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The Biopsychosocial Model

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The Biopsychosocial Model
457
Explaining Psychological Disorders
In summary, it is difficult, and probably impossible, to define a specific set of behaviors that everyone, everywhere, will agree constitutes abnormality. Instead, the practical
approach sees abnormality as including those patterns of thought, behavior, and emotion that impair functioning, cause discomfort, and/or disrupt the lives of others.
Explaining Psychological Disorders
䉴 What causes abnormality?
doing
2
learn
by
SITUATIONAL FACTORS IN
DEFINING ABNORMALITY
When this college student attended classes virtually nude to protest
“social repression,” complaints from other
students led to his dismissal. Yet if he
lived in a nudist colony, he might be seen
as overdressed. Make a list of the reasons
you would give for or against labeling
him “abnormal.” Which criteria for abnormality did you use in making your list?
Since the dawn of civilization, people have tried to understand the causes of psychological disorder. Centuries ago, explanations of abnormal behavior focused on gods or
demons. Disordered people were seen either as innocent victims of evil spirits or as
social or moral deviants suffering supernatural punishment. In Europe during the late
Middle Ages, for example, people who engaged in threatening or unusual behavior
were seen as controlled by the devil or other evil beings. Supernatural explanations of
psychological disorders are still invoked today in many cultures around the world—
including certain ethnic and religious subcultures in North America (Nickell, 2001;
Tagliabue, 1999).
The Biopsychosocial Model
More generally, however, mental health researchers in Western cultures attribute the
appearance of psychopathology to three other causes: biological factors, psychological
processes, and sociocultural contexts. For many decades, there was controversy over
which of these three causes was most important, but it is now widely agreed that they
can all be important. Most researchers have adopted a biopsychosocial model in
which mental disorders are seen as caused by the combination and interaction of biological, psychological, and sociocultural factors, each of which contributes in varying
degrees to particular problems in particular people (Krueger & Markon, 2006; U.S.
Surgeon General, 1999).
The biological factors thought to be involved in causing mental disorders include physical illnesses and disruptions or imbalances of bodily
Biological Factors
The exorcism being
performed by this Buddhist monk in Thailand is designed to cast out the evil forces
seen as causing this child’s disorder. Supernatural explanations of mental disorder remain influential among religious
groups in many cultures and subcultures
around the world (Fountain, 2000). Awareness of this influence in the United States
and Europe has increased recently following cases in which people have died during exorcism rituals (e.g., Christopher,
2003; Radford, 2005).
AN EXORCISM
458
Chapter 12 Psychological Disorders
As shown in
William Hogarth’s portrayal of “Bedlam”
(slang for London’s Saint Mary’s of Bethlehem hospital), most asylums of the
1700s were little more than prisons. Notice the well-dressed visitors. In those
days, the public could buy tickets to look
at mental patients, much as people go to
the zoo today.
VISITING BEDLAM
processes. This medical model of psychological disorder has a long history. For example, Hippocrates, a physician in ancient Greece, said that psychological disorders
result from imbalances among four humors, or bodily fluids (blood, phlegm, black
bile, and yellow bile). In ancient Chinese cultures, psychological disorders were seen
as arising from an imbalance of yin and yang, the dual forces of the universe flowing in the physical body.
As the medical model gained prominence in Western cultures after the Middle Ages,
special hospitals for the insane were established throughout Europe. Treatment in these
early asylums consisted mainly of physical restraints, laxative purges, bleeding of
“excess” blood, and induced vomiting. Cold baths, fasts, and other physical discomforts
were also used in efforts to “shock” patients back to normality.
The medical model gave rise to the concept of abnormality as mental illness—and
in fact, most people in Western cultures today still tend to seek medical doctors and
hospitals for the diagnosis and treatment of psychological disorders. The medical model
is now more properly called the neurobiological model, because it explains psychological disorders in terms of particular disturbances in the anatomy and chemistry of
the brain and in other biological processes, including genetic influences (e.g., Kendler,
2005; Plomin & McGuffin, 2003). Neuroscientists and others who adopt a neurobiological approach investigate these disorders as they would investigate any physical illness, seeing problematic symptoms stemming primarily from an underlying illness that
can be diagnosed, treated, and cured.
The biological factors we have described are constantly
influencing, and being influenced by, a variety of psychological processes, such as our
wants, needs, and emotions; our learning experiences; and our way of looking at the
world. The roots of the psychological model of disorder can be found in ancient
Greek literature and drama dealing with psyche, or mind—and especially with the problems people experience as they struggle to resolve inner conflicts or to overcome the
effects of stressful events.
These ideas took center stage in the late 1800s, when Sigmund Freud challenged the
assumption that psychological disorders had only physical causes. As described in the
chapter on personality, Freud viewed psychological disorders as resulting mainly from
the effects of unresolved, mostly unconscious clashes between people’s inborn impulses
and the limits placed on those impulses by the environment. These conflicts, he said,
begin early in childhood. Today’s versions of this psychodynamic model focus less on
Psychological Processes
neurobiological model
A view of
mental disorder as caused by physical
illness or an imbalance in bodily
processes, including disturbances in the
anatomy and chemistry of the brain.
psychological model An approach
that views mental disorder as arising
from inner conflicts or other psychological processes.
Explaining Psychological Disorders
LINKAGES
Are psychological disorders
learned behaviors? (a link to
Learning)
LINKAGES
How do societies define what
is abnormal? (a link to Social
Psychology)
sociocultural model An approach to
explaining mental disorder that emphasizes the role of factors such as gender
and age, physical situations, cultural values and expectations, and historical era.
459
instinctual urges and more on the role of attachment and other early interpersonal
relationships (Schultz & Schultz, 2005).
Other theories discussed in the personality chapter suggest still other psychological
processes that contribute to the appearance of mental disorders. For example, socialcognitive theorists, also known as social-learning theorists, see most psychological disorders as the result of past learning and current situations. These theorists say that just as
people learn to avoid touching hot stoves after being burned, bad experiences in school
or a dental office can “teach” people to fear such places. Social-cognitive theorists also
emphasize the effects of expectancies and other mental processes. They see depression,
for example, as stemming from negative events, such as losing a job, and from learned
patterns of thoughts about these events, such as “I never do anything right.”
According to the humanistic, or phenomenological, approach to personality, behavior disorders appear when a person’s natural tendency toward healthy growth is
blocked, usually by a failure to be aware of and to express true feelings. When this happens, the person’s perceptions of reality become distorted. The greater the distortion,
the more serious the psychological disorder.
Sociocultural Context Together, neurobiological and psychological factors can go
a long way toward explaining many forms of mental disorder. Still, they focus mainly
on causes residing within the individual. The sociocultural model of disorder suggests that we cannot fully explain all forms of psychopathology without also looking
outside the individual—especially at the social and cultural factors that form the context, or background, of abnormal behavior. Looking for causes of disorders in this sociocultural context means paying attention to factors such as gender, age, and marital status; the physical, social, and economic situations in which people live; and the cultural
values, traditions, and expectations in which they are immersed (Evans et al., 2000;
Johnson et al., 1999; Whisman, 1999). Sociocultural context influences not only what
is and is not labeled “abnormal” but also who displays what kind of disorder.
Consider gender, for instance. The greater tolerance in many cultures for open
expression of emotional distress among women, but not men, may contribute to the
higher rates of depression reported by women compared with men (Nolen-Hoeksema,
Larson, & Grayson, 1999). Similarly, the view held in many cultures that excessive alcohol consumption is less appropriate for women than for men is a sociocultural factor
that may set the stage for higher rates of alcohol abuse in men (Helzer et al., 1990).
Sociocultural factors also influence the form that abnormality takes (Kyrios et al.,
2001). For example, depression is considered a culture-general disorder because it
appears virtually everywhere in the world. However, specific symptoms tend to differ
depending on a person’s cultural background (Hopper & Wanderling, 2000). In Western cultures, in which the emotional and physical components of disorders are generally viewed separately, symptoms of depression tend to revolve around despair and
other signs of emotional distress (Kleinman, 1991). But in China and certain other
Asian cultures, in which emotional and physical experiences tend to be viewed as one,
depressed people are as likely to report stomach or back pain as to complain of sadness (Kleinman, 2004; Parker, Gladstone, & Chee, 2001).
There are also culture-specific forms of disorder. For instance, Puerto Rican and
Dominican Hispanic women sometimes experience ataques de nervios (“attacks of
nerves”), a unique way of reacting to stress that includes heart palpitations, shaking,
shouting, nervousness, depression, and possibly fainting or seizure-like episodes
(Spiegel, 1994). In Asia, Khmer refugees sometimes suffer from panic-related fainting
spells known as kyol goeu (Hinton, Um, & Ba, 2001). And in Southeast Asia, southern
China, and Malaysia, a condition called koro is occasionally observed. Victims of this
disorder, usually men, fear that their penis will shrivel, retract into the body, and cause
death. In females, the fear relates to shriveling of the breasts. Koro appears only in cultures that hold the specific supernatural beliefs that explain it (Tseng et al., 1992).
In short, sociocultural factors create differing social roles, stressors, opportunities,
and experiences for people who differ in age, gender, and cultural traditions. They also
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