Lecture Notes For Abnormal Psychology, 18th Edition

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Instructor’s Resource Manual
For
Abnormal Psychology
Eighteenth Edition
Jill M. Hooley, Harvard University
Matthew K. Nock, Harvard University
James N. Butcher, University of Minnesota
Prepared by
David Lee, University of California, Irvine
Regina M. Hughes, Collin College
Linda Lockwood, Ph.D., Metropolitan State University of Denver

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Chapter 1: Abnormal Psychology:
Overview and Research Approaches
Learning Objectives
1.1 Explain how we define abnormality and classify mental disorders.
1.2 Describe the advantages and disadvantages of classification.
1.3 Explain how culture affects what is considered abnormal, and describe two different culture-
specific disorders.
1.4 Distinguish between incidence and prevalence, and identify the most common and prevalent
mental disorders.
1.5 Discuss why abnormal psychology research can be conducted in almost any setting.
1.6 Describe three different approaches used to gather information about mental disorders.
1.7 Explain why a control (or comparison group) is necessary to adequately test a hypothesis.
1.8 Discuss why correlational research designs are valuable, even though they cannot be used to
make causal inferences.
1.9 Explain the key features of an experimental design.
Chapter Overview/Summary
A precise definition of abnormality remains elusive. Elements that can be helpful in considering
whether something is abnormal include subjective distress, maladaptiveness, statistical deviancy,
violation of societal norms, social discomfort, irrationality and unpredictability, and
dangerousness. The DSM employs a category type of classification similar to that used in
medicine. Disorders are regarded as discrete clinical entities, though not all clinical disorders
may be best considered in this way. Even though it is not without problems, the DSM provides us
with working criteria that help clinicians and researchers identify and study specific difficulties
that affect the lives of many people. It is far from a “finished product,” but familiarity with the
DSM is essential to significant study of the field.
Classifying disorders provides a common language as well as a communication shorthand. It
also allows us to structure information in an efficient manner and provides us with an
organizational framework. This facilitates research and treatment. In addition, classification
defines the domain of what is considered to be pathological. From a practical perspective, it
delineates the types of psychological difficulties that warrant insurance reimbursement and
identifies the disorders that mental health professionals treat. When we classify, we lose detailed
personal information about the individual with the disorder. Classification can also facilitate

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stigma, stereotyping, and labeling, although we should keep in mind that these problems are not
caused by the classification system itself. Fear of being viewed negatively or being discriminated
against may lead some people to avoid seeking treatment.
Culture shapes the presentation of clinical disorders in some cases. Culture also provides the
backdrop against which we must evaluate whether a particular behavior is abnormal or not.
Certain disorders appear to be highly culture specific. Taijin kyofusho is an anxiety disorder that
is quite prevalent in Japan. It involves the fear that one’s body, body parts, or body functions
may offend, embarrass, or make others feel uncomfortable. Ataque de nervios is another
culturally rooted expression of distress. It is found in people of Latino descent, especially those
from the Caribbean. This condition does not have a clear counterpart in the DSM. Symptoms can
include crying, trembling, fainting, uncontrollable screaming, and a general feeling of loss of
control.
Epidemiology involves the study of the distribution and frequency of disorders. Incidence is
the number of new cases that occur in a given period of time. Prevalence refers to the total
number of cases in a population during any specified period of time. Just under 50 percent of
people will experience some form of mental disorder during their lifetime. Mood disorders and
anxiety disorders are particularly common.
Studying and drawing inferences from past case studies alone often leads to erroneous
thinking, as we often focus on data that confirm our ideas of how things are. Research prevents
us from being misled by natural errors in thinking and can be conducted in clinics, hospitals,
schools, prisons, and on the street. It is not the setting that determines whether a given research
project may be undertaken. The importance lies in the researcher’s methodology.
Information about mental disorders can be collected through case studies, self-report data,
and observational approaches. Case studies can be a valuable source of new ideas and serve as a
stimulus for research. They also may provide insight into unusual clinical conditions that are too
rare to be studied in a more systematic way. Self-report data allows us to study behavior in a
more rigorous manner. This type of research often involves having research participants
complete questionnaires of various types or conducting interviews with them. When we collect
information in a way that does not involve asking people directly, we are using some form of
observational approach. Exactly how we go about this depends on what it is we seek to
understand.
Unless there is a control or comparison group, researchers cannot test their hypothesis
adequately. The control group must be comparable in all major respects (e.g., age, educational
level, proportion of males and females) to the criterion group, except for the fact that they do not
exhibit the disorder of interest. The control group could be made up of psychologically healthy
people or people with a different disorder. Only when they are using a suitable control or
comparison group can researchers compare the two groups on the variables of interest to see if
there are significant differences.
Correlational research examines factors as they currently are, allowing us to identify factors
that appear to be associated with certain disorders. Just because two variables are correlated does
not mean that there is a causal relationship between them. Correlation does not equal causation.
The direction of the relationship or the possibilities of a third variable bias are not accounted for
in correlational studies.
Experimental research involves manipulating one variable (the independent variable) and
observing the effect this manipulation produces with regard to another variable (the dependent
variable). Because the experimenter is changing the experimental conditions, experimental

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research designs permit causal inferences to be made. Although most experiments involve the
study of groups, single-case experimental designs (e.g., ABAB designs) may also be used to
make causal inferences in individual instances.
Detailed Chapter Outline
INTRODUCTION
1. Abnormal psychology is concerned with understanding the nature, causes, and
treatment of mental disorders.
2. Family aggregation is whether a disorder runs in families.
I. WHAT DO WE MEAN BY ABNORMALITY?
Learning Objective 1.1: Explain how we define abnormality and classify mental
disorders.
A. Indicators of Abnormality
1. No one behavior or single indicator is enough to define abnormality. However,
the more that someone has difficulties in the following areas, the more likely it is
that they have some form of mental disorder:
a. Subjective distress: If people suffer or experience psychological pain, we are
inclined to consider this indicative of abnormality; however, although
subjective distress is an element of abnormality in many cases, it is neither a
sufficient condition nor even a necessary condition for us to consider that
something is abnormal.
b. Maladaptiveness: Any behavior that is maladaptive for the individual or
toward society (e.g., anorexia) is maladaptive.
c. Statistical deviancy: The word abnormal literally means “away from the
normal.” Just because something is statistically common or uncommon,
though, does not reflect abnormality (e.g., having an intellectual disability,
which is statistically rare, represents a deviation from the normal).
d. Violation of the standards of society: All cultures have rules. Some of these
are formalized as laws; others form the norms and moral standards that we are
taught to follow. When people fail to follow the conventional social and moral
rules of their cultural group, we may consider their behavior to be abnormal
(e.g., the Amish of Pennsylvania not driving cars or watching television).

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e. Social discomfort: Not all rules are explicit, and it doesn’t bother us when
some rules are violated. However, when someone breaks a social rule and
those around this individual experience a sense of discomfort or unease (e.g.,
if you are sitting on an almost empty bus and someone gets on and sits
directly next to you), it may be considered an abnormal behavior.
f. Irrationality and unpredictability: People are expected to behave in socially
acceptable ways and abide by social rules. For example, if someone next to
you started screaming and yelling obscenities at nothing, this behavior would
be viewed as unpredictable, disorganized, and irrational.
g. Dangerousness: This describes someone who is clearly a danger to himself or
another person. Therapists are required to hospitalize suicidal clients, and if
they have a client who makes an explicit threat to harm another person, they
are required to contact both the police and the person who is the target of the
threat. But if we rely only on dangerousness as our sole feature of
abnormality, we will run into problems. For example, someone who engages
in high-risk sports such as free diving or base jumping is not immediately
considered mentally ill.
2. Decisions about abnormality involve social judgments. Therefore, culture plays a
role in determining what is abnormal.
B. The DSM-5 and the Definition of Mental Disorder
1. In the United States, the accepted standard for defining various types of mental
disorders is the American Psychological Association’s Diagnostic and Statistical
Manual of Mental Disorders.
2. Commonly referred to as DSM, it is revised and updated from time to time. The
current version, DSM-5, was published in 2013; it contains a total of 541
diagnostic categories.
3. The World Health Organization publishes the International Classification of
Diseases for use in countries outside the United States. The 11th edition is the
most recent.
4. Within DSM-5, a mental disorder is defined as a syndrome that is present in an
individual and involves clinically significant disturbance in behavior, emotion
regulation, or cognitive functioning. These disturbances are thought to reflect a
dysfunction in biological, psychological, or developmental processes that are
necessary for mental functioning.
5. DSM-5 also recognizes that mental disorders are usually associated with
significant distress or disability in key areas of functioning, such as social,
occupational, and other activities.

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a. Predictable or culturally approved responses to common stressors or losses
(such as the death of a loved one) are excluded.
b. The dysfunctional pattern of behavior must not stem from social deviance or
conflicts that the person has with society as a whole.
c. This new DSM-5 definition of mental illness was based on input from various
DSM-5 work groups as well as other sources.
d. Keep in mind that any definition of abnormality or mental disorder must be
somewhat arbitrary.
II. CLASSIFICATION AND DIAGNOSIS
Learning Objective 1.2: Describe the advantages and disadvantages of classification.
1. At the most fundamental level, classification systems provide us with a
nomenclature (a naming system). This gives clinicians and researchers both a
common language and shorthand terms for complex clinical conditions.
2. Classification systems enable us to structure information in a more helpful
manner. They facilitate research, which gives us more information and facilitates
greater understanding about what causes various disorders and how they might
best be treated.
3. Defining the domain of what is considered pathological establishes the range of
problems that the mental health professional can address, and thus delineates
which types of psychological difficulties warrant insurance reimbursement and
the extent of such reimbursement.
A. What Are the Disadvantages of Classification?
1. Using any form of shorthand inevitably leads to a loss of information.
2. As we simplify through classification, we lose personal details about the actual
individual with the disorder.
3. Stigma, or disgrace, is still associated with having a psychiatric diagnosis.
4. Stereotyping, or forming automatic beliefs about other people, may lead to
incorrect inferences about those who have been diagnosed.
a. We unavoidably learn stereotypes as a result of growing up in a particular
culture (e.g., people who wear glasses are more intelligent; New Yorkers are
rude).

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5. A stigma could be perpetuated by the problem of labeling.
a. It is important to keep in mind that classification systems don’t classify
people; they classify the disorders that people have.
6. When someone has an illness, we should take care not to define them by that
illness. Respectful and appropriate language should be used instead. For example,
it was once quite common for mental health professionals to describe a patient as
“a schizophrenic” or “a manic-depressive.” Now it is more widely acknowledged
that it is more accurate and considerate to use “person-first language”—“a person
with schizophrenia” or “a person with bipolar disorder.”
B. How Can We Reduce Prejudicial Attitudes Toward People Who Are Mentally Ill?
1. Prejudicial attitudes are common.
2. The results of a study by Arthur and colleagues (2010) suggest that stereotyping,
labeling, and stigma toward people with mental illness are not restricted to
industrialized countries.
3. For a long time, it was thought that educating people that mental illnesses were
“real” brain disorders might be a solution, but sadly this does not seem to be the
case. Increases in the proportion of people who understand that mental disorders
have neurological causes have not resulted in decreases in stigma.
4. Stigma does seem to be reduced by having more contact with people in the
stigmatized group. However, studies suggest that people may tend to avoid those
with mental illness because of the psychophysiological arousal and distress they
may experience.
III. CULTURE AND ABNORMALITY
Learning Objective 1.3: Explain how culture affects what is considered abnormal, and
describe two different culture-specific disorders.
1. There is considerable variation in the way that different cultures describe
psychological distress.
2. The way some disorders present themselves may depend on culturally sanctioned
ways of articulating distress.
3. Culture can shape the clinical presentation of disorders like depression, which are
present across cultures around the world.

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4. Despite progressively increasing cultural awareness, we still know relatively little
concerning cultural interpretation and expression of abnormal psychology.
5. The vast majority of the psychiatric literature originates from Euro-American
countries (i.e., Western Europe, North America, and Australia/New Zealand).
6. Research published in languages other than English tends to be disregarded.
7. Some types of psychopathology appear to be highly culture-specific. For example,
taijin kyofusho is an anxiety disorder that is quite prevalent in Japan, and ataque de
nervious, an “attack of nerves,” is found in people of Latino descent.
8. Certain unconventional actions and behaviors, such as hearing voices, laughing at
nothing, defecating in public, drinking urine, and believing things that no one else
believes, are almost universally considered abnormal behaviors.
IV. HOW COMMON ARE MENTAL DISORDERS?
Learning Objective 1.4: Distinguish between incidence and prevalence, and identify the
most common and prevalent mental disorders.
1. How many and what sort of people have diagnosable psychological disorders is a
significant question. It is essential for planning and establishing mental health
services, and it provides valuable cues as to the causes of these disorders.
A. Prevalence and Incidence
1. Epidemiology is the study of the distribution of diseases, disorders, or health-
related behaviors in a given population.
2. Prevalence is the number of active cases in a population during any given period
of time (i.e., the percentage of the population that has the disorder).
3. Point prevalence refers to the estimated proportion of actual, active cases of a
disorder in a given population at a given point in time.
4. 1-year prevalence refers to everyone who experienced a particular disorder
throughout an entire year.
5. Lifetime prevalence is an estimate of the number of people who have had a
particular disorder at some time in their lives (even if they have now recovered).
Lifetime prevalence estimates tend to be higher than other kinds of prevalence
estimates.
6. Incidence refers to the number of new cases that occur over a period of time
(typically one year).

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B. Prevalence Estimates for Mental Disorders
1. The most comprehensive source of prevalence estimates for adults in the United
States diagnosed with mental disorders is the National Comorbidity Survey
Replication (NCS-R), which sampled the entire adult population using a number
of sophisticated methodological strategies. As indicated in Table 1.1, the study’s
findings included:
a. Anxiety disorders have an estimated lifetime prevalence of 28.8 percent and a
1-year prevalence of 18.01 percent.
b. The lifetime prevalence for any mood disorder is 20.8 percent, and the 1-year
prevalence is 9.5 percent.
2. The lifetime prevalence of having any DSM-IV disorder is 46.4 percent, and the 1-
year prevalence is 26.2 percent.
a. This may be an underestimate, as the NCS-R study did not assess for certain
disorders, including eating disorders, schizophrenia, and autism. It also did not
include measures of most personality disorders.
b. The most common individual disorders were major depressive disorder,
alcohol abuse, and specific phobias (see Table 1.2).
c. Although the lifetime and 1-year rates of mental disorders appear to be quite
high, the duration of an individual’s disorder may be relatively brief. Also,
many people who meet the criteria for a disorder will not be seriously affected
by it.
d. Because the NCS-R is well over a decade old, another survey, the National
Survey on Drug Use and Health (NSDUH), is conducted every year.
3. Comorbidity is the presence of two or more disorders in the same person. It is
especially high—50 percent—in people who have severe forms of mental
disorders; those with milder forms have only a 7 percent rate.
C. The Global Burden of Disease
1. Worldwide, mental and substance use disorders account for over 7 percent of the
global burden of disease.
2. Because they are so common, anxiety disorders, depressive disorders, and
substance use disorders together account for 184 million disability-adjusted years
of life (DALYs), where one DALY can be thought of as the loss of one year of
otherwise “healthy” life.

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3. Depression accounts for more than 40 percent of DALYs.
4. Estimates indicate that worldwide, mental disorders will cost $16 trillion—or
about 25 percent of global GDP in 2010—over the next 20 years. This number
does not include the costs of treatment—or the personal, emotional costs that
living with a mental disorder can cause an individual and their family.
5. There is a need to find better ways to provide mental health services, particularly
in developing countries.
D. Treatment
1. Although there are many available treatments for psychological disorders—from
medication to psychotherapy—not all people with disorders receive treatment.
Some deny or minimize their problems; others fear the stigma of diagnosis; and
many delay treatment, even if they recognize they need help (half of those with
depression delay seeking treatment for 6 to 8 years; for those with anxiety
disorders, the delay ranges from 9 to 23 years). In addition, some are treated by
their family physician rather than by a mental health specialist.
2. Hospitalization and inpatient care are the preferred options for people who need
more intensive treatment than can be provided on an outpatient basis.
3. Admissions to mental hospitals have decreased substantially over the past 45
years, due in part to the increased development of medications that control
symptoms of severe disorders, budget cuts that have forced many large state or
county facilities to close, and hospital stays not being authorized by insurance
companies, forcing patients to seek treatment elsewhere.
4. Deinstitutionalization has had many unintended consequences, as described in
Chapter 2.
E. Mental Health Professionals
1. When individuals receive inpatient treatment, several different mental health
professionals often work as a team to provide the necessary care. A psychiatrist
may prescribe medications and monitor the patient for side effects, a clinical
psychologist may provide individual therapy, a clinical social worker may help
the patient resolve family problems, and a psychiatric nurse may check in with the
patient on a daily basis to provide support.
2. Patients treated in outpatient settings may also work with a team of professionals,
but the number of mental health specialists involved is typically much smaller.
For example, a patient might receive all treatment from a psychiatrist, who will
prescribe medication and provide psychotherapy; or they may receive medications

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from a psychiatrist and see a psychologist or clinical social worker for regular
therapy sessions.
V. RESEARCH APPROACHES IN ABNORMAL PSYCHOLOGY
Learning Objective 1.5: Discuss why abnormal psychology research can be conducted
in almost any setting.
1. We need to conduct research in order to study the characteristics, or nature, of
disorder.
2. Through research we can learn about the symptoms of a disorder, its prevalence,
whether it tends to be either acute (short in duration) or chronic (long in
duration), and the problems and deficits that often accompany it.
3. Research also allows us to further understand the etiology (or causes) of
disorders.
4. Abnormal psychology research can take place in clinics, hospitals, prisons, and
highly unstructured contexts, such as natural observations of homeless people on
the street.
VI. SOURCES OF INFORMATION
Learning Objective 1.6: Describe three different approaches used to gather information
about mental disorders.
A. Case Studies
1. Much can be learned when skilled clinicians use the case study method.
a. Psychiatrists Emil Kraepelin and Eugen Bleuler provided detailed accounts of
patients whom researchers today would easily recognize as having disorders
such as schizophrenia and manic depression.
b. Alois Alzheimer depicted a patient with an unusual clinical picture that
subsequently became known as Alzheimer’s disease.
c. Sigmund Freud published multiple clinical cases describing what we now
recognize as phobia and obsessive-compulsive disorder.
2. The information presented in case studies is subject to bias because the writer of
the case study selects which information to include and omit.
3. Another concern is that the material in a case study is often relevant only to the
individual being described, meaning that the conclusions drawn have low

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generalizability—that is, they cannot be used to draw conclusions about other
cases when those cases involve people with a seemingly similar abnormality.
B. Self-Report Data
1. Self-report data might involve having research participants complete
questionnaires of various types. Or the data could originate in interviews, where
the researcher asks a series of questions and records what the person says.
2. Self-reports can be misleading because they ask about the rater’s own subjective
states of experiences.
C. Observational Approaches
1. When we collect information in a way that does not involve asking people
directly (self-report), we are using some form of observational approach.
2. For example, Direct observation would be used, for example, if you were trying
to observe aggression in children’s behavior. Observers would record the number
of times children hit, bit, pushed, punched, or kicked their playmates. Information
about biological variables (e.g., heart rate and cortisol) might also be collected.
3. Brain-imaging technology—such as functional magnetic resonance imaging
(fMRI) and transcranial magnetic stimulation (TMS)—allows us to observe how
the brain works.
4. In practice, much clinical research involves a mix of self-report and observational
methods
VII. FORMING AND TESTING HYPOTHESES
Learning Objective 1.7: Explain why a control (or comparison group) is necessary to
adequately test a hypothesis.
1. A hypothesis is an effort to explain, predict, or explore something.
2. Anecdotal accounts such as case studies can be very valuable in helping us
develop hypotheses, although they are not well suited for testing the hypotheses
they may have inspired.
3. Other sources of hypotheses are unusual or unexpected research findings.
4. Hypotheses are vital because they frequently determine the therapeutic
approaches used to treat a particular clinical problem.

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A. Sampling and Generalization
1. Studies that examine groups of people are valued over single cases. Group studies
may identify multiple causes for disorders, and they can generalize results to other
cases.
2. Sampling is the careful selection of a subgroup that is representative of a larger
population for close study.
3. The more representative the sample, the more able we are to generalize. Ideally,
we would be able to use random sampling to avoid potential biases, as erroneous
conclusions can emerge from faulty sampling.
B. Internal and External Validity
1. External validity is the extent to which we can generalize our findings beyond the
study itself.
2. Internal validity reflects how confident we can be in the results of a given study
C. Criterion and Comparison Groups
1. To test their hypotheses, researchers use a comparison group (sometimes called
a control group). This may be defined as a group of people who do not exhibit
the disorder being studied but who are comparable in all other major respects to
the criterion group
2. People with the disorder being studied are the criterion group.
VIII. CORRELATIONAL RESEARCH DESIGNS
Learning Objective 1.8: Discuss why correlational research designs are valuable, even
though they cannot be used to make causal inferences.
1. A correlational research design involves studying the world as it is.
2. Correlational research does not involve any manipulation of variables.
3. We use correlational design any time we study the differences between
individuals who do and do not have a particular disorder.
A. Measuring Correlation
1. The strength of a correlation is measured by a correlation coefficient, which is
denoted by the symbol r. A correlation runs from 0 to 1, with a number closer to 1

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representing a stronger association between the two variables. The + sign or –
sign indicates the direction of the association between the two variables.
2. Positive correlation is when measures vary together in a direct, corresponding
manner. For example, higher scores on one variable are associated with higher
scores on another variable.
3. With negative correlation, there is an inverse correlation between the variables
of interest. For example, as scores on one variable go up, scores on the other
variable tend to go down.
B. Statistical Significance
1 The notation p < .05 is an example of how the level of statistical significance is
depicted. This means that the probability of the correlation occurring purely by
chance is less than 5 out of 100. Researchers consider correlations that have p <
.05 to be statistically significant and worthy of attention.
2. Statistical significance is influenced not only by the magnitude or size of the
correlation between the two variables but also by the sample size.
C. Effect Size
1. The effect size reflects the size of association between two variables, independent
of the sample size.
2. An effect size of zero means that there is no association between the variables.
D. Meta-Analysis
1. A meta-analysis is a statistical approach that calculates and then combines the
effect sizes from numerous studies.
2. Within a meta-analysis, each separate study can be thought of as being equivalent
to an individual participant in a conventional research design.
E. Correlations and Causality
1. Correlation does not mean causation.
2. A might cause B, or B might cause A; or A and B might both be caused by C. A
and B are involved in a complex web of relationships with other variables.
3. The third variable problem is when some unknown, third variable might be
causing both events to happen

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F. Retrospective Versus Prospective Strategies
1. A retrospective research strategy involves looking back in time. In other words,
we would try to collect information about how the patients behaved earlier in their
lives, with the goal of identifying factors that might be associated with what went
wrong later.
2. A prospective research strategy involves looking ahead in time. The idea is to
identify individuals who have a higher-than-average likelihood of becoming
psychologically disordered, and to focus research attention on them before a
disorder manifests.
3. A study with a longitudinal design follows people over time and tries to identify
factors that predate the onset of a disorder
IX. THE EXPERIMENTAL METHOD IN ABNORMAL PSYCHOLOGY
Learning Objective 1.9: Explain the key features of an experimental design.
1. Correlational research does not allow us to draw any conclusions about
directionality This is known as the direction of effect problem. To draw
conclusions about causality and resolve questions of directionality, an
experimental research approach must be used. In such studies, scientists control
all factors except one—the factor that could have an effect on a variable or
outcome of interest.
2. The factor that is manipulated is referred to as the independent variable.
3. If the outcome of interest—the dependent variable—is observed to change as the
manipulated factor changes, then that independent variable can be regarded as a
cause of the outcome.
A. Studying the Efficacy of Therapy
1. In treatment research, it is important that the treated and untreated groups be as
equivalent as possible, except for the presence or absence of the proposed active
treatment.
2. Patients are typically randomly assigned. Random assignment means that every
research participant has an equal chance of being placed in the treatment or the
no-treatment condition.
3. The ethics of withholding effective treatment may lead to an alternative research
design in which two or more treatments are compared in differing yet comparable
groups. This is called a standard treatment comparison study.

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4. In a double-blind study, neither the subjects nor the experimenter working with
them knows who is receiving the genuine treatment.
5. Placebo treatment conditions enable experimenters to control for the possibility
that simply believing one is getting an effective type of treatment may produce
benefits.
B. Single-Case Experimental Designs
1. In single-case research designs, the same individual is studied over a period of
time. Behavior or performance at one point in time can then be compared to
behavior or performance at a later time, after a specific intervention or treatment
has been introduced.
2. One of the most basic experimental designs in single-case research is the ABAB
design. The letters refer to different phases of the intervention: The first A is the
baseline condition; the first B is the introduction of the treatment.
C. Animal Research
1. Using animal subjects, we are able to perform studies that would not be possible
to implement with humans. Nonetheless, ethical considerations still apply.
2. One major assumption is that findings from animal studies can be generalized to
humans. Experiments of this kind are generally known as analogue studies,
where we study not the true item of interest but an approximation to it.
3. Analogue studies may also involve humans (e.g., when we try to study depression
by studying healthy research participants whom we have made mildly and
transiently sad).
4. Findings from animal research have provided impetus for the learned helplessness
model of depression.

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Key Terms
ABAB design
abnormal psychology
acute
analogue studies
bias
case study
chronic
comorbidity
comparison or control group
correlation
correlation coefficient
correlational research
criterion group
dependent variable
direct observation
double-blind study
effect size
epidemiology
etiology
experimental research
external validity
family aggregation
generalizability
hypothesis
incidence
independent variable
internal validity
labeling
lifetime prevalence
longitudinal design
meta-analysis
negative correlation
nomenclature
1-year prevalence
placebo treatment
point prevalence
positive correlation
prevalence
prospective research
random assignment
retrospective research
sampling
self-report data
single-case research design
statistical significance
stereotyping
stigma
third variable problem
Lecture Suggestions and Activities
Learning Objective 1.1: Explain how we define abnormality and classify mental disorders.
LECTURE SUGGESTIONS
Why Are You Taking This Course?
Students taking abnormal psychology often have a variety of reasons for doing so. These range
from satisfying a degree requirement to a desire for enhanced personal insight. The expectations of
the students regarding the course, and what they may or may not get out of it, are interesting issues
to explore at the very outset. Students should be encouraged to volunteer their reasons for enrolling
in the course. Common answers that usually arise include: to learn more about my own behavior,
to understand others, and to learn about the different mental health professions. Hearing other
peoples’ answers to this question can also help students expand their ambitions in the course
beyond the ones they originally held. This discussion can also provide a good opportunity to
present the rationale behind studying abnormal psychology and how the scientific tradition assists

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Abnormal Psychology 18e, Hooley/Butcher
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in increasing our understanding of behavior and its determinants. After this discussion, students
should have a clear understanding of the demands and expectations of this course and how their
expectations fit into the course design. Students can also write one reason anonymously on a piece
of paper and designate a couple of students or the professor to read them aloud.
The Various Ways Abnormality Is Defined
Begin the in-class discussion with the various ways in which abnormal behavior is defined and
classified so that researchers and mental health professionals can communicate with each other
about the people they see. Again, as a reminder, the textbook defines abnormal behavior as
encompassing subjective distress, maladaptiveness, statistical deviancy, violation of the
standards of society, social discomfort, irrationality and unpredictability, and dangerousness.
Evolutionary Psychology
If you have a background that includes evolutionary psychology, you may want to discuss
adaptive value and ask students to generate possible reasons why we would see maladaptive
behaviors not die out. Because one of the main tenets of evolutionary psychology is that
behaviors that persist must in some way be or have been adaptive, how does this explain the
disorders we see today? One example can be built on the example above on the “adaptive value”
of schizophrenia. Ask students if someone lived in a remote tribe in South America or Africa and
they reported talking to God, how would their village receive them? Could there be other
situations with other disorders where some of these behaviors are actually adaptive in some way?
Evolving Conceptualizations of Homosexuality
Prior to the publication of DSM-III in 1980, homosexuality was considered a mental illness. In
DSM-III it was considered a disorder only if the homosexual person was emotionally troubled by
it—that is, only if it was ego-dystonic. In DSM-IIIR (1987) it moved into a general category of
sexual disorders “not otherwise specified,” where it was recast as “persistent and marked distress
about one’s sexual orientation,” for ego-dystonic heterosexuality as well as homosexuality.
These transitions were not driven by scientific research but by evolving societal norms and
political pressure. Evolving conceptualizations of homosexuality provide interesting material for
discussing diagnosis, science, and politics. It is also sometimes quite interesting to discuss the
kinds of research that could be conducted to establish the diagnostic status of behaviors,
including homosexuality. Are there data that would certify behaviors as abnormal, or are societal
values absolutely necessary?
ACTIVITY
Defining Abnormality
To initiate a class discussion of abnormality, ask students the following question: “How would
you define abnormal behavior?” A number of different answers will be generated, and these
should be recorded on the blackboard. The instructor should challenge each of the answers in
order to illustrate the concepts expressed in the text. The responses generated by the students can
then be categorized into the different areas identified in Chapter 1—for example, the view that
abnormality is always dangerous or that mental disorder is something to be scorned. Through the
course of the discussion, students should come to appreciate the problem in defining abnormal
behavior and gain an insight into factors affecting the labeling of abnormality.

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Learning Objective 1.2: Describe the advantages and disadvantages of classification.
LECTURE SUGGESTION
Invite a Student with a Disability
You may want to consider asking students with disabilities to come in and participate in a short
discussion on what it is like for many of the students on your campus with disabilities. The
discussion of labeling and stereotyping lends itself well to more general discussions on labeling
of all forms. Many students in abnormal psychology classes, more so than other classes, often
self-disclose diagnoses and other forms of personal information. This discussion may make
students more sensitive to others in the class who have been “labeled” and how that in and of
itself has affected them.
ACTIVITIES
Hospitalization
Using a PowerPoint slide or a whiteboard, write the following question and answer choices:
“Your city is planning to create a half-way house for adult men who have been hospitalized for
paranoid schizophrenia. Where would be the best place to put this home? A. Next door to your
home; B. In your neighborhood; C. Anywhere in town would be fine; D. In the next town.”
Asking students to answer privately on their own paper prior to beginning any discussion of this
topic is typically necessary.
Stereotypes in the Media
Stereotypes and stigma often originate in media portrayals of both the mentally ill and the
professionals who treat and study them. Television and the movies consistently use
psychological labels to describe unpleasant and dangerous characters. The written media
likewise often use lurid descriptions of crimes, including psychological diagnoses and terms.
Most students in the class will be able to cite examples of such portrayals from their own
experience. An excellent way to combat erroneous beliefs about abnormal psychology is to rebut
these salient portrayals. Asking students to bring examples to class can readily accomplish this.
Each student can be required to bring at least one newspaper or magazine article, video clip, or
even Web site portraying some aspect of abnormal psychology. The class can be asked to
comment on these materials before the instructor points out what is generally representative and
accurate, given the scientific literature on the topic, versus what is not representative or even
inaccurate. For instance, a student might bring a clip from A Beautiful Mind, which provides
vivid images of visual hallucinations, even though these are much less common in schizophrenia
than auditory hallucinations. This film also provides a good opportunity to discuss medications
and the prospects for overcoming schizophrenia through mere effort of will. Large classes can be
broken into groups that can compile materials and present their observations and questions to the
rest of the class.

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Learning Objective 1.3: Explain how culture affects what is considered abnormal, and
describe two different culture-specific disorders.
LECTURE SUGGESTIONS
What’s Your Frame of Reference?
The concept of social labeling provides an excellent topic for a lecture/discussion session. Any
number of cultural groups can be used as examples to provide contrasts in how societies label
pathology. Students can be asked to generate their own examples of social labeling, using
experiences with subcultural groups. The behaviors found among different age groups are often
labeled as abnormal by the dominant age group in our society. For instance, street slang may be
evaluated as maladaptive by the school system, yet it provides rich communication in its own
subcultural context. The behavior of adolescents may be labeled as pathological by adults who
see the behavior as maladaptive (e.g., body piercing or tattooing). Students should find the
discussion of social labeling an interesting one, because they can contribute experiences from
their own subcultural group. In-class lecture can illustrate that, although social labeling can be a
powerful process, some behaviors (such as depression) are generally assumed to be maladaptive
in all subcultures and societies. Students can be asked to identify other behaviors whose
maladaptiveness transcends cultural boundaries. An easy way to begin a discussion of this type
might be to ask students the number of piercings that they have. Tally the number of students
who report 0, 1, 2, 3, 4, 5 or more piercings, and talk about how the acceptance of piercing has
changed in the past few years in our culture.
Cultural Relativity
Students sometimes view stigma, cultural relativity, and social causation as rather weak
compared to biological factors and cultural universals. The force of cultural and social
phenomena can be established experientially by assigning students to violate an innocuous norm
in a way that would be inconsequential elsewhere. Caution them to avoid illegal activities or
ones that infringe on the rights of others. For instance, if social and interpersonal forces are
innocuous, it should be inconsequential to wear a football helmet all day or to carry around a
houseplant adorned with Christmas ornaments.
ACTIVITY
Researching Culture-Bound Syndromes
Have students work in groups to conduct online research on a culture-bound syndrome found in
a different country or region of the world. For each syndrome, students can present the syndrome
and why it might be present in that region but not considered abnormal in the United States.

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Learning Objective 1.4: Distinguish between incidence and prevalence, and identify the
most common and prevalent mental disorders.
LECTURE SUGGESTION
Rates of Incidence
Here you may want to again discuss the issue of rates of incidence with students. Do they feel
these numbers include everyone? What about gender differences? Do they think one gender may
be diagnosed more? Why or why not? Perhaps one sex is more likely to seek help? What about
disorders like substance abuse? Will everyone be represented in the data?
ACTIVITIES
Exploring Prevalence Rates Online
Have students guess what the most prevalent psychological disorders are. Then have them
conduct online research on prevalence numbers. Have them compare and contrast 1-year
prevalence and point prevalence. They could also contrast the prevalence numbers by region and
ethnicity. Finally, have students discuss why the statistics vary by source.
Handout: What Is Abnormal?
For each of the behaviors listed, indicate whether you think it would be considered distressful,
maladaptive, deviant, a violation of the standards of society, socially uncomfortable, irrational,
and/or dangerous. You may select none or more than one for each.
Distressful Maladaptive Deviant Violation of
Society
Standards
Socially
Uncomfortable
Irrational Dangerous
A man talking to
himself as he walks
down the street
A strong preference
for yellow socks
Owning 25 cats
Washing hands over
50 times a day
A man telling you
that God has asked
him to help you
Having to sit in the
same seat in every
class you take
Believing that all
your neighbors are
plotting against you
Not eating solid
foods for one week
Becoming extremely
tense and jittery
before an exam
Created by: David Lee, University of California, Irvine. No third-party material included.

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Learning Objective 1.5: Discuss why abnormal psychology research can be conducted in
almost any setting.
LECTURE SUGGESTIONS
On Being Sane in Insane Places
Rosenhan (1973) published a classic abnormal psychology study in the extremely high-profile
journal Science (vol. 179, pp. 250–258). This study raises many interesting questions about
research methods, definitions of abnormality, and the ability of mental health professionals to
distinguish actual from feigned mental illness. In this study, eight healthy volunteers, several of
them psychologists and psychiatrists, went to mental hospitals and complained of hearing voices
saying “empty,” “hollow,” or “thud.” These pseudo-patients acted normally in every way except
for the reported auditory hallucinations. As soon as they were admitted, they stopped
complaining of these symptoms. Although many of the real hospitalized patients suspected the
pseudo-patients were faking, none of the hospital staff apparently did. All pseudo-patients were
labeled schizophrenic and their stays ranged from 7 to 52 days, with an average stay of 19 days.
Originally, this was taken as evidence of how important labels and expectations affect
interpretations of people’s behavior. However, it is worth envisioning a control group of pseudo-
patients who report equally severe physical symptoms to physicians. Indeed, people with some
kinds of somatoform disorder (Chapter 8) succeed in getting fairly dramatic treatments,
including surgery, in the absence of genuine organic pathology. It is also worth noting that many
pseudo-patients were diagnosed with atypical subtypes of schizophrenia, suggesting that the
hospital staff recognized that there was something quite different about these patients. The
Rosenhan study also raises questions about securing informed consent from research
participants, draining precious treatment resources, and how long it is reasonable to observe an
apparently recovered psychotic person to ensure that relapse is not imminent. These, and other
design, ethical, and statistical matters, many of which were published in a subsequent issue of
Science (1973, vol. 180, pp. 1116–1122), qualify the interpretation of this classic report
substantially.
Sampling Issues in Abnormal Psychology
Discuss with students where the data in this area comes from. Is it from Intro to Psych students
like data in Social? Is it from schools and education data clearinghouses like Developmental?
Here you are generally looking at what sample? Who’s included? Who’s excluded? By getting
students to think about where the data comes from and if it excludes many people, students
should be able to think about how good is the data in this area and if there are ways to get better
data.
Ethics in Scientific Research
This is a great time to discuss the ethical treatment of subjects, both human and animal. Point out
to students that drug studies, for example, involve both humans and animals. Regardless of the
long-term pay off, the cost to a subject can be high; where should the line be drawn?

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ACTIVITY
Creating a Survey
Have students create a 15-item survey/questionnaire to assess depression or anxiety symptoms in
adolescents. Then have students discuss which questions can provide insight as to whether a
symptom is chronic or acute. Also ask students to include questions that might provide
information about the etiology of the disorder. Finally, discuss any questions that might cause
ethical concerns.
Learning Objective 1.6: Describe three different approaches used to gather information
about mental disorders.
LECTURE SUGGESTION
Issues with Case Studies
This is a good time to point out the problems with case studies. For example, Alex the African
parrot. Despite many attempts, researchers have never replicated these results. Keep in mind,
although case studies can be dead on (e.g., early descriptions of schizophrenia, the role of the
amygdale in Phineas Gage’s uncontrolled emotions, Piaget’s observations of his children), they
can also be very wrong (e.g., Alex the African parrot, some of Freud’s assumptions based on his
case studies). Also, remind students that although there are significant limitations to case studies,
many times it is the only way, for example, when only a handful of people have a condition, or in
cases of brain damage.
ACTIVITY
Pros and Cons of Research Approaches
After discussing the three approaches to gathering information—case study, self-report, and
observation—have students discuss the pros and cons of each one. Then have students conduct
research to find studies illustrating each type of approach. Either individually or in groups,
students can conduct online research to browse recent issues of Journal of Abnormal Psychology,
Journal of Consulting and Clinical Psychology, Archives of General Psychiatry, and American
Journal of Psychiatry to find at least one article of interest.
Learning Objective 1.7: Explain why a control (or comparison group) is necessary to
adequately test a hypothesis.
LECTURE SUGGESTION
The Importance of a Control Group
Discuss the many different types of control in the experimental method. Discuss the advantages
and disadvantages of a placebo-group (active) control versus a passive control group study. Also

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discuss the advantages and disadvantages of repeated designs, such as ABAB, versus comparing
two independent groups. Factors to discuss might include time, attrition, cost, and control of
confounding variables.
ACTIVITY
Different Methods of Control
Have students design a study examining the effectiveness of a psychotherapy treatment method
for anxiety. How many groups should they compare? Will they use an active or a passive control
group? Then have them design a study examining the effectiveness of a medical treatment for
anxiety. How many groups should they compare? Will they use an active or a passive control
group? Is there a difference in the way they would design control groups for medication studies
compared to psychotherapy studies?
Learning Objective 1.8: Discuss why correlational research designs are valuable, even
though they cannot be used to make causal inferences.
LECTURE SUGGESTION
Correlation Is Not Causation
Students often assume that a correlation can be interpreted as a causal relationship. Provide
examples of alternative explanations for strong correlations. For example, you can discuss the
strong positive correlation between ice cream sales and drowning deaths to discuss the third
variable bias. Or you can discuss the direction problem in the relationship between self-esteem
and achievement.
ACTIVITY
Journal Browsing
Students can gain a greater appreciation for scientific approaches to the study of abnormal
psychology by perusing current issues of some of the more rigorous journals in the field. Either
individually or in groups, students can conduct online research to browse recent issues of
Journal of Abnormal Psychology, Journal of Consulting and Clinical Psychology, Archives of
General Psychiatry, and American Journal of Psychiatry to find at least one article of interest.
They can then be asked to present this article to the class, summarizing its purpose and main
findings. It can also be instructive to ask that students make some general classifications of the
research design. Is the selected study correlational or experimental? Retrospective or
prospective? What diagnosis is under consideration? Does the article address etiology,
descriptive psychopathology, or treatment? Is there a control group? A historical perspective can
be encouraged by randomly assigning students to study articles from various decades

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Learning Objective 1.9: Explain the key features of an experimental design.
LECTURE SUGGESTION
The Experimental Design
Manipulation and control are key features of the experimental design. Using a concrete example,
such as a clinical drug trial study for depression, discuss and identify the independent and
dependent variables in the study. Have students help with the manipulation process by forming
the comparison groups for the independent variable. Discuss the importance of placebo groups
and of having an active, rather than passive, control group. Finally, emphasize the significance of
random assignment in eliminating confounding variables.
ACTIVITY
Single-Case Experimental Design
James Carr and John Austin (1997) developed a demonstration of single-case experimental
design that can easily be used in a classroom setting. Students are instructed on how to take their
own pulse rate and record these data for five, 1-minute intervals. This constitutes baseline. The
treatment phase then begins by asking students to stand up and do jumping jacks for 20 seconds.
The students then sit and take their pulse rate again for one minute. Students repeat the treatment
phase four additional times. Following the collection of the five pulse rates during “treatment,”
the students once again sit and record five resting pulse rates in 1-minute intervals. Students
could repeat the treatment phase if the instructor wishes to demonstrate an ABAB design. Once
the data is collected, each student could draw a graph of his or her results and attempt to draw
some conclusions regarding how “treatment” impacted heart rate.
Revel Videos
What Does It Mean to Have a Mental Disorder?
Case Studies
Self-Report Data
Correlational and Experimental Research Designs

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Abnormal Psychology 18e, Hooley/Butcher
1
Chapter 2: Earliest Views of
Abnormal Behavior
Learning Objectives
2.1 Explain the first views of mental disorders.
2.2 Describe the effect that scientific thinking had on views of abnormal psychology and the rise
of early asylums.
2.3 Describe the historical development of humanitarian reform.
2.4 Describe the changes in social attitudes that led to changes in how we think about and treat
mental disorders.
2.5 Identify developments that led to the contemporary view of abnormal psychology.
Chapter Overview/Summary
Understanding of abnormal behavior has not evolved smoothly or uniformly over the centuries.
The steps have been uneven, with great gaps in between, and unusual—even bizarre—views or
beliefs have often sidetracked researchers and theorists. The dominant social, economic, and
religious views of the times have had a profound influence over how people have viewed
abnormal behavior.
In the ancient world, superstitious explanations for mental disorders were followed by the
emergence of medical concepts in many places, such as Egypt and Greece; many of these
concepts were developed and refined by Roman physicians. After the fall of Rome, near the end
of the fifth century, superstitious views dominated popular thinking about mental disorders for
over 1,000 years. In the fifteenth and sixteenth centuries, it was still widely believed, even by
scholars, that some of the people experiencing mental disturbances were possessed by a devil.
Great strides have been made in our understanding of abnormal behavior. For example,
during the latter part of the Middle Ages and the early Renaissance, a spirit of scientific
questioning reappeared in Europe, and several noted physicians spoke out against inhumane
treatments. There was a general movement away from superstitions and “magic” toward
reasoned, scientific studies.
With recognition of a need for the special treatment of people with mental illness came the
founding of various “asylums” toward the end of the sixteenth century. However,
institutionalization led to the isolation and maltreatment of patients. Slowly, this situation was
recognized, and in the eighteenth century further efforts were made to help afflicted individuals

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Abnormal Psychology 18e, Hooley/Butcher
2
by providing them with better living conditions and humane treatment, although these
improvements were the exception rather than the rule.
The nineteenth and early twentieth centuries witnessed a number of scientific and
humanitarian advances. The work of Philippe Pinel in France, William Tuke in England, and
Benjamin Rush and Dorothea Dix in the United States prepared the way for several important
developments in contemporary abnormal psychology. Among these were the gradual acceptance
of patients with mental illness as afflicted individuals who need and deserve professional
attention; the successful application of biomedical methods to disorders; and the growth of
scientific research into the biological, psychological, and sociocultural roots of abnormal
behavior.
The reform of mental hospitals continued into the twentieth century, but during its last four
decades, there was a strong movement to close mental hospitals and release people into the
community. This deinstitutionalization movement remains controversial into the early part of the
twenty-first century.
In the nineteenth century, great technological discoveries and scientific advancements that
were made in the biological sciences enhanced the understanding and treatment of individuals
with mental illness. One major biomedical breakthrough came with the discovery of the organic
factors underlying general paresis—syphilis of the brain—one of the most serious mental
illnesses of the day.
Beginning in the early part of the eighteenth century, knowledge of anatomy, physiology,
neurology, chemistry, and general medicine increased rapidly. These advances led to the
identification of the biological, or organic, pathology underlying many physical ailments.
The development of a psychiatric classification system by Kraepelin played a dominant role
in the early development of the biological viewpoint. Kraepelin’s work (a forerunner to the DSM
system) helped to establish the importance of brain pathology in mental disorders and made
several related contributions that helped establish this viewpoint.
The first major steps toward understanding psychological factors in mental disorders
occurred with mesmerism, followed by the work of Sigmund Freud. During five decades of
observation, treatment, and writing, he developed a theory of psychopathology known as
psychoanalysis, which emphasized the inner dynamics of unconscious motives. During the past
half century, other clinicians have modified and revised Freud’s theory, which has thus evolved
into new psychodynamic perspectives.
Scientific investigation into psychological factors and human behavior began to make
progress in the latter part of the nineteenth century. The end of the nineteenth century and early
twentieth century saw experimental psychology evolve into clinical psychology with the
development of clinics to study, as well as intervene in, abnormal behavior.
Understanding the history of psychopathology—its forward steps and missteps alike—helps
us understand the emergence of modern concepts of abnormal behavior.

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Abnormal Psychology 18e, Hooley/Butcher
3
Detailed Chapter Outline
I. THE FIRST VIEWS OF MENTAL DISORDERS
Learning Objective 2.1: Explain the first views of mental disorders.
A. Demonology, Gods, and Magic
1. Abnormal behavior was attributed to possession by a demon or a god. Whether
the “possession” was assumed to involve good or evil spirits typically depended
on the individual’s symptoms (if they appeared to have a religious or mystical
significance, it was usually thought that good spirits or a god were involved).
Most possessions, however, were considered the work of an angry god or an evil
spirit.
2. The primary treatment for demonic possession was exorcism, which included
techniques for casting evil spirits out. These techniques included magic, prayer,
incantation, noisemaking, and the use of horrible-tasting concoctions.
B. Hippocrates’ Early Medical Concepts
1. Around 400 B.C., there was a shift in focus away from the supernatural to
problems in the human body.
2. Hippocrates insisted that mental disorders were due to natural causes. He believed
that the brain was the central organ of intellectual activity and that mental
disorders were due to brain pathology. He also emphasized the importance of
heredity and predisposition, and pointed out that injuries to the head could cause
sensory and motor disorders.
3. Hippocrates classified all mental disorders into three general categories, based on
detailed clinical observations: mania, melancholia, and phrenitis (brain fever).
4. The best known of the earlier paradigms for explaining personality or
temperament is the doctrine of the four humors, associated with Hippocrates and
later with the Roman physician Galen.
a. The four essential fluids of the body were blood (sanguis), phlegm, bile
(choler), and black bile (melancholer), .
b. A person’s temperament was determined by which of the humors was
dominant.
5. Hippocrates considered dreams to be important in understanding a patient’s
personality.

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Abnormal Psychology 18e, Hooley/Butcher
4
6. He recommended various treatments, including a regular and tranquil life,
sobriety and abstinence from all excesses, a vegetable diet, celibacy, exercise
short of fatigue, and bleeding if indicated. He also emphasized the importance of
environment and promoted the removal of patients from their families if
necessary.
7. Hippocrates believed that hysteria was restricted to women and caused by a
wandering uterus and pining for a child, and he believed that the cure was
marriage.
C. Early Philosophical Conceptualizations of Abnormal Behavior
1. Plato (429–347 B.C.) was a Greek philosopher who studied individuals with
mental disturbances who had committed criminal acts and how to deal with them.
He noted that such persons were, in some “obvious” sense, not responsible for
their acts and should not receive punishment in the same way as normal persons.
a. Plato emphasized in The Republic the importance of individual differences in
intellectual and other abilities and took into account sociocultural influences
in shaping thinking and behavior.
b. He recommended “hospital” care for those who developed beliefs counter to
the broader social order.
c. Despite these modern ideas, Plato believed that mental disorders were in part
divinely caused.
2. Aristotle (384–322 B.C.) was a pupil of Plato. His most lasting contributions to
psychology are his descriptions of consciousness.
a. Aristotle held the view that “thinking” as directed would eliminate pain and
help attain pleasure.
b. He generally subscribed to the Hippocratic theory of disturbances in the bile.
3. Galen (A.D. 130–200) was a Greek physician who took a scientific approach to
mental health and divided the causes into physical and mental categories.
D. Early Chinese Conceptualizations of Abnormal Behavior
1. Chinese medicine was based on a belief in natural rather than supernatural causes
of illnesses.
2. Around A.D. 200, Chung Ching, called the Hippocrates of China, wrote two
medical works that implicated organ pathologies as primary causes of mental
disorders.

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Abnormal Psychology 18e, Hooley/Butcher
5
3. From the latter part of the second century through the early part of the ninth
century, Chinese views regressed to a belief in supernatural forces such as ghosts
and devils as causal agents of mental disorders.
4. During the past 50 years, China has been experiencing a broadening of ideas in
mental health services and incorporating many ideas from Western psychiatry.
E. Views of Abnormality During the Middle Ages
1. During the Middle Ages (about 500 to 1500), the more scientific aspects of Greek
medicine survived in the Islamic countries of the Middle East.
a. The first mental hospital was established in Baghdad in 792, where they
provided humane treatment.
b. Referred to as the “prince of physicians,” Avicenna from Persia (c. 980–1037)
authored The Canon of Medicine.
2. The Middle Ages in Europe were largely devoid of scientific thinking and
humane treatment for those with mental illnesses.
a. Management of those who were mentally disturbed was left largely to the
clergy.
b. Some monasteries practiced combining exorcisms with vaguely understood
medical treatments.
3. Some recent interpretations have questioned the long-held notion that during the
Middle Ages, many people with mental disturbances were accused of being
witches and killed. The confusion between witchcraft and mental illness may be
due, in part, to misunderstandings about demonic possession.
II. VIEWS OF ABNORMAL BEHAVIOR IN THE 1500S AND 1600S
Learning Objective 2.2: Describe the effect that scientific thinking had on views of
abnormal psychology and the rise of early asylums.
1. During the latter part of the Middle Ages and the early Renaissance, scientific
questioning reemerged, and a movement emphasizing human interests and
concerns, referred to as humanism, began.
2. The superstitious belief that had hindered the understanding of therapeutic
treatment began to be challenged.

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