set for yourself e.g. deciding if something
is familiar is easier than remembering her name.

These 2 factors cues and retrieval task are involved in an important memory distinction recall
versus recognition memory.

Recall is a memory measure in which the individual must retrieve previously learned
information as an easy test. Recognition is a memory measure in which the individual only
has to identify (Recognize learned items, as on MCQ tests. Most students prefer MCQ for
they are easier than essay test.

Do you remember faces (Recognition) better than names (Retrieval).

2.5.2 Priming

Retrieval also benefits from priming, which involves activating particular connections or
associations in memory. In many cases, these associations are unconscious.

2.5.3 Reasons for Forgetting

1. Interference

Interference theory states that we forget not because memories are actually lost from storage,
but because other information gets in the way of what we remember. Two kinds of
interference.

a) Proactive: - occurs when material that was learned earlier disrupts the recall of

material learned later.

b) Retroactive interference: - occurs when material learned later disrupts retrieval of

 information learned earlier.

2. Decay theory states that when something new is learned, a neurochemical memory trace is
formed but over time this trace tends to decay. Sometimes older memories will remain intact
even after a long time especially if they were emotional.

2.5.4 Amnesia

Amnesia is loss of memory and there are 2 types of amnesia. Anterograde amnesia: this is a
memory disorder that affects the retention of new information or events.

Retrograde amnesia: this is memory loss for a segment of the past but not new events. It is
more common than anterograde amnesia and frequently occurs from head injury. The key
difference is that Anterograde amnesia is that the forgotten information is old (prior to the event
that caused amnesia) and the person’s ability to acquire new memories is not affected.

2.6 Section Summary

Memory is the retention of information over time. Amnesia is loss of memory. There are four
memory processes and 3 types of memory.

2.7 Activity
Discuss how you can improve your memory

HCH100: BEHAVIOURAL SCIENCES - HEALTH CARE AND HEALTH CARE

SYSTEMS

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

UNIVERSITY OF NAIROBI DEPARTMENT OF PSYCHIATRY

In collaboration with

CENTRE FOR OPEN AND DISTANCE LEARNING

HCH 100: BEHAVIOURAL SCIENCES

MODULE 10: HEALTH CARE AND HEALTH CARE SYSTEMS

2014

Copyright
Behavioural Sciences Course to Undergraduate Students in the College of Health Sciences by
Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

© University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced
in any form or by any means without permission in writing from the Publisher.

Writer: Prof. Caleb Othieno

Reviewer:

Chief Editor: Joshua M. Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

The University of Nairobi (UoN), College of Health Sciences wish to acknowledge the
contribution of the Department of Psychiatry and PRIME-K whose financial assistance made
the development of this e-learning course possible.

Module Introduction
We have now come to the last module in the Behavioural Science course. In this module you
will learn about the health services and roles of the health workers including the auxiliaries.
In addition we shall discuss the health delivery and pathways to care. In mental health
systems we shall learn about the roles of the various social agencies especially how they
interact and complement each other. As a doctor you will be working not only with other
medical professionals such as nurses and psychologists but will also be interacting with
professionals from diverse backgrounds such as lawyers and politicians in formulating health
policies. We therefore hope that what you learn in this module will hone your managerial
skills and make you better advocates for health promotion and management. In module 6 we
learnt about the doctor-patient relationship. We shall go into more details in medical ethics as
we learn about the moral obligations of a doctor and the principles guiding medical ethics.

This module is divided into 4 units namely:

Unit 1: Health care systems, determinants of use of health facilities and pathways to care

Unit 2: Health and social policies; roles of auxiliaries in health services

Unit 3: Guiding principles of medical ethics and decision making in health care

Unit 4: Health Care Profession, work stress and Iatrogenic Disorders

Let us go through the objectives that will guide our discussion.

Module Objectives

By the end of this module you should be able to:

1. Outline the structure of the Kenyan health care system including mental health.
2. Describe the health and social policies and the role of auxiliaries in the health
services.
3. Describe the guiding principles of medical ethics and decision making in health care.
4. Describe the effects of stress on the health care profession and iatrogenic disorders.

UNIT 1: HEALTH CARE SYSTEMS, DETERMINANTS OF USE OF HEALTH

FACILITIES AND PATHWAYS TO CARE

This is the first of the four units of this module on Health Systems. In this unit we shall
outline the structure of the health care system in Kenya and also look at the pathways and
stages that an individual goes through before they receive the appropriate treatment for their
medical problem. An understanding of these processes will enable you as doctor to appreciate
the patients' expectations and fears. It will also help you to see how the services should work
together and complement each other and how you fit into the bigger picture.

This unit is divided into three sections, namely:

Section 1: Health Care Systems in Kenya

Section 2: Determinants of use of the Health Services

Section 3: Pathways to Care

I hope this unit will motivate you to learn more about health care systems.

Unit Objectives

By the end of this unit, you should be able to:

1. Describe the health care system in Kenya.

2. Discuss the determinants of use of the health services.
3. Describe the pathways to care.

We now start the first section of this unit by looking at the health care systems in Kenya. This
section should give you an idea of the various levels of care from the community level to the
tertiary referral hospitals with specialised personnel and equipment.

SECTION 2: DETERMINANTS OF USE OF HEALTH FACILITIES AND PATHWAYS

TO CARE

Many factors may influence an individual’s behaviour and the same is true regarding health
seeking behaviour. The decision to see medical personnel or to visit a hospital can be
influenced by environmental and cultural factors. The doctor needs to be aware of these factors
so that he can act in the best collaborative manner possible as he prescribes treatment and offers
advice to the patient.

Let us begin by looking at the objectives of this section.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Describe reactions to illness.

2. Discuss health seeking behaviour.
3. Discuss the determinants of use of health facilities.
4. Describe the pathways to care.

Good, now we shall start by discussing the first sub-section in detail.

2.3 Response to Illness

How do we respond when we feel ill? People respond to the presence of illness in various ways
that include:
 a. Reduce or stop what you are doing, stay home
b. Wear different clothes, pyjamas, loose fitting clothes, dressing gowns
c. Eat and drink different food
d. Expect others to help us

These factors are all important because an individual should be willing to accept help
appropriately offered. Other factors influencing response to illness include:

a. Severity of illness,
b. Expectations of how one should react (cultural expectations),
c. Gender,
d. Social background, and
e. Expectations of others.

The expectations of others could include decision of whether to see a doctor or not, take advise,
recover, or return to normal life. The type of help is also determined by personal and cultural
factors. In particular, health beliefs concerning the causation of illness may determine whether
help is sought from a traditional healer, faith healer or a conventional biomedical doctor. The
response and concerns of relatives is also equally important.

Complications associated with the illness also determine the response to illness. For example
when illness an illness long-term or chronic; or when an illness has an insidious onset such as
hypertension and the symptoms are not obvious.

Insight: Insight into an illness also determines the illness response. It can be considered as “a
correct attitude to morbid change in oneself’ (Lewis, 1934). It involves awareness of disease;
correct labelling of abnormality and willingness to take treatment. The concept of insight is
multidimensional and incorporates both current and retrospective components. It is usually not
an ‘all-or-none’ phenomenon (David, 1990). Medication compliance and awareness of illness
are separate but overlapping constructs which contribute to insight. For example, to assess
insight in a mentally ill patient one should consider recognition of illness (signs, symptoms,
etc.), attribution of illness (attribution of illness phenomena to a mental disorder), awareness
of treatment, awareness of social consequences of illness, e.g. disability, involuntary committal
to hospital.

2.3.1 Altered Thinking in Physical Health Problems

Ones views of illness can be altered in several ways. There could be uncertainty about the
causes of the illness, diagnosis and the future. Feelings of helplessness and low expectations
regarding how one can improve things may occur. Ones view of doctors and others around him
may also change. It may seem to the individual that the hospitals have let him down, no one
understands him and that he does not deserve help. The focus of the mind may be solely on the
body. Excessive attention to physical symptoms and bodily processes may alter how the person
feels and may also lead to unhelpful thinking styles. Some of the unhelpful thinking styles are
listed below.
Altered behaviour during an illness could include reduced activity and avoidance. Unhelpful
behaviours such as excessive awareness/checking for illness; reassurance seeking, self-
medication and use of alcohol and drugs may occur.

2.4 Health Seeking Behaviour

We hope that you are now ready to start session 1

Let us begin by asking a question

Activity 2.2
Think of the process you or your close relative went through before your last consultation
with doctor or hospital visit. List down the steps you went through.

Generally before one consults a doctor they must decide whether or not they are ill. And if they
are ill is any intervention needed. At this point the draw on their previous experience and may
also consult close relatives. There are healthy ways of responding to an illness that would
maximise the likelihood of a good outcome. The response to illness could also be abnormal
leading to further complications. We shall first look at the former.

2.5 Determinants of use of Health Services

Before we consider the determinants of use of health services it is useful to remind ourselves
of the determinants of illness behaviour. Some of these are summarised below:

 the visibility and recognisability of symptoms

 the extent to which symptoms are seen as being serious
 knowledge and cultural understanding of the symptoms
 basic needs leading to denial
 competition between needs and illness responses
 competing interpretations assigned to symptoms
 availability and proximity of treatment resources and the costs in terms of time, money,
effort, and stigma

The cultural understanding of the illness is important. For example, in cases where the
individual thinks that the illness is caused by supernatural causes or witchcraft then hospital
treatment may not be sought in the first instance. It is however common for the indigenous
people in this country to use both the traditional and the biomedical services concurrently. Thus
hospital treatment is sought to treat the immediate threat but the perceived real cause of the
illness still has to be removed by a traditional healer either a herbalist, diviner or faith healer.

2.6 Pathways to Care

As we have seen in the first unit the health services were designed such that the first point of
contact with the health services should be the primary health workers and the dispensaries.
Serious cases would then be referred to the next level as the situation demands. In reality walk
in – walk out clinics tend to be operated at most levels with the exception of the referral
hospitals. At each point there could be hindrances to the health services. These are known as
filters. Some of the barriers are listed below.
 a. Social factors: age, sex, ethnic background, socioeconomic status
b. Service organization and provision: time and location of clinics, length of waiting list
c. Aspects of the disorder itself for example severity
d. Chronicity of the disorder or illness
e. Decision to consult the primary care provider
f. The recognition of the disorder by the primary care provider
g. The decision by the primary care provider as to whether or not to refer the patient to a
specialist

Because of the differentials in access to health care by different sectors of the

population, studies in the western countries have shown that risk of death before retirement
was 2.5 x greater in social class V than in social class I; in social class V, the neonatal mortality
was twice as high and that there is ‘a consistency of class gradients in mortality throughout the
lifetime’

2.6 Section Summary

In this session we have learnt about the reactions to illness including both useful and harmful
coping styles. We have also learnt about the determinants of use of health services and
pathways to care.

UNIT 1 REVIEW QUESTIONS

For each of the questions below choose the best response out of the five choices
The functions of a dispensary in the health care systems involves the following except

Household visits
Provision of antenatal care
Immunizations
Filling prescriptions prescribed by doctors
Dressing wounds

The following statements are true except

All dispensaries should be manned by an appropriately trained doctor

Only qualified doctors should inject patients
Ideally intensive care units should be established in all district hospitals
Basic diagnostic tests such as blood tests for malaria should be available at the
dispensary level
Consultant medical personnel are not usually required at the dispensary level.

Referral Hospitals should perform the following except

Teaching and training

 Research
Accept referrals from the lower care levels
Routinely carry out quality assessments
Mainly focus on preventive medical care

UNIT 2: HEALTH AND SOCIAL POLICIES AND THE ROLE OF AUXILIARIES IN

THE HEALTH SERVICES

Health policies are useful in guiding and coordinating the response to health challenges. In this
unit we shall look at the Kenya health policy and other specific related policies such as the
mental health policy. No coordinated plans can be effected without a policy and it is a matter
of great concern that 40.5% of countries in the world have no mental health policy and that
30.3% have no programme. The health field is affected by many policies, standards and
ideologies that are not necessarily directly related to health. We shall look at a few of the
related social policies. Likewise health provision is not only done by the doctors. A holistic
approach is needed for the complete well being of the individual. In this regard other personnel
and support staff are essential. We shall therefore examine the role of auxiliaries in the health
services in the fourth section of this unit.

This unit is therefore divided into four sections as follows:

Section 1: Kenyan Health Policies

Section 2: Social Policies

Section 3: Kenya Mental Health Act

Section 4: Auxiliaries and their Role in the Health Service

Before proceeding further with the unit, let us familiarize ourselves with the objectives of this
unit.

Unit Objectives

By the end of this unit, you should be able to

1. Describe the Kenyan health policies.

2. Describe social policies.
3. Describe the Kenya Mental Health Act.
4. Describe the auxiliaries and their role in the health service.

Good! It’s my belief that we are now ready for the first section of this unit.

SECTION 1: KENYAN HEALTH POLICIES

This is the first section of the unit on health and social policies and the role of auxiliaries in the
health services. We shall learn why it is essential to have a health policy and how it relates to
plans and programmes. I hope this section will encourage you to examine more closely if we
have suitable policies in place. We shall start by first defining and distinguishing between
policies, plans and programmes.

Let us begin by looking at the objectives of this section.

Section Objectives

By the end of this section, you should be able to:

1. Define policy, plans and programmes.

2. Describe the steps in policy development.
3. Describe the Kenya Health Policy.
4. Describe the Kenya Mental Health Policy.

In-Text Question 1.1

What is a policy and how is it related to plans and programmes?

1.3 Policy, Plans and Programmes

A policy is a statement of intent. A policy is an organized set of values, principles and

objectives for improvement. Just as institutions may set for themselves visions in the same way
a country may have a policy to guide its ideals and aims. Thus a policy is a way of doing
something that has been officially agreed and chosen by an institution.

A plan defines priority strategies, time frames, resources, targets and activities for
implementing the policy.

A programme focuses on specific health issues which require concentrated and usually shorter
term interventions.

A health policy is essential to coordinate all services and activities related to health. Without
adequate policies and plans, aspects of health are likely to be treated in an inefficient and
fragmented manner.
In-Text Question 1.2
Does Kenya have a health policy?

Currently there is The Health Bill, 2014 that is under discussion in parliament.

1.4 Policy Development

Developing a policy is a process and takes many consultative meetings to ensure that all
interested parties give their views. This is an outline of the steps.
a. Assess the population needs

b. Gather evidence for effective strategies

c. Consultation and negotiation

d. Exchange with other countries

e. Set the vision, principles and objectives of the policy

f. Determine areas of action

g. Identify the major roles and responsibilities of different sectors

Some of the agencies involved in the development of health policy and plans also have specific
roles to play. These should be clearly stated in the plans. Some of the institutions that need to
be engaged are:

a. Governmental agencies (health, education, employment, social welfare, housing, justice)

b. Academic institutions

c. Professional associations

d. General health and mental health workers

e. Consumer and family groups

f. Health providers

g. Nongovernmental organizations (NGOs)

h. Traditional health workers

In developing plans the following steps should be followed

a. Determine the strategies and time frames

b. Set indicators and targets

c. Determine the major activities

d. Determine the costs, available resources and the budget

Areas for specific action could include the following:

a. Financing

b. Legislation and human rights

c. Organization of services

d. Human resources and training

e. Promotion, prevention, treatment and rehabilitation

f. Essential drug procurement and distribution

g. Advocacy

h. Quality improvement

i. Information systems

j. Research and evaluation of policies and services

k. Intersectional collaboration

1.5 Kenyan Health Policy

Kenya is in the process of developing a comprehensive health policy and a bill has been
developed. The outline of the bill is given below. Notable is the emphasis on health promotion
and preventive measures as opposed to curative service. Recognition is also given to the
traditional healers who have hitherto been licensed under the ministry of social services with
little or no attention to safety measures. Another new inclusions is the proposed use of
information and communication technology (ICT) in form of e-health.

1.5.1 The Kenyan Health Bill, 2014

“The bill an act of Parliament to establish a unified health system, to coordinate the inter-
relationship between the national government and county government health systems, to
provide for regulation of health care service and health care service providers, health products
and health technologies and for connected purposes”.

It intends to give guidelines for the establishment and regulation of the following institutions:

a. Establishment of the Kenya health professions oversight authority

b. Regulation of health products and health technologies

c. Promotion and advancement of public and environmental health

d. Mental health

e. Traditional and complementary medicines

f. Human organs, human blood, blood products, other tissues and gametes

g. Health financing

h. Private sector participation

i. Promotion and conduct of health research

j. E- health

k. Inter- departmental collaboration

1.6 Kenya Mental Health Policy

“A mental health policy and plan is essential to coordinate all services and activities related
to mental health. Without adequate policies and plans, mental disorders are likely to be
treated in an inefficient and fragmented manner” WHO, 2004. Despite this, Kenya is among
the countries with no mental health policy. The mental health workers in the country are
well aware of this and have been trying to develop a mental health policy but have met
many obstacles. This perhaps reflects the low priority given to mental health.
More recently an increasing number of nongovernmental organisations including human
rights activists have joined the fray and a bill is currently in parliament albeit with some
controversial issues pending. Generally the bill aims to:
a. Reduce the incidence and prevalence of specific mental disorders in the general
population.
b. Reduce the mortality associated with specific mental disorders both from suicide and
physical illness.
c. Reduce the extent and severity of problems associated with specific mental disorders.
d. Ensure that appropriate care services are provided address mental health problems
with a “basket” of essential health and social services.
e. Reverse people’s negative perceptions of mental disorders.
f. Continue research in the causes, consequences and care of mental disorders.
g. Provide comprehensive mental health care services
h. Integrate mental health programmes in primary health care (PHC) activities.
i. Train adequate mental health personnel.
j. Ensure equitable access mental health care services.
k. Increase the annual health budgetary allocation for mental health.
l. Develop effective mental health management information systems.
m. Develop mental health promotion and education programmes.
 n. Encourage and promote effective collaboration and partnership with all mental health
stakeholders.
o. Ensure advocacy for mental health among all stakeholders.
p. Carry out operational research provide data for purposes of policy formulation and
evaluation of mental health services.

1.7 Section Summary

In this section we have described policies, plans and programmes and how they relate to each
other. We have given specific c examples from Kenya to illustrate the importance of each. I
hope you will now have a better understanding of mental health systems from this
perspective.

SECTION 2: KENYAN SOCIAL POLICIES

In the first section of this unit we considered health policies and what they contain. In this
section we shall look at social policies and see how they relate to the health policies.

Let us begin by looking at the objectives of this section

2.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the Kenyan social policies.

2. Explain the relationship between social policies and health policies.

2.3 Kenyan Social Policies

The health field is affected by many policies, standards and ideologies that are not necessarily
directly related to health (WHO, 1987; WHO, 2001). Indeed the health and social acts could
be combined into one comprehensive document such as the Health and Social Care of the UK
(2012). Related social policies include

1. Education programmes (low education is related to poor health)

2. General Public Health interventions
o Health (chronic illness)
o Immunisation programmes
o Child health surveillance
o Promotion of sexual health
o Programmes to reduce substance abuse (Alcohol policy)
o Alternative and complementary medicine (traditional healers)

3. Social
  Programmes to promote safe environment
 Driving and licensing laws
 Welfare and employment policies,
 Taxation
 Economic programmes (poverty, debt)
 Maintenance of law and order (exposure to violence)
 Policies specifically addressing the young and the old, and housing,
 City planning and municipal services

2.4 Social Policies in Relation to Health Policies

 The narrow view of medical services as comprising only of curative services is no

longer acceptable. We have to do more to prevent the diseases occurring in the first
place. And once the disease has occurred, it is not only necessary to cure it but also to
minimise its effects through appropriate rehabilitation and even modification of the
environment. With this in mind it is easy to see how the policies listed above augment
the health policies. For example, appropriate driving and licensing laws will minimise
injuries sustained from road traffic accidents. Child health surveillance and
immunisation will prevent many childhood diseases some of which could be
debilitating such as polio. Another example is that a literate individual is better able to
comprehend some of the hygienic measures to combat disease such as use of toilets and
hand washing.

2.5 Section Summary

In this section we have examined the social policies and how they relate to the health policies
in trying to achieve the goal of good health for all. In the next section we shall examine in
details the laws governing the treatment of the mentally ill. This is a vulnerable group that
needs to be protected from harm and exploitation by others.

SECTION 3: KENYA MENTAL HEALTH ACT

Welcome to Section 3. In this section we are going to discuss the Kenya Mental Act and how
it is related to general aspects of health.

Let us begin by looking at the objectives of this section.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the major components of the Kenya Mental Health Act.

2. Discuss the Kenya Mental Health Act.

3.3 Overview and need for Mental Health Act

 Mentally ill people are a vulnerable group and may be at risk of abuse. At the same time they
may cause harm to others or themselves. It is therefore essential that their treatment be guided
by special laws. The principles for the protection of persons with mental illness and the
improvement of mental health care (WHO, 1991) include:

a. Fundamental freedoms and basic rights

b. Right to best available mental health care

c. Right to treatment humanely and respect

d. Right to protection from economic, sexual, other forms of exploitation, physical or other abuse
and degrading treatment

e. No discrimination on the grounds of mental illness

f. Right to exercise all civil, political, economic, social and cultural rights

The Mental Health Act currently in use in Kenya was established in 1989. Since then a number
of changes have occurred hence it became necessary to review the act. Moreover there was a
perception that vital areas dealing with the prevention of mental illness and the rehabilitation
of persons with mental illness had not been adequately addressed. The human rights issues
were also not adequately addressed and having mental illness was taken to mean that one could
not enter into any contract regardless of the capacity of the person at that particular time. The
proposed Mental Health Act 2014 is designed “to amend and consolidate the law relating to
the treatment, care and rehabilitations of persons with mental disorder; to provide for
procedures for admission, treatment and general management of their estates; for the
management and control of mental health care facilities; and for connected purposes”.

3.4 Components of the Mental Health Act

It covers the admission and treatment of voluntary and involuntary patients. Some of the
highlights of the proposed bill include the following:

a. No treatment shall be given to a patient without his or her informed consent, except in
special cases such as involuntary patients
b. Where any treatment is authorized without the patient's informed consent, every effort
shall nevertheless be made to inform the patient about the nature of the treatment and
any possible alternatives and to involve the patient as far as practicable in the
development of the treatment plan.
c. Physical restraint or involuntary seclusion of a patient shall not be employed except in
accordance with the officially approved procedures of the mental health facility and
only when it is the only means available to prevent immediate or imminent harm to the
patient or others Sterilization shall never be carried out as a treatment for mental illness.
d. A major medical or surgical procedure may be carried out on a person with mental
illness only where it is permitted by domestic law, where it is considered that it would
best serve the health needs of the patient and where the patient gives informed consent,
except that, where the patient is unable to give informed consent, the procedure shall
be authorized only after independent review.
e. In no circumstances shall a patient be subject to forced labour.
 Activity 3.1
Discuss with your tutor the implications of the points highlighted from the proposed Mental
Health Act.

3.5 Section Summary

In this session we have learnt the importance of policies in directing health related plans and
programmes. We considered specific policies and saw how various other policies could affect
health.

In the last section we looked at special laws governing the admission and treatment of the
mentally ill. We saw that in special circumstances a person who is suffering from mental
illness may be deprived of his liberty and treatment offered against his will. We shall revisit
this issue again in the last unit of this module that deals with medical ethics. But first in the
final section of this unit we consider the role of auxiliaries in the provision of health services.

SECTION 4: AUXILIARIES AND THEIR ROLE IN THE HEALTH SERVICES

In this section you will learn about other professionals who work together with health care
personnel and support staff. In providing a holistic care to the patient a bio-psychosocial
approach is often used. Because of this several personnel are often involved. Some of these are
part of the health team but there could also be other non-medical personnel. Apart from doctors,
some of the staff involved in caring for the ill includes psychologists, social workers,
occupational health workers and physiotherapist. There are also other professionals such as
counsellors, teachers, paediatricians, speech therapists, and lawyers.

Let us begin by looking at the objectives of this section.

4.2 Section Objectives

By the end of this section, you should be able to:

1. Describe the auxiliaries in the health care.

2. Describe the role of auxiliaries in the health care.

Good, now we shall start by discussing the first sub-section in detail. We shall first look at
the types of auxiliary staff that exist in health care and then consider their roles in the next
section.

4.3 Auxiliaries in the Health Services

An auxiliary is a person or thing providing supplementary or additional help or support. As

applied in the health service it refers to individuals or group of professionals who work with
the health care personnel in a supporting or augmenting capacity. Each country has its own
peculiar history and needs so the types of auxiliaries in a particular setting may not be exactly
similar to another area. For example, in the UK there are the health care assistants who work
in hospital or community settings. They would be guided by the qualified medical staff for
example general practitioners or nurses. In the latter case they are known as nursing auxiliaries
or auxiliary nurses. Other examples include clinical support workers such as physiotherapists,
radiographers, podiatrists, speech and language therapists, dieticians, occupational therapist
and dental hygienist. Donor carers, dramatherapists and chaplains may also be considered as
auxiliary staff.

In Kenya we have the dressers who work in dispensaries and even hospitals caring for surgical
patients by attending to their wounds. The concept of clinical assistants or clinical officers was
aimed at having staff that could assist doctors.

Activity 4.1
Look up and list all the auxiliary staff you can find. Can you think of other essential staff that
may be needed in patient care?

4.4 Role of Auxiliaries in the Health Care

Auxiliary staffs play an import role in patient care. As you will have learnt in the holistic
approach to medical care the sick patient has many needs that require team work from diverse
professions. You will also appreciate that the training of doctors is expensive and takes long.
It would therefore not be practical to have doctors perform all the duties related to patient care.
This is especially so if the task required is fairly routine. Locally there are many other
volunteers and people who work in various fields. The proposed health bill hopes to provide a
framework for the coordination and cooperation of the various bodies.

In Kenya, before many doctors were trained, the cadre of clinical officers fulfilled the role of
doctors. It took a shorter time to train them and they could perform most of the tasks that a
doctor would be expected to do. This approach has remained useful especially in specialties
such as ear nose and throat (ENT), surgery, ophthalmology and anaesthesia.
Take Note 4.1
Most of the staff described above under auxiliary play important roles in their own right and
may be the only staff available in certain settings. Therefore the term auxiliary should be
used carefully.

4.5 Section Summary

In this last section we considered the auxiliaries in health care and the roles they play. We
reiterated the need fro a holistic approach in medical care and saw how the systems can work
more efficiently with task sharing.

We have now come to the end of this unit on health and social policies and the role of
auxiliaries in the health services. In the next unit we shall consider the rules that govern the
behaviour of medical personnel in health care under medical ethics and decision making.

REVIEW QUESTIONS
Discussion question

1. What are the differences between a policy, a plan and a programme? How are they
related?

2. Critically discuss why traditional healing practices should be included in the Kenya
Health Bill.

3. Why are auxiliary staffs crucial in the provision of health services?

For each of the following statements indicate whether true or false

1. Auxiliary staff refer to individuals who work with the health care personnel in a
supporting or augmenting capacity True
2. Auxiliary staff in medical care are exactly the same across all
counties False
3. The Mental Health Act states that no treatment may be given to a patient without his
consent in all circumstances False
4. The World Health Organisation lays down the principles for the protection of persons
with mental illness and the improvement of mental health care. True.
5. Patients should always be informed about the nature of the treatment they are given
even if they refuse to give consent True

We have now come to the end of this unit on health and social policies and the role of
auxiliaries in the health services. In the next unit we shall consider the rules that govern the
behaviour of medical personnel in health care under medical ethics and decision making.

UNIT 3: GUIDING PRINCIPLES OF MEDICAL ETHICS AND DECISION MAKING IN

HEALTH CARE

In this unit we shall discuss the guiding principles of medical ethics. We shall see the harms
and difficulties that may arise if appropriate ethical standards are not adhered to. As a doctor it
is essential that you conduct yourself in a manner that upholds the high esteem of the
profession. Because patients often entrust us with their emotions and innermost private feelings
they have to be confident that they are dealing with people of high moral standards and
impeccable character. In whatever you do you should do no harm to the patient.

This Unit has three sections, namely:

Section 1: Concepts of Medical Ethics

Section 2: Aspects of Law Related to Medical Ethics

Section 3: Current Bioethical Issues

 Unit Objectives

By the end of this unit, you should be able to:

1. Discuss the concepts of medical ethics.

2. Describe aspects of law related to medical ethics.
3. Discuss the current bioethical issues.

In the first section of this unit we shall consider the definitions of medical ethics and the
principles on which they are built.

SECTION 1: CONCEPTS OF MEDICAL ETHICS

This is the first section of this unit on principles that with guide your day to day behaviour as
a doctor. It is therefore important that you have a clear idea of the concepts on which they are
built.

We hope that you are now ready to start session 1. Let us begin by looking at the objectives
of this section.

Section Objectives

By the end of this section, you should be able to:

1. Define medical ethics.

2. Describe the doctor’s duties.
3. Explain the principles guiding medical ethics.

Good, now we shall start by discussing the first sub-section in detail.

1.3 Medical Ethics

Let us begin by asking a question.

In-Text Question 1.1

How do you define medical ethics?

We can therefore see why the study of ethics is not only of interest to physicians but also to
theologians and lawyers.
Medical ethics is mainly physician centred but there is also health care ethics that includes
nurses and other healthcare providers. Clinical ethics is concerned with hospital case decisions
while bioethics deals with general issues of reproduction, equitable distribution of organs or
other scarce resources and also the protection of the biosphere.

Examples of what medical ethics deals with include patient – doctor relationship, third party
evaluations: need to disclose to the patient, conflicts of interest between physicians and their
employers and third-party payers, public and private; confidentiality; medical record,
disclosure, informed decision making and consent. the rights of patients or their surrogates to
refuse life-sustaining treatments or request assistance in dying; drug experiments on children,
demented or dying patients, and other incompetent or desperate patients; bias-free definitions
of health, death, disease, and futility of treatment; removing viable organs from patients who
are brain dead or in cardiac arrest; grounds for foetal testing, selection, and abortion;
involuntary hospitalization and treatment of mentally disturbed people.

Before we get into details about the guiding principles in medical ethics we need to outline
the doctor’s duties.

1.4 Doctors Duties

In-Text Question 1.2

What are the doctor’s duties?

A doctor’s duties include:

a. The care for patients,

b. Research and
c. Teaching.

The last two duties are often not emphasised but they are equally important. Whatever field or
location you are working it is important that you keep abreast with the latest advances in the
medical field and also think of ways in which the practice of medicine can be improved. It is
also essential that such knowledge is shared among the medical fraternity. You will also have
a duty to teach your junior colleagues.

Take Note
The time spent in each of the three activities will of course differ depending on the nature of
employment. A researcher in a laboratory may have minimal or no contact with patients.
However what he does impacts on patients care.

We shall now describe the principles guiding medical ethics

1.5 Principles Guiding Medical Ethics

The following four are the principles that guide medical ethics:

a. Beneficence: The duty to promote good and act in the best interest of the patient and
the health of society
b. Non-maleficence: The duty to do no harm to patients
c. Respect for patient autonomy: The duty to protect and foster a patient’s free, un-
coerced choices
d. Justice: The equitable distribution of the life-enhancing opportunities afforded by
health care

While it is desirable to promote good and act in the best interest of the patient as noted in the
principle of beneficence you should note that you should protect and foster the patient’s free,
un-coerced choices. In order to determine whether a patient is able to give consent to treatment
we have to determine whether on not they are competent to do so.

1.6 Section Summary

In this section we have defined ethics and outlined a doctor’s duties. In addition we have
described the principles that guide the approach to ethics. In the next section we shall look at
how the medical ethics relate to the laws.

SECTION 2: LAW AND MEDICAL ETHICS

In the previous section we defined ethics and described how a doctor is expected to conduct
himself with regard to patient care. In this section you will learn about common law principles
in relation to medical ethics.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Describe capacity assessment and treatment without consent.

2. Describe the common law principles.
3. Discuss concepts of doctor-patient confidentiality.
4. Describe landmark court cases relating to medical ethics.

Before we consider the common law principles we shall look at another concept that is related
to patient management. The common law principles outlined below presumes that an adult has
capacity to make decisions. We shall therefore describe how this can be assessed using some
examples.

2.3 Capacity Assessment and Treatment without Consent

In assessing capacity we have to determine the following:

1. capable of understanding the nature of the proposed treatment the alternatives to it

2. the risks, benefits, and consequences of it (ability to weigh the evidence)
 3. Ability to communicate the decision

Activity 2.1

Case vignette:

The wife of a 40 year old business man is concerned that the husband is drinking a lot of
alcohol and would like him to be admitted to hospital for treatment. The man sees no need for
treatment as he says he has no problem. As a doctor what would you advise?

Good!

Did you think of the following?

1. The need for further assessment

2. The need to determine man’s capacity to make decisions

Two weeks after the wife had consulted you the man was brought to the casualty of a hospital
that you work in. You are called to assess the patient. He is unconscious.

Activity 2.2
What would be your course of action?
Good. I am sure you recognise that the patient has no capacity to make decisions. Therefore
you would have to treat the patient without his consent in these circumstances
We shall now consider other situations in which a patient may be treated without consent

2.4 Common Law Principles

Common law principles include the following elements:

a. Act in accordance with the patient’ wishes

b. Presume capacity in adults
c. Apply “reasonableness” test
d. Act in the patient’s best interest
e. Doctrine of necessity
f. Act in accordance with a recognised body of opinion
g. Act in a logically defensible manner
h. Consider use of appropriate law
i. Consider request for court judgement

2.5 Concepts of Doctor Patient Confidentiality

In this section we shall consider other aspects of importance in medical ethics. These
include confidentiality and when it can be breached. We shall also look at ethics that govern
research.
 2.5.1 Confidentiality

The principle of confidentially requires that the information given to the doctor by the
patient be held in confidence. However, it is may be necessary to disclose the information in
certain circumstances such as

a. disclosure to protect the patient and others

b. disclosure in connection with courts orders

c. Disclosure to employers

d. Notification of known communicable disease

e. Inquests

It is always advisable to inform the person concerned or surrogate prior to disclosure

2.6 Landmark Court Cases relating to Medical Ethics

The guidelines provided often do not cover all aspects of a case that may arise and the courts
may be required to offer guidance. Some of the famous court cases related to medical ethics
include the following:

1. Tarasoff case (1969)

This is the case of Tarasoff vs Regents of University of California of 1976 that gave rise to the
concept of duty to warn. It requires psychiatrists to warn about dangerous patients and inform
third parties. A patient told his therapist that he planned to kill his former girlfriend. He
murdered her two months later. The therapist had alerted his colleagues and the police.
Although the police apprehended him and interviewed him he was released because he
appeared rational. The relatives sued the police and the therapist claiming that they should have
warned the victim. The judge found that the therapist had a duty to warn. This was later
modified to include the duty to protect a potential victim. Thus the therapist should have
hospitalised the patient. The controversies continue as it is not clear on how the therapist can
accurately assess the dangerousness of such a patient. Moreover patient’s readiness to confide
in therapists may be diminished.

2. Gillick case

A mother who challenged the right of doctors to prescribe contraceptives to her under 16-year-
old daughter. It was held that in some circumstances a minor could consent to treatment and in
such circumstances a parent had no power to veto the treatment.

3. Bolam test

A doctor is not guilty of an offence if he had acted in accordance with a reasonable body of
professional opinion.
4. Bolitho case

Even if the doctor’s actions were in accordance with the professional’s opinions the doctor
could still be judged negligent if according to the judge it was not logical to act in that manner.

2.7 Section Summary

In this section we have highlighted a few important cases that have changed the way we view
patient’s rights and the doctor’s decisions. In the next section we shall consider some current
bioethical issues.

SECTION 3: CURRENT BIOETHICAL ISSUES

In the first two sections of this unit we learnt about the rules governing the doctor’s behaviour
on routine activities related to medical care. However, due to advances in basic sciences new
questions are emerging touching on moral, legal and religious issues. These include abortion,
euthanasia, life extension, gene engineering and cloning. We can only consider a few of these
here.

3.2 Section Objectives

By the end of this section, you should be able to:

1. Define bioethics.
2. Discuss contemporary bioethical issues.

3.3 Bioethics

Bioethics is derived from the term bios (life) and ethos (behaviour). Initial debates revolved
around the use of animals in experiments. The field has now expanded and includes issues
such as abortion and the beginning of life

3.4 Contemporary Biomedical Issues

Some of the biomedical issues include:

a. Reproductive health

Recent advances have made it possible not only to conduct in vitro fertilisation but also to
choose and determine the genetic makeup of the foetus. Linked to this is the question of when
does life actually start and whether the foetus has a right as a human being. Questions are also
being asked whether it is right to use foetal tissues in research and brain implants for example
treatment of certain disorders like Parkinson’s disease

b. Prolonged life support and Euthanasia

Because of advances in medical science doctors are now able to support life even in cases of
major organ failures including brain death. People are able to make living wills on how they
should be treated when they do not have the capacity to make decisions for example when they
are in coma or advanced cases of dementia. Should the life support be turned off when they are
in such states? Where does one draw the line when individuals with terminal illness who still
have capacity decide they do not want to live? What is the role of doctors in this?

c. Organ transplants

Organ transplantation has been going on for sometime now and range from cornea transplants
and to kidney, liver and heart. There has also been success in transplant of uterus and penis.
Related to these are sex change operations which may include amputation of the penis.
Recently there have been plans to have head transplants done.

Activity 3.1
Discuss the ethical issues concerning the items listed above. You can add on to the list above.

3.5 Section Summary

We have come to the end of this section where we have learnt issues regarding bioethics. As
a doctor it is imperative that you incorporate these concepts while in your practice.

UNIT 3 REVIEW QUESTIONS

Choose the correct answer

The principles that guide medical ethics include the following except

Beneficence
Maleficence
Justice
Non-maleficence
Respect for patient autonomy

The doctor’s duty includes the following except

Care for patients

Research
Teaching
Participation in state sanctioned torture
Reporting or publication of case reports
Principles of medical ethics can be used to guide decisions in the following circumstances
except

Conflicts of interest between physicians and their employers

Confidentiality
Drug experiments on children
Involuntary hospitalisation
Religious practice of the patients

In assessing a person’s capacity to make decisions the following should be taken into account

Does the person understand the nature of the proposed treatment?

The risks involved in the treatment
Previous decisions made by the patient
Ability of the patient to communicate the decision
The consequences of making the decision

Elements from the principles of common law include the following

Applying the “reasonableness test”

Presuming capacity in adults
Acting in the doctor’s best interest
Acting in the patient’s best interest
Using the doctrine of necessity

UNIT 4: HEALTH CARE PROFESSION, WORK STRESS AND IATROGENIC

DISORDERS

The health care profession is demanding. It takes long to train competent personnel. After
qualification they often work some cases very difficult conditions. Because of this cases of
psychological distress may arise. The work related distress may lead to inefficient work output
and poor delivery of services. In this unit we shall look at how some of these adverse effects
may be mitigated. In the second section of this unit we shall consider the iatrogenic disorders.
These are disorders that are doctor caused. This may arise directly out of the doctor’s actions
or as a result of the medications or other treatments prescribed by the doctor.

This unit is divided into two sections as follows:

Section 1: Health Care Profession and Work Stress

Section 2: Discuss Iatrogenic Disorders

 Unit Objectives

By the end of this unit, you should be able to:

1. Health care profession and work stress.

2. Discuss iatrogenic disorders.

In the first section we shall look at how work stress affects the health care profession. It is
important to detect stress early hence we shall describe the symptoms and signs of stress before
discussing how stress can be managed

SECTION 1: HEALTH CARE PROFESSION AND WORK STRESS

Work related stress may arise from many factors. Some of these arise directly from patient
care. Patients may react in a hostile manner to the caregivers as a result of irritation. The
patients may become stressed because of difficulties in adjusting to sick role and the hospital
life; having to live in close proximity to strangers in the hospital and unfamiliar surroundings.
Thus trivial matters can lead to aggressive behaviour. Reasons related to treatment include the
medications used and special procedures some of which may require restrictions in movement
or modifications in lifestyles. The illness itself may also cause difficult behaviour.

Let us begin by looking at the objectives of this section.

1.2 Section Objectives

By the end of this section, you should be able to:

1. Define stress.
2. Discuss causes of work stress related to the health profession.
3. Discuss the presentation of work stress.
4. Describe the approaches to managing stress at work.

1.3 Stress

Whereas it is unavoidable and considered healthy that people experience challenges related to
their work and that up to a certain point an increase in pressure leads to increased performance,
excessive pressure can be detrimental to health, stress is the adverse reaction that people have
to excessive pressure or other types of demand placed on them.

1.4 Causes of Work Stress Related to the Health Profession

Causes of stress include excessive workload, inadequate training for the job required, and lack
of control or autonomy. Poor working relations are also important and an overbearing or
bullying manager may cause or aggravate the stress.
1.5 Presentation of Work Stress

Changes in behaviour or performance are usually the first signs to be noticed. Other symptoms
include regression, withdrawal, aggressive behaviour and withdrawal. Physical signs as listed
below may become manifest with sustained stress.

1. Work performance: declining or inconsistent performance, uncharacteristic errors, loss

of control over work, loss of motivation or commitment, indecision, lapses in memory,
increased time at work, lack of holiday planning and usage

2. Withdrawal: arriving late to work, leaving early, extended lunches, absenteeism, resigned
attitude, reduced social contact, elusiveness or evasiveness

3. Regression: crying, arguments, undue sensitivity, irritability, moodiness, over-reaction to

problems, personality clashes, sulking, immature behaviour

4. Aggressive behaviour: malicious gossip, criticism of others, vandalism, shouting,

bullying or harassment, poor employee relations and temper outbursts

5. Physical signs: nervous stumbling speech, sweating, tiredness/lethargy, upset,

stomach/flatulence, tension headaches, hand tremor, rapid weight gain or loss, constantly
feeling cold

6. Other behaviours: out of character behaviour, difficulty in relaxing, increased

consumption of alcohol, increased smoking, lack of interest in appearance/hygiene,
accidents at home or work, reckless driving, unnecessary risk taking

1.6 Managing Stress at Work

It is considered to be the duty of the employer to undertake risk assessments and manage
activities to reduce the incidence of stress at work. The four main approaches listed below can
be adopted by organisations to address stress at work. These can be used collectively or
selectively.

1. Policy, procedures and systems audit: the organisation should undertake an audit of its
policies, procedures and systems to ensure that the working environment protects the well-
being of the workforce and that there are systems in place to identify troubled employees
and provide them with appropriate levels of support.

2. Problem-centred approach: provides a problem-solving model for dealing with stress

and other psycho-social issues. It takes issues and problems that arise within the workplace
and identifies why they have occurred and then finds ways to solve them. The identification
process may involve undertaking a risk assessment, examining sickness absence levels,
employee feedback, claims for compensation and performance deficits.

3. Well-being approach: the aim of in this approach is to maximise employee well-being.

Although similar tools are used as in the problem-centred approach it is much more
proactive in identifying ways to create a healthy workforce.
4. Employee-centred approach: focuses on the individual employee. Individuals are
provided with education and support in order to help them deal with the problems they face
in the workplace. The employee-centred approach focuses on employee counselling and
stress management training. This could include recognition of the early signs of stress and
how to avoid or minimise the consequences.

1.7 Section Summary

In this first section we have defined stress and looked at some of the varied ways in which it
can present. We also suggested some ways in which the effects of stress can be mitigated
but ideally the focus should be on prevention. Stress can sometimes lead to mistakes at work
which may have grave consequences. We shall now look at some of these in the next section
on iatrogenic disorders.

SECTION 2: IATROGENIC DISORDERS

This is the last section of this unit and we shall look at iatrogenic disorders. Whereas there are
few documented cases of intentional harm inflicted on patients by physicians the number of
iatrogenic cases seems to be rising. Perhaps due to increasing awareness of their rights, patients
may be more ready to lodge complaints against health workers.

Let us begin by looking at the objectives of this section.

2.2 Section Objectives

By the end of this section, you should be able to:

1. Define iatrogenic disorders.

2. Discuss the causes of iatrogenic disorders.

2.3 Definition of Iatrogenic Disorder

Iatrogenic is derived from the words “Iatro”, from the Greek “Iatro" Which means “physician
"or “medicine and genic that is produced by. Iatrogenic thus means induced in a patient by the
treatment or comments of a physician. By consensus iatrogenic refers only to the unintended
effects such as adverse drug reactions. It does not refer to the positive or good effects.

2.4 Causes of Iatrogenic Disorder

These are mainly due to adverse effects of therapeutic regimens - adverse drug reaction (ADR),
and adverse effects of diagnostic procedures such as mechanical procedures &diagnostic
radiology. Other important causes include mistakes made by doctors such as giving wrong
prescriptions or offering inappropriate advice for surgical operations. Although the main focus
is usually on doctors, perhaps because they are often the team leaders, iatrogenic disorders can
be caused by other health professionals including nurses and pharmacists.

2.5 Prevention of Iatrogenic Disorders

To mitigate such misadventures it is essential that standard protocol should be laid down and
followed strictly. Because of the potential for lawsuits directed against the physician there are
often elaborate warning signs accompanying medication. Even before such medicines are
released to the public they have to go through several phases of trial.

2.6 Section Summary

In this final section of the unit we learnt about the iatrogenic disorders and how they can be
minimised.

Congratulations for coming this far! I hope you enjoyed the module. Attempt the following
review questions to see how much you understood this unit.

UNIT 4 REVIEW QUESTIONS

1. What does the term iatrogenic mean?

2. List some of the common iatrogenic disorders

3. Who are the health staffs that may be implicated in causing iatrogenic disorders?

4. How can iatrogenic disorders be minimised?

Choose the correct answer

Work related stress may present with the following

Aggressive behaviour
Increased productivity especially during periods of insomnia
Reduced social contact
Withdrawal and resigned attitude
Bullying others at work

The main approaches in managing stress at work include the following except

Well-being approach
Employee-centred approach
Problem centred approach
Policy and systems audit
Prompt punishment of any errant behaviour

Iatrogenic disorders can be mitigated by

Establishing clear protocol

 Institution severe punitive measures
Closely monitoring patients on medication
Encouraging the reporting of adverse effects of medication
Not relying solely on animal experiments to decide the safety of medications

REFERENCES

Snyder S (2012). American College of Physicians Ethics Manual Sixth Edition. Annals of
Internal Medicine, 156:73-104.

World Medical Associations International Code of Medical Ethics

The Belmont Report Ethical Principles and Guidelines for the Protection of Human Subjects
of Research The National Commission for the Protection of Human Subjects of Biomedical
and Behavioral Research 1979 http://www.hhs.gov/ohrp/policy/belmont.html

Nuremberg Code

Protection of Human Research Participants (online training) http://phrp.nihtraining.com/