Case Analyses for Abnormal Psychology

Learning to Look Beyond the Symptoms

Randall E. Osborne, Joan Esterline Lafuze, David V. Perkins

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317445463
• Edition: 2
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Case Analyses for Abnormal Psychology, Second Edition uses case studies to explore the etiology, biology, and dynamics of psychiatric disorders in the DSM-5. Readers will learn about the new classifications and treatments for disorders while simultaneously reading the personal history of each consumer both before and during the development of each case. Every case ends with a section on the particular disorder presented, as viewed from a biological perspective. This updated edition bridges advances in abnormal psychology and neuroscience in understanding mental illness.

1 Major Perspectives and the Assumptions Each Makes About Human Behavior

DOI: 10.4324/9781315696287-2

One important aspect to understanding any science (and psychology is a science) is an awareness of what “data” the scientist is using. Psychologists seek to understand human behavior and mental processes in sometimes complex circumstances. To the extent that not all of those circumstances can be taken into account at any one time, the scientist tends to focus his or her awareness on a subset of those circumstances.

This focusing of awareness and concentration, then, determines the kinds of data that scientist will use to try and understand and explain human behavior and mental processes. If we decide, for example, that the behavior of someone else is more important to understanding a situation than the person’s thought processes prior to engaging in that behavior, then we will use behavior as our data in trying to figure out the person we are observing.

Most therapeutic approaches are linked fairly closely with the psychological perspective. You no doubt will note the tentative manner in which that sentence was written. It is not all cut-and-dried. Perspectives are often presented as if they come in nice tidy packages with clearly established boundaries separating them. For a long time in the history of psychopathology, that was predominantly the case. If one adopted a psychodynamic perspective, then one would employ a psychodynamic approach to treatment. Likewise, if one believed that abnormal behaviors were learned, then one adopted a behavioral approach to treatment. But this linear approach has been tried and, for the most part, has failed (e.g., Barlow & Durand, 1999).

In the history of treating mental illness, perspectives on treatment have been limited by the technology of the time. Clearly, Freud was constrained by technology. Many students do not realize that Freud was trained as a medical doctor and truly believed that a medical explanation could be found for the mental disorders of the day. But technology limited his ability to locate such causes. Rather than being diverted by this lack of technology, however, Freud sought out a different path of explanation.

Needless to say, times have changed. Brain scanning technology, neural tissue staining methods, and the development of microscopic electrodes with which the electrical activity of single neurons can be measured have changed the face of psychopathology. Few clinicians adopt a single perspective for assessing and treating mental illness. Most, in fact, follow Barlow and Durand’s (1999) advice and utilize an “integrative approach.” Ultimately, the best approach would appear to be one that assumes that abnormal behavior is the result of multiple factors and successful treatment will require that each of these factors be confronted and dealt with.

With serious illnesses, such as schizophrenia, multiple strategies from more than one of the perspectives may need to be employed. As an example, schizophrenia involves disturbances in thought processes, emotions, sensory and perceptual processes, and even motor movements. Clearly no single approach could effectively treat all symptoms. Before beginning our in-depth look at the cases, then, we will briefly introduce these perspectives and their link to therapeutic strategies in enough detail that you can recognize these when they are being employed by the care providers in the cases that come next in this book.

The Scenario. As an example, we will examine an event that might not be very unusual (and therefore, not likely to labeled as “abnormal”) in American culture. Consider the following situation:

You have just entered the arena to watch a hockey game because you have heard that one of the players is a woman. The players skate out onto the ice, and the action begins. Within a few moments, two players collide, and one slams the other hard into the wall. Immediately following this, a large portion of the audience begins to shout, “Kill, kill, kill!” Subsequently, the player who was slammed into the wall skates after the other player, and beats that player upside the head several times into unconsciousness. The crowd immediately starts to cheer, and the avenging hockey player raises her arms and hockey stick in triumph.

The Question. How would a psychologist interpret this complex situation? There are so many different details and nuances to focus on that it is difficult to know where to start. The scenario can be interpreted from a variety of perspectives and these tend to be where the psychologist will start.

The perspective that a psychologist takes tends to direct his or her focus in trying to determine why the events that occurred unfolded the way they did. To understand both the assumptions a psychologist will make about a situation, and the direction in which he or she will seek answers, it is useful to understand the multiple perspectives.

Perspectives That Provide Possible Answers

There are seven basic perspectives that a psychologist might take to explain behavior and mental processes: biological, psychodynamic, humanistic, behavioral, cognitive, sociocultural, and evolutionary.

Let’s take a quick look at each of these perspectives and figure out what aspects of the scenario just described would be of the most interest to a psychologist working from that perspective.

Biological

The biological perspective focuses on what biological factors might be playing a role in the situation. This perspective might focus on the emotions of the players or the audience members. How might the emotions being experienced influence such physiological measures as heart rate, blood pressure, and respiration? If we change the biological aspects of the person (e.g., lower his or her heart rate), will this result in a change in the way the person thinks?

Psychodynamic

The psychodynamic perspective is primarily associated with the psychoanalytic method and theories originally developed by Sigmund Freud and expanded upon by his followers. The focus with this perspective would be on the personality and motives (primarily unconscious) of the key persons involved. Freud theorized that human beings are driven by two categories of instincts. Instincts toward life (which he called “Eros”) motivate persons to procreate and to care for others. Instincts toward death (which he called “Thanatos”) motivate people to want to hurt and even kill. This approach also assumes that people can “vent” some of this aggressive instinctual energy by engaging in or witnessing aggressive and violent activity. How do individual characteristics and motives influence the level of aggressive behavior displayed? What personality characteristics and motives influenced these players to choose hockey as a profession or an audience member to pay money to see the event?

Humanistic

The humanistic perspective developed as a reaction against the perceived pessimism of Freud’s version of psychodynamic theory. Unlike Freud, who felt that human beings are driven primarily by aggressive and sexual urges, those operating from the humanistic perspective assume that all human beings have a unique capacity for self-actualization and will develop to that potential unless too many obstacles intervene. Psychologists operating from this perspective might want to know what unique capacities each person is attempting to fulfill or what makes each person feel “special.” Living among such enormous numbers and varieties of other people, we all have a need to believe that, somehow, “I am special” within that context. In addition, this perspective might want to know what needs are being met by the persons involved. One need, for example, is to be physiologically fulfilled. Perhaps the players engage in the game to earn a paycheck so they can eat and survive. A second need could be mastery. According to this perspective, human beings have a strong need to master their environment. As such, humans will generally strive to be as good as they can be at what they do.

Behavioral

The behavioral perspective assumes that we do not need to assess unconscious motives or even biological drives to understand why people do the things they do. According to this perspective, people engage in the behaviors they do because they have learned to behave and think that way. Positive reinforcement and punishment are used to shape and mold the way people behave. A person operating from this perspective would emphasize the events that are occurring and attempt to predict how people have been influenced to behave in specific ways. This approach is interested in defining the consequences of behavior (e.g., Was the person positively reinforced or punished for doing it?). As a result of knowing the consequences of a behavior, then, we can predict whether the person will engage in that action in the future.

Cognitive

The cognitive perspective would focus on the thoughts of the individuals involved. What was the player thinking that caused him to “slam” the other player into the wall? What did his opponent think about that action that may have caused her to retaliate? What was the audience thinking would happen when they chanted “kill, kill, kill”? This perspective clearly emphasizes the linkage between what and how people think and the resulting behaviors.

Sociocultural

A person operating from the sociocultural perspective would focus on social and cultural factors that might be influencing the observed events and how people are interpreting those events. Why would more aggressive sports such as hockey be more popular in some cultures than others? If hockey is a male-dominated sport, how did the woman involved gain entry into this sport?

Evolutionary

The focus of the evolutionary perspective is on inherited human tendencies. In other words, to what extent were the actions of those involved (e.g., the initial slamming, the chanting to kill, the revenge-type action, and the crowd cheering) influenced by tendencies of the human species? Does aggressiveness in sports represent some more basic level of human aggressiveness passed on from our past? Do the types of stimulating activities people choose represent a human need for excitement? The focus here is not on the individual and his or her heredity (that would be more in line with the biological perspective). The focus is on characteristics of the species that might explain current behavior patterns.

A Brief Connection to Historical Thoughts About Abnormal Behaviors

These same perspectives may play a role in determining the assumptions that a psychologist might make about abnormal behavior. Not all of these perspectives are as popular as the others and some have been more popular in the past than they are in the present. The psychodynamic perspective is a good example. This was one of the first and most influential perspectives in all of psychology. Yet, contrary to the thoughts of some, this was not the first perspective to make assumptions about the origins of abnormal behaviors. One of the earliest perspectives was postulated by Hippocrates (yes, the one known as the “father” of modern medicine), and then later refined by Galen. Hippocrates proposed a biologically based system for mental disorders. In addition, this system was developed by Galen into the first diagnostic system for classifying abnormal behaviors.

Hippocrates believed that human beings had four kinds of fluids in their bodies that he called “humors.” In order to understand this theory, it is important to remember that Hippocrates was a physician. As such, he saw a lot of persons suffering from all types of ailments. Hippocrates noticed that virtually all major illnesses involved excesses or disruptions of bodily fluids. A bad infection, for example, might cause the sore to seep a yellowish pus. This led Hippocrates to believe that one of the major humors (bodily fluids) was yellow bile. His hypothesis was that if the fluids were brought back in balance, the illness would go away. Hippocrates proposed four humors that would affect the physical state of the body. These humors were: black bile, blood, phlegm, and yellow bile. Hippocrates believed that the balance of these fluids was vital to the health of the body. In addition, he believed that excesses of these humors would affect the physical status of the individual.

Galen built upon this work and extended the concept to characteristics of persons. His assumption was that the presence of an excess of one of these fluids would be associated with a different negative personality type and associated characteristics. Excess yellow bile, for example, was associated with a personality type referred to as “choleric.” Choleric individuals were believed to have irritability as their most dominant personality characteristic, according to Galen’s typology. This concept—that bodily status and personality characteristics are linked—is still found in contemporary theories. It is also a part of our popular culture. We might assume, for example, that a large, round man will be gentle and jolly, while a muscle-bound man will be harsh and aggressive. Although many of these assumptions may not be true, we tend to draw such conclusions nonetheless.

Galen completed his theory by connecting personality types to the four humors and the four physical elements of air, earth, fire, and water, as illustrated in Table 1.1.

Table 1.1 Galen’s Diagnostic Categories

Type	Humor (or fluid)	Characteristics
Sanguine	Blood	Happy, optimistic
Melancholic	Black bile	Introverted, sentimental, sad
Choleric	Yellow bile	Short-tempered, ambitious
Phlegmatic	Phlegm	Sluggish, cowardly

You will note from this table that this system also served as an early diagnostic method. If an individual had an excess of black bile, for example, the personality type would be “melancholic.” Just like the term melancholia suggests, these individuals were observed to have a depressed temperament.

From this classification, then, early methods of treatment were derived. “Sanguine” individuals (those believed to have an excess of blood) were optimistic. N...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Authors
• Preface
• Acknowledgments
• Introduction
• 1 Major Perspectives and the Assumptions Each Makes About Human Behavior
• 2 Case Formulation Interviews: The Importance of Critical Thinking in the Clinical Process
• 3 Classification and Diagnosis
• 4 The Case of Ricky G: Schizophrenia
• 5 The Case of Barbara M: Major Depressive Disorder
• 6 The Case of Sally W: Bipolar Disorder
• 7 The Case of Carl V: Borderline Personality Disorder
• 8 The Case of Margaret H: Obsessive-Compulsive Disorder
• 9 The Case of Jacob T: Autism Spectrum Disorder
• 10 The Case of Sarah O: Bulimia Nervosa
• 11 The Case of Latisha Q: Panic Disorder
• 12 The Case of Richard B: Alcohol Use Disorder
• 13 The Case of Paula H: Posttraumatic Stress Disorder
• 14 The Case of Brighid C: Dissociative Identity Disorder
• 15 Wrapping Up the Journey
• References
• Index