Origins and challenges in defining abnormal psychology

Roots of Abnormal Psychology

Abnormal Psychology

The recognition that mental disorders exist goes all the way back to primitive societies (Hansell and Damour, 2008, p. 26). Ancient skulls with holes drilled into them suggests animistic cultures practiced trephination, which entails drilling holes into the heads of living persons to provide an escape route for unhealthy spirits. Societies that believed in animism, or the existence of a powerful spirit world, would sometimes use trephination to open a way for spirits to leave the body of afflicted persons. Exorcism was practiced for the same purpose.

Ancient Greece also recognized the existence of mental disorders, but the approach towards treatment was a bit less barbaric (Hansell and Damour, 2008, p. 28-29). The famous Greek physician Hippocrates, who lived between 460 and 377 B.C.E., believed that all diseases came from an imbalance between four humours: blood, phlegm, and black and yellow bile. An imbalance in these humours could produce mood instability, lethargy, depression, aggression, or anxiety.

More recent efforts to diagnose and treat mental disorders created a division within the ranks of physicians. On one side were those who believed all mental disorders could ultimately be traced to a biological cause, while the other side believed the causes were primarily psychological (Hansell and Damour, 2008, p. 33-34). The German neurologist Richard von Kraft-Ebing made the connection in 1897 between what was then called general paresis to untreated syphilis infections, thus proving psychosis could sometimes have a biological etiology. By comparison, researchers have recently shown that psychosocial dwarfism is caused by severe emotional deprivation during childhood. This division in how abnormal psychology is approached has largely disappeared today and most consider both views valid.

Throughout time societies have therefore been faced with the task of diagnosing and treating those who have succumbed to mental illness. The local physician or shaman may have relied on some of the same criteria in use today, such as help seeking, irrational and/or dangerous behavior, deviance, emotional distress, and significant impairment, but these diagnostic criteria remain largely inaccurate and unreliable even today. The shaman's task would have been complicated by the existence of predisposing conditions, also called diathesis, and whether a triggering event or stressor could be identified. In addition, the symptoms were probably occasionally subtle and there could have been a biological etiology or contribution.

The Scientific Method and Abnormal Psychology

Two of the main principles of scientific investigation are reliability and validity (Hansell and Damour, 2008, p. 73-74). Reliability implies the same result would be obtained if an experiment were repeated, whereas validity implies the experimental results mean what we think they mean. Reliable and valid diagnostic criteria for psychopathology would therefore be able to arrive at the same diagnosis regardless of who performs the task and be accurate.

The French psychiatrist Philippe Pinel (1745-1826) developed what was probably one of the first scientific diagnostic systems for mental disorders (Hansell and Damour, 2008, p. 75-76). He classified mental illness into four categories: depression, mania, retardation, and dementia. The list was expanded to 13 disorders a century later by the German physician Emil Kraepelin (1856-1926). During this period the U.S. Census questionnaire expanded the number of categories from one in 1840 to seven by 1880. In 1952 a group of psychiatrists at Washington University in St. Louis developed the Diagnostic and Statistics Manual that described 26 distinct disorders. The original purpose of this manual was to create a standard set of diagnostic tools that would facilitate psychopathology research, and with time the validity of diagnostic criteria used in clinical settings. Since then both the manual and its purpose has expanded considerably, but some would argue not its validity (Hansell and Damour, 2008, p. 76-78).

Theoretical Models for Psychopathology

The biomedical/medical theoretical model has a long history, dating back to Hippocrates in ancient Greece (Hansell and Damour, 2008, p. 28-29). When Richard von Kraft-Ebing made the connection between untreated syphilis infections and psychosis the biological approach to psychopathology became more widely accepted (Hansell and Damour, 2008, p. 33-34). Since then, biology has become a dominant force in diagnosing and treating psychopathology. Today a revolution in medical imaging technology is increasing our understanding of mental disorders, what causes them, and how such diseases progress (Hansell and Damour, 2008, p. 95-99).