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UNIT 1 A BRIEF HISTORY OF
PSYCHOPATHOLOGY
Structure
1.0 Introduction
1.1 Objectives
1.2 The Ancient Supernatural Beliefs 1.2.1 Witchcraft and Demonology 1.2.2 Moon and Stars 1.2.3 Mass Hysteria
1.3 Biological Models
1.3.1 Early Greek Contributions: Hippocrates and Galen 1.3.2 Nineteenth Century: J.P. Grey and E. Kraeplin 1.3.3 Twentieth Century: Insulin Shock Therapy and Electroconvulsive Therapy
1.4 Psychological Approaches 1.4.1 Early Psychological Approaches 1.4.2 Psychoanalytic Approach 1.4.3 Humanistic Approach 1.4.4 Behavioural Approach
1.5 Let Us Sum Up
1.6 Unit End Questions
1.7 Glossary
1.8 Suggested Readings
1.0 INTRODUCTION
Throughout history, human civilisations have held quite different views of the problems that we consider now to be mental disorders. The search for explanations of the causes of abnormal behaviour dates to ancient times, as do conflicting opinions about the aetiology of mental disorders. There have also been a number of approaches to treat these mental disorders or psychopathologies. Ancient beliefs attributed abnormal behaviour to the disfavour of a supernatural power or the mischief of demons. A second stream of beliefs started attributing mental disorders to some physiological dysfunctions and biochemical imbalances in the body. This was only late nineteenth or early twentieth century when psychological explanations of nature, aetiology and treatment of mental disorders began to be conceptualised and getting importance. In this unit we will be dealing with the ancient supernatural beliefs followed by Biological Models where in we discuss early Greek contributions and the 19th^ century writers and the 20th^ century concepts. This will be followed by the next section which will consider the psychological approaches which will consider psychoanalytic, humanistic and behavioural approaches.
1.1 OBJECTIVES
After reading this unit, you will be able to:
Explain supernatural belief regarding causes and treatment of psychopathology;
Describe the biological approach to psychopathology;
Explain the psychoanalytic theory of psychopathology;
Foundations of Psychopathology
Present an account humanistic approach to psychopathology; and
Understand the relevance of behaviouristic approach in explanation of psychopathology.
1.2 THE ANCIENT SUPERNATURAL BELIEFS
Throughout history, human civilisations have held quite different views of the problems that we consider now to be mental disorders. The search for explanations of the causes of abnormal behaviour dates to ancient times, as do conflicting opinions about the aetiology of mental disorders. There have also been a number of approaches to treat these mental disorders or psychopathologies. Ancient beliefs attributed abnormal behaviour to the disfavour of a supernatural power or the mischief of demons. A second stream of beliefs started attributing mental disorders to some physiological dysfunctions and biochemical imbalances in the body. This was only late nineteenth or early twentieth century when psychological explanations of nature, aetiology and treatment of mental disorders began to be conceptualised and getting importance.
The ancient human civilisations believed that abnormal behaviours are caused by some supernatural magic, evil spirits, demons, moon and the stars. There was a strong belief that our behaviours, affects and thought are governed by the agent situated outside our bodies and environment. These agents included supernatural entities (divinities, demons and spirits), celestial objects (stars and moon) and other phenomena like magnetic fields.
1.2.1 Witchcraft and Demonology
The individuals suffering from mental disorders were supposed to be possessed and controlled by magical, evil spirits and demons. Nature of the spirit was judged by the nature of behaviour exhibited by the affected person. Excessive spiritual behaviours were attributed to holy spirits, while destructive behaviours were thought to be caused by evil spirits. The treatments included punishments like chaining them or keeping them in cages or horrible ritual of boring a hole in the skull. These victims after going through an unfair trial were condemned as witches or demons were burned alive or hanged.
1.2.2 Moon and Stars
The Latin word for moon is Luna, this inspired people to use the word lunatic for abnormal people, but now this word, is not used any more. According to this notion the movements of the full moon and the stars have an effect on behaviour of people. This view is reflected by followers of astrology who think that their behaviour as well as major events in their lives can be predicted by the position of the planets.
1.2.3 Mass Hysteria
It is a phenomenon in which the experience of an emotion seems to spread to those in the surroundings around. If an individual is frightened and sad this feeling and experience spreads to nearby people and soon this feeling further escalates, develops into a panic and the whole community is affected. The Supernatural model is still popular and used in undeveloped cultures where poverty is high and literacy rate is low and mental health professionals are not permitted to play their role. People still look towards magic and rituals performed by holy persons for the solutions of mental disorders.
Foundations of Psychopathology
of Insulin, the patients had convulsions and went into a state of coma but surprisingly these patients recovered so physicians started to use it frequently. The method was abandoned because it was dangerous, caused coma and even death. Joseph Meduna, in 1920 observed that Schizophrenia was rarely found in epileptics (which later did not prove to be true) and his followers concluded that induced brain seizures might cure Schizophrenia. Electroconvulsive Therapy (ECT) was used extensively and frequently by doctors but was a controversial method some doctors even used it to penalise the difficult unmanageable patients. It is effective with suicidal patients.
Self Assessment Questions
- Explain the early supernatural approach of understanding psychopathology.
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- Describe the early Greek contributions in development of biological models of psychopathology.
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- Explain the contribution of J.P. Grey and E. Kraeplin in development of psychopathology.
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- Give an account of insulin shock therapy and electroconvulsive therapy.
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1.4 PSYCHOLOGICAL APPROACHES
Psychological viewpoints stressed that there were so many emotional problems that could not be attributed to any organic disorder. These approaches emphasise on psychological, interpersonal, social and cultural factors in explanation and treatment of abnormality.
1.4.1 Early Psychological Approaches
Psychological approaches began with the moral and mental hygiene movement which advocated humane and responsible care of the institutionalised patients and encouraged and reinforced social interaction with them. Mental hygiene movement started with the concept of moral therapy. Pioneers in the mental reforms were P. Pinel (1745- 1826), William Tuke (1732-1822), Benjamin Rush (1745-1813) and Dorothea Dix (1802-1887). All these individuals were the pioneers in the mental hygiene movement which led to asylum reforms in Europe and America.
In Europe during the Middle Ages mentally ill and mentally retarded, commonly called as the “lunatics” and “idiots”, aroused little interest and were given marginal care. Disturbed behaviour was considered to be the responsibility of the family rather than the community or the state. In the 1600s and 1700s, “insane asylums” were established. Early asylums were little more than human warehouses, but as the nineteenth century began, the moral treatment movement led to improved conditions in at least some mental hospitals. Founded on a basic respect for human dignity and the belief that humanistic care would help to relieve mental illness, moral treatment reform efforts were instituted by leading mental health professionals of the time.
In the middle of the 1800s, Dorthea Dix argued that treating the mentally ill in hospitals was to be more humane and more economical than caring for them haphazardly in their communities. She urged that special facilities be provided to house mental patients. The creation of large institutions for the treatment of mental patients led to the development of a new profession of psychiatry.
By the middle of the 1800s, superintendents of asylums for the insane were almost always physicians who were experienced in taking care of people with severe mental disorders. The Association of Medical Superintendents of American Institutions for the Insane (AMSAII), which later became the American Psychiatric Association (APA), in 1844. In 1833, the state of Massachusetts opened a public supported asylum for the people with mental disorders, in Worcester. Samuel Woodward, the asylum’s first superintendent, also became the first president of the AMSAII. Woodward claimed that mental disorders could be cured just like other types of illnesses. Treatment at the Worcester Lunatic Hospital included a blend of physical and moral procedures.
1.4.2 Psychoanalytic Approach
Psychoanalysis was pioneered by Sigmund Freud (1856-1939). He learned the art of hypnosis from France. He experimented with somewhat different procedures of hypnosis. He used hypnosis in an innovative way. He encouraged his patients to talk freely about their problems, conflicts and fears. He discovered the unconscious mind and its influence in psychopathology by using the techniques of free association, dream analysis and Freudian slips. Freud emphasised on internal mental processes and childhood experiences. The core elements of this approach include:
a) Analysis of Mental Structures
b) Levels of Consciousness
c) Stages of Psychosexual Development
d) Anxiety and Defense Mechanisms
e) Psychoanalytic Therapy
A Brief History of Psychopathology
Phallic Stage (3 to 5 years) : Phallic stage begins at three years and goes up to five years. In this stage boys have oedipal complex, a wish to have sexual attachment with their mothers, while girls shift away from mother and get closer to father, an experience labelled as Electra complex.
Latency (5 to 12 years) : In this stage sex drives are subsided and child is mainly engaged in acquiring social, academic and professional skills.
Genital 12 years and onwards) : Latency stage is where interest in sexual drive is less but it is the genital stage where interest in and tendency to impress opposite sex develops. One is more preoccupied to make a good impression on the members of opposite sex through one’s looks, dress and conversation. Often you see a young growing up standing in front of the mirror and either trying to focus how to look even better etc. Each stage of development is important for a healthy adjustment and fixation at any stage may result in formation of psychopathology or an immediate behaviour.
d) Anxiety and Defense Mechanisms: Freud noted that a major drive for most people is the reduction in tension, and that a major cause of tension was anxiety. He identified three different types of anxiety.
Reality Anxiety : This is the most basic form of anxiety and is typically based on fears of real and possible events, such as being bitten by a dog or falling from a ladder. The most common way of reducing tension from Reality Anxiety is taking oneself away from the situation, running away from the dog or simply refusing to go up the ladder.
Neurotic Anxiety : This is a form of anxiety which comes from an unconscious fear that the basic impulses of the Id (the primitive part of our personality) will take control of the person, leading to eventual punishment (this is thus a form of Moral Anxiety).
Moral Anxiety : This form of anxiety comes from a fear of violating values and moral codes, and appears as feelings of guilt or shame.
The ego is always threatened by the possibility of expression of irrational and antisocial sexual and aggressive drives of the id. Thus, the ego fights a battle to stay on top of id and super ego. The conflicts between id and super ego produce anxiety that is a threat to ego. The threat or anxiety experienced by ego is a signal that alerts the ego to use unconscious protective processes that keep primitive emotions associated with conflicts in check. These protective processes are defense mechanisms or coping styles.
All defense mechanisms share two common properties: They often appear unconsciously and they tend to distort, transform, or otherwise falsify reality. In distorting reality, there is a change in perception which allows for a lessening of anxiety, with a corresponding reduction in felt tension. Freud’s list of basic defense mechanisms includes:
Denial: claiming/believing that what is true to be actually false.
Displacement: redirecting emotions to a substitute target.
Intellectualisation: taking an objective viewpoint.
Projection: attributing uncomfortable feelings to others.
A Brief History of Psychopathology
Foundations of Psychopathology
Rationalisation: creating false but credible justifications.
Reaction Formation: overacting in the opposite way to the fear.
Regression: going back to acting as a child.
Repression: pushing uncomfortable thoughts into the subconscious.
Sublimation: redirecting ‘wrong’ urges into socially acceptable actions.
e) Psychoanalytic Therapy: Psychoanalytic therapy involves reliving repressed fantasies and fears both in feeling and in thought. This process involves transference, i.e. a projection of the attitudes and emotions, originally directed towards the parents, onto the analyst. This is necessary for successful treatment. Access to these repressed fears is gained often through dream interpretation, where the manifest content in dreams is understood as a symbolic expression of the hidden or latent content. (Internal censorship demands that the wish be transformed, leading to a disguised or symbolic representation.) The sources of dream content results from lost memories, linguistic symbols and repressed experiences.
Dreams are “guardians of sleep”, i.e. wish fulfilments that arise in response to inner conflicts and tensions whose function is to allow the subject to continue sleeping. Dream –Work is the production of dreams during sleep- the translation of demands arising from the unconscious into symbolic objects of the preconscious and eventually the conscious mind of the subject. Dream Interpretation is the decoding of the symbols (manifest content) and the recovery of their latent content, i.e. the unconscious and, hence, hidden tensions and conflicts that give rise to the dreams in the first place. Evaluation: Some of the criticisms typically raised against the Freudian theory are:
Freud’s hypotheses are neither verifiable nor falsifiable. It is not clear what would count as evidence sufficient to confirm or refute theoretical claims.
The theory is based on an inadequate conceptualisation of the experience of women.
The theory overemphasises the role of sexuality in human psychological development and experience.
Self Assessment Questions
- Explain the early psychological approaches of understanding psychopathology.
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- Describe the Freudian topographical structure of personality.
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Foundations of Psychopathology
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perceives herself as strong may well behave with confidence and come to see her actions as actions performed by someone who is confident.
The self-concept does not necessarily always fit with reality, and the way we see ourselves may differ greatly from how others see us. According to Rogers, we want to feel, experience and behave in ways which are consistent with our self-image and which reflect what we would like to be like, our ideal-self. The closer our self-image and ideal-self are to each other, the more consistent or congruent we are and the higher our sense of self-worth. A person is said to be in a state of incongruence if some of the experience are unacceptable and are denied or distorted in the self- image. As we prefer to see ourselves in ways that are consistent with our self-image, we may use defence mechanisms like denial or repression in order to feel less threatened by some of what we consider to be our undesirable feelings. A person whose self-concept is incongruent with their real feelings and experiences will defend themselves because the truth hurts. For example, a person on occasion may feel possessive but not want to see themselves as possessive. They will therefore push it out of their awareness, leaving them with a self-image of a generous person, not at all possessive.
The total experiencing individual including all feelings and experiences, denied or accepted is called the organismic self by Rogers. The greater the gap between the organismic self and the self-concept, the greater the chance of confusion and maladjustment. The self-concept of the congruent person, however, reflects the inevitability of change that occurs in the environment and is therefore, flexible. Similarly, as stated above, the closer the ideal-self is to the self-image (i.e. the closer the person you would like to be is to how you see yourself), the more fulfilled and happier the person you will be. So, we can see that two kinds of incongruence can develop: incongruence between self-concept and organismic self and incongruence between ideal-self and self-image.
ii) Person Centered Therapy: In order to enhance congruence and move towards self-actualisation the person needs to be self-accepting and to replace the conditions of worth with truer, organismic values. This is established according to Rogers by having at least one relationship in which the person experiences unconditional positive regard, where the person is totally accepted and supported regardless of what they do, think or feel. The relationship obviously must be controlled or directed not by the other person in the relationship but by oneself. The person him/herself is at the centre, hence the term ‘person-centred’.
Any relationship which reduces incongruence is a therapeutic relationship according to Rogers. Such a relationship is characterised by one person experiencing another person who communicates: (a) unconditional positive regard, (b) empathy (i.e. accepting that another person experiences the world in an entirely different manner from yourself and reflecting back what this is like) (c) genuineness (i.e. being oneself rather than playing a role, of say, therapist, friend, parent or teacher)
If a person demonstrates these three qualities consistently in a relationship, they are offering a therapeutic context to the other person. If a person feels these three qualities in a relationship, they are said to be in a therapeutic, healing or growing relationship.
Evaluation: Some of the criticisms raised against the humanistic approach are:
- This approach criticized behaviourism for not acknowledging mental events, though the humanistic theorists overlooked scientific methods of studies.
Wishful thinking of man is not supported by scientific investigation and facts.
Humanistic approach used the terms like intuition and reasoning, which were philosophy and could not be tested.
This approach rejected animal research in psychology.
Concepts of this approach are sometimes not amenable to clear definition and verification.
1.4.4 Behavioural Approach
The behavioural perspective is identified with the Russian physiologist Ivan Pavlov (1849–1936), the discoverer of the conditioned reflex, and the American psychologist John B. Watson (1878–1958), the father of behaviourism. The behavioural perspective focuses on the role of learning in explaining both normal and abnormal behaviour. From a learning perspective, abnormal behaviour represents the acquisition, or learning, of inappropriate, maladaptive behaviours. From the learning perspective the abnormal behaviour itself is the problem. In this perspective, abnormal behaviour is learned in much the same way as normal behaviour. Why do some people behave abnormally? It may be that their learning histories differ from other people’s. For example, a person who was harshly punished as a child for masturbating might become anxious, as an adult, about sexuality.
Poor child-rearing practices, such as capricious punishment for misconduct and failure to praise or reward good behaviour, might lead to antisocial behaviour. Children with abusive or neglectful parents might learn to pay more attention to inner fantasies than to the world outside and have difficulty distinguishing reality from fantasy.
Watson and other behaviourists, such as Harvard University psychologist B. F. Skinner (1904–1990), believed that human behaviour is the product of our genetic inheritance and environmental or situational influences. Like Freud, Watson and Skinner discarded concepts of personal freedom, choice, and self-direction. But whereas Freud saw us as driven by irrational forces, behaviourists see us as products of environmental influences that shape and manipulate our behaviour. Behaviourists also believed that we should limit the study of psychology to behaviour itself rather than focus on underlying motivations. Therapy, in this view, consists of shaping behaviour rather than seeking insight into the workings of the mind. Behaviourists focus on the roles of two forms of learning in shaping both normal and abnormal behaviour, classical conditioning and operant conditioning.
Role of Classical Conditioning: The Russian physiologist Ivan Pavlov discovered the conditioned reflex (now called a conditioned response ) quite by accident. In his laboratory, he harnessed dogs to an apparatus to study their salivary response to food. Along the way he observed that the animals would salivate and secrete gastric juices even before they started to eat. These responses appeared to be elicited by the sound of the food cart as it was wheeled into the room.
So Pavlov undertook an experiment that showed that animals could learn to salivate in response to other stimuli, such as the sound of a bell, if these stimuli were associated with feeding. Because dogs don’t normally salivate to the sound of bells, Pavlov reasoned that they had acquired this response. He called it a conditioned response (CR), or conditioned reflex, because it had been paired with what he called an unconditioned stimulus (US)—in this case, food—which naturally elicited salivation. The salivation to food, an unlearned response, Pavlov called the
A Brief History of Psychopathology
1 7
Adaptive, normal behaviour involves learning responses or skills that lead to reinforcement. We learn behaviours that allow us to obtain positive reinforcers or rewards, such as food, money, and approval, and that help us remove or avoid negative reinforcers, such as pain and disapproval. But if our early learning environments do not provide opportunities for learning new skills, we might be hampered in our efforts to develop the skills needed to obtain reinforcement. A lack of social skills, for example, may reduce our opportunities for social reinforcement (approval or praise from others), which may lead in turn to depression and social isolation.
Punishment can be considered the flip side of reinforcement. Punishments are aversive stimuli that decrease the frequency of the behaviour they follow. Punishment may take many forms, including physical punishment, removal of a reinforcing stimulus, assessment of monetary penalties, taking away privileges, or removal from a reinforcing environment.
Social-Cognitive Theory: Social-cognitive theory represents the contributions of theorists such as Albert Bandura, Julian B. Rotter, and Walter Mischel. Social- cognitive theorists expanded traditional learning theory by including roles for thinking, or cognition, and learning by observation, which is also called modelling (Bandura, 2004). A phobia for spiders, for example, may be learned by observing the fearful reactions of others in real life, on television, or in the movies.
Social-cognitive theorists believe that people have an impact on their environment, just as their environment has an impact on them (Bandura, 2001, 2004). Social- cognitive theorists agree with traditional behaviourists like Watson and Skinner that theories of human nature should be tied to observable behaviour. However, they argue that factors within the person, such as expectancies and the values placed on particular goals, also need to be considered in explaining human behaviour. For example, people who hold more positive expectancies about the effects of a drug are more likely to use the drug and to use larger quantities of the drug than are people with less positive expectancies.
Behaviour Modification: Processes and techniques used for treatment of maladaptive behaviours based on different theories of behaviouristic approach are called behaviour modification. Conditions suitable for behaviour therapy are phobic disorders, obsessive compulsive disorders, generalised anxiety disorder, panic disorders, habit disorders, sexual deviations/dysfunctions, social skills deficits and enuresis. Major techniques used under behaviour modification are relaxation therapy, systematic desensitisation, biofeedback, aversion therapy, habit reversal, modelling, shaping, token economy and cognitive behaviour therapy.
Evaluation : Learning perspectives have spawned a model of therapy, called behaviour therapy (also called behaviour modification), that involves systematically applying learning principles to help people change their behaviour. Behaviour therapy techniques have helped people overcome a wide range of psychological problems, including phobias and other anxiety disorders, sexual dysfunctions, and depression. Moreover, reinforcement based programs are now widely used in helping parents learn better parenting skills and helping children learn in the classroom. Some of the criticisms raised against the behaviouristic theories are:
Behaviourism alone cannot explain the richness of human behaviour and that human experience cannot be reduced to observable responses.
Many learning theorists too, especially social-cognitive theorists, have been dissatisfied with the strict behaviouristic view that environmental influences (rewards and punishments) mechanically control our behaviour.
A Brief History of Psychopathology
Foundations of Psychopathology
Humans experience thoughts and dreams and formulate goals and aspirations. Behaviourism does not seem to address much of what it means to be human.
Social-cognitive theorists have broadened the scope of traditional behaviourism, but critics claim that social-cognitive theory places too little emphasis on genetic contributions to behaviour and doesn’t provide a full enough account of subjective experience, such as self-awareness and the flow of consciousness.
Self Assessment Questions
- Explain the basic assumptions of humanistic approaches to psychopathology.
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- Describe the role of self-concept and congruence in development of unhealthy personality as explained by Carl Rogers.
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- Explain the assumptions of learning theories regarding maladaptive behaviour.
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- Present an account of the theory of classical conditioning in explaining acquired fears and anxiety.
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- Elucidate that how the theory of operant conditioning explains abnormal behaviours.
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Foundations of Psychopathology
Mass Hysteria : A phenomenon in which the experience of an emotion seems to spread to those in the surroundings around.
Biological Models : A model that attribute mental disorders to physical diseases and biochemical imbalances in the body.
The Id : The part of personality which is the unorganised reservoir of wishes or passions related to our sexual and aggressive drives striving for their immediate gratification.
The Ego : The part of personality which operates according to the reality principle characterised by logic, reason.
Neurotic Anxiety : This is a form of anxiety which comes from an unconscious fear that the basic impulses of the Id will take control of the person, leading to eventual punishment.
Defense Mechanisms : Defense mechanisms are unconscious protective processes employed by the Ego that keep primitive emotions associated with conflicts in check and protect from threat or anxiety experienced by ego.
Self-Concept : Self-concept is defined as the organised, consistent set of perceptions and beliefs about oneself.
Classical Conditioning : When a neutral stimulus (conditioned stimulus, CS) is paired with a natural stimulus (unconditioned stimulus, UCS), neutral stimulus alone acquires the ability to elicit the response (conditioned response, CR) which naturally occurs (unconditioned response, UCR) after natural stimulus.
Positive Reinforcers : Commonly called as rewards, positive reinforcers increase the likelihood of behaviour when they are introduced or presented.
Negative Reinforcers : Negative reinforcers increase the likelihood of behaviour when they are removed.
Punishment : Punishments are aversive stimuli that decrease the likelihood of the behaviour they follow.
Social Cognitive Theory : A learning-based theory that emphasises observational learning and incorporates roles for cognitive variables in determining behaviour.
1.8 SUGGESTED READINGS
Barlow, D. H., & Durand, V. M. (2005). Abnormal Psychology: An Integrative Approach (4th^ ed). Belmont, CA: Thomson-Wadsworth.
Carson, R. C., Butcher, J. N., & Mineka, S. (2002). Clinical assessment and treatment. In Fundamentals of Abnormal Psychology and Modern Life. New York: Allyn & Bacon.
References
Staddon, J.E.R. & Cerutti, D. T. (2003). Operant conditioning, Annual Review of Psychology, 54, 115-144.
B. F. Skinner (1938). The Behavior of Organisms: An Experimental Analysis. Cambridge, Massachusetts: B. F. Skinner Foundation.
Watson, J.B. & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3, 1, 1–14.
Bandura, A. (2001). Social cognitive theory and clinical psychology. In N. J. Smelser & P. B. Baltes (Eds.), International encyclopedia of the social and behavioral sciences. Oxford: Elsevier Science.
Bandura, A. (2004). Modeling. In E. W. Craighead & C. B. Nemeroff (Eds.). The concise Corsini Encyclopedia of psychology and behavioral sciences. New York: Wiley.
A Brief History of Psychopathology
Present an account of DSM-IV (TR); and
Evaluate DSM-IV (TR).
2.2 MEANING AND PURPOSE OF
CLASSIFICATION OF PSYCHOPATHOLOGY
In order to classify the psychological disorders we need a classification system. The term classification refers to process to construct categories and to assign people to these categories on the basis of their attributes. Classification in scientific context refers to taxonomy. It also refers to nomenclature, which describes the names and labels that may make up a particular disorder such as schizophrenia or depression. Classification is at the heart of every science. If we cannot label and order objects or experiences or behaviours scientists could not communicate with one another and our knowledge will not advance.
Without labelling and organising patterns of abnormal behaviour, researchers could not communicate their findings to one another, and progress toward understanding and decision about these disorders would come to a halt. Certain psychological disorders respond better to one therapy than another or to one drug than another. Classification also helps clinicians predict behaviour. Finally, classification helps researchers identify populations with similar patterns of abnormal behaviour. By classifying groups of people as depressed, for example, researchers might be able to identify common factors that help explain the origins of depression. Classification of psychopathology fulfils following five primary purposes:
Communication
Control
Comprehension
Distinction
Prognosis/prediction
2.2.1 Approaches to the Classification of Psychopathology
Psychologists use three approaches or strategies to classify disorders:
i) Categorical approach: It was Kraepelin, the first psychiatrist to classify psychological disorders from a biological or medical point of view. For Kraepelin in term of physical disorders, we have one set of causative factors which do not overlap with other disorders. We have one defining criteria, which everybody in the category or in the group should meet, e. g. Schizophrenia. After a category has been defined, an object is either a member of the category or it is not. A categorical approach to classification assumes that distinctions among members of different categories are qualitative. In other words, the differences reflect a difference in kind (quality) rather than a difference in amount (quantity).
ii) Dimensional approach: A second strategy is a dimensional approach, in which we note the variety of cognitions, moods and behaviours with which the patient presents and quantify them on a scale. For example, on a scale of 1 to 10, a patient might be rated as severely anxious (10), moderately depressed (5), and mildly manic (2) to create a profile of emotional functioning (10, 5, 2). Although dimensional approaches have been applied to psychopathology, they are relatively
Classification of Psychopathology: DSM IV TR
Foundations of Psychopathology
unsatisfactory. Dimensional approach to classification describes the objects of classification in terms of continuous dimensions. Rather than assuming that an object either has or does not have a particular property, it may be useful to focus on a specific characteristic and determine how much of that characteristic the object exhibits.
iii) Prototypical approach: A third approach, for organising and classifying behavioural disorders which is an alternative to the first two. It is called a prototypical approach. It identifies some essential characteristics of a disorder and it also allows for certain non-essential variations that do not necessarily change the classification. With this approach classifying the disorder by different possible features or properties any candidate must meet (but not all) of them to fall in that category. In depression, there are five important symptoms such as: depressed mood all the day, weight loss, insomnia, fatigue and feeling of worthlessness. For a person might have three or four of the characteristics of the depression but not all five of them. Yet we still diagnose the person as depressed.
2.3 HISTORY OF CLASSIFICATION OF
PSYCHOPATHOLOGY
The most ancient classification of psychopathology was of senile deterioration, melancholia and hysteria. The oldest systematic classification finds its mention in the Ayurveda, an Indian body of thought. The Greek philosopher Hippocrates (460– B.C.) classified mental illness into delirium, mania, paranoia, hysteria, melancholia resulting from 4 basic temperaments. Philippe Pinel’s (1745–1826) father of modern psychiatry, classification system was based on functional disorders of nervous system. He described four functional disorders: dementia, mania, melancholia and idiotism. Karl Ludwig Kahlbaum (1828-1899) distinguished organic and non organic mental disorders. Emil Kraepelin’s (1856- 1926) classification system was based on clinical features of disorders: cause, course and outcomes. His primary classifications were manic depressive psychosis and dementia praecox. Eugen Bleuler combined Kraepelin and Meyerian approaches and classified mental disorders on the basis of psycho- pathological processes.
2.3.1 Development of ICD
In 1893 1st^ international list of causes of death was published. This stimulated worldwide organised effort for classification of diseases which resulted in the publication of International Statistical Classification of Diseases and Related Health Problems-1 (ICD-1) by the World Health Organisation in 1900. However, it was only ICD-6 which was published with a separate section on mental disorder in 1949. ICD-8 was published in 1972 with a comprehensive glossary of mental disorders. ICD-9 was published in 1977 with greater clinical modification. Vol. 1 and 2 of ICD-9 described diagnostic codes, while vol. 3 explained procedure codes for the Mental and Behavioural Disorders.
ICD-10: In 1978, WHO entered into a long-term collaborative project with the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) in the USA, aiming to facilitate further improvements in the classification and diagnosis of mental disorders, and alcohol and drug related problems. A series of workshops brought together researchers and practitioners from a number of different psychiatric traditions and cultures, reviewed knowledge in specified areas, and developed recommendations
