Abnormal psychology

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which may or may not be understood as precipitating a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology generally deals with behavior in a clinical context.[1][2] There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant (statistically, functionally, morally or in some other sense), and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind-body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.[3]

The science of abnormal psychology studies two types of behaviors: adaptive and maladaptive behaviors. Behaviors that are maladaptive suggest that some problem(s) exist, and can also imply that the individual is vulnerable and cannot cope with environmental stress, which is leading them to have problems functioning in daily life in their emotions, mental thinking, physical actions and talks. Behaviors that are adaptive are ones that are well-suited to the nature of people, their lifestyles and surroundings, and to the people that they communicate with, allowing them to understand each other.[4] Clinical psychology is the applied field of psychology that seeks to assess, understand and treat psychological conditions in clinical practice. The theoretical field known as 'abnormal psychology' may form a backdrop to such work, but clinical psychologists in the current field are unlikely to use the term 'abnormal' in reference to their practice. Psychopathology is a similar term to abnormal psychology but has more of an implication of an underlying pathology (disease process), and as such is a term more commonly used in the medical specialty known as psychiatry.

History

Supernatural traditions

Throughout time, societies have proposed several explanations of abnormal behavior within human beings. Beginning in some hunter-gatherer societies, animists have believed that people demonstrating abnormal behavior are possessed by malevolent spirits. This idea has been associated with trepanation, the practice of cutting a hole into the individual's skull in order to release the malevolent spirits.[5] Although it has been difficult to define abnormal psychology, one definition includes characteristics such as statistical infrequency.[6]

A more formalized response to spiritual beliefs about abnormality is the practice of exorcism. Performed by religious authorities, exorcism is thought of as another way to release evil spirits who cause pathological behavior within the person. In some instances, individuals exhibiting unusual thoughts or behaviors have been exiled from society or worse. Perceived witchcraft, for example, has been punished by death. Two Catholic Inquisitors wrote the Malleus Maleficarum (Latin for "The Hammer Against Witches"), that was used by many Inquisitors and witch-hunters. It contained an early taxonomy of perceived deviant behavior and proposed guidelines for prosecuting deviant individuals.

Asylums

The act of placing mentally ill individuals in a separate facility known as an asylum dates to 1547, when King Henry VIII of England established the St. Mary of Bethlehem asylum in London. This hospital, nicknamed Bedlam, was famous for its deplorable conditions.[7] Asylums remained popular throughout the Middle Ages and the Renaissance era. These early asylums were often in miserable conditions. Patients were seen as a “burden” to society and locked away and treated almost as beasts to be dealt with rather than patients needing treatment. However, many of the patients received helpful medical treatment. There was scientific curiosity into abnormal behavior although it was rarely investigated in the early asylums. Inmates in these early asylums were often put on display for profit as they were viewed as less than human. The early asylums were basically modifications of the existing criminal institutions.[8]

In the late 18th century the idea of humanitarian treatment for the patients gained much favor due to the work of Philippe Pinel in France. He pushed for the idea that the patients should be treated with kindness and not the cruelty inflicted on them as if they were animals or criminals. His experimental ideas such as removing the chains from the patients were met with reluctance. The experiments in kindness proved to be a great success, which helped to bring about a reform in the way mental institutions would be run..[8]

Institutionalization would continue to improve throughout the 19th and 20th century due to work of many humanitarians such as Dorethea Dix, and the mental hygiene movement which promoted the physical well-being of the mental patients. "Dix more than any other figure in the nineteenth century, made people in America and virtually all of Europe aware that the insane were being subjected to incredible abuses."[9] Through this movement millions of dollars were raised to build new institutions to house the mentally ill. Mental hospitals began to grow substantially in numbers during the 20th century as care for the mentally ill increased in them.

By 1939 there were over 400,000 patients in state mental hospitals in the USA.[10] Hospital stays were normally quite long for the patients, with some individuals being treated for many years. These hospitals while better than the asylums of the past were still lacking in the means of effective treatment for the patients, and even though the reform movement had occurred; patients were often still met with cruel and inhumane treatment.

Things began to change in the year 1946 when Mary Jane Ward published the influential book titled “The Snake Pit” which was made into a popular movie of the same name. The book called attention to the conditions which mental patients faced and helped to spark concern in the general public to create more humane mental health care in these overcrowded hospitals.[10]

In this same year the National Institute of Mental Health was also created which provided support for the training of hospital employees and research into the conditions which afflicted the patients. During this period the Hill-Burton Acts was also passed which was a program that funded mental health hospitals. Along with the Community Health Services Act of 1963, the Hill-Burton Acts helped with the creation of outpatient psychiatric clinics, inpatient general hospitals, and rehabilitation and community consultation centers.[8]

Deinstitutionalisation

In the late twentieth century however, a large number of mental hospitals were closed due to lack of funding and overpopulation. In England for example only 14 of the 130 psychiatric institutions that had been created in the early 20th century remained open at the start of the 21st century.[10] In 1963, President John Kennedy launched the community health movement in the United States as a "bold new approach" to mental health care, aimed at coordinating mental health services for citizens in mental health centers. In the span of 40 years, the United States was able to see an about 90 percent drop in the number of patients in Psychiatric hospitals.[11]

This trend was not only in the England and the United States but worldwide with countries like Australia having too many mentally ill patients and not enough treatment facilities. Recent studies have found that the prevalence of mental illness has not decreased significantly in the past 10 years, and has in fact increased in frequency regarding specific conditions such as anxiety and mood disorders.[12]

This led to a large number of the patients being released while not being fully cured of the disorder they were hospitalized for. This became known as the phenomenon of deinstitutionalization. This movement had noble goals of treating the individuals outside of the isolated mental hospital by placing them into communities and support systems. Another goal of this movement was to avoid the potential negative adaptations that can come with long term hospital confinements. Many professionals for example were concerned that patients would find permanent refuge in mental hospitals which would take them up when the demands of everyday life were too difficult. However, the patients moved to the community living have not fared well typically, as they often speak of how they feel “abandoned” by the doctors who used to treat them. It also has had the unfortunate effect of placing many of the patients in homelessness. Many safe havens for the deinstitutionalized mentally ill have been created, but it is nevertheless estimated that around 26.2% of people who are currently homeless have some form of a mental illness.[13] The placing of these individuals in homelessness is of major concern to their wellbeing as the added stress of living on the streets is not beneficial for the individual to recover from the particular disorder with which they are afflicted. In fact while some of the homeless who are able to find some temporary relief in the form of shelters, many of the homeless with a mental illness "lack safe and decent shelter".[14]

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