Читать книгу Abnormal Psychology - William J. Ray - Страница 67

Three major themes—behavior and experience, neuroscience, and the evolutionary perspective—give us important perspectives for thinking about psychopathology. In addition, an integrative perspective ranging across a number of different levels of analysis provides a greater understanding of psychopathological processes. These levels range from the highest levels of environment, culture, and society to social relationships to individual behavior and experience to our sensory, motor, emotional, and cognitive systems to the physiological processes that make up our central and peripheral nervous systems to the cortical network level to the most basic level of genetics and epigenetics. The genetic level in turn takes us back up to the highest level to understand how environmental conditions influence genetic processes.

Five ideas are critical to the concept of psychopathology. First, the processes involved are maladaptive and not in the individual’s best interest. Second, these processes cause personal distress. Third, the processes are considered to be deviant from cultural and statistical norms. Fourth, the individual has difficulty connecting with his or her environment and also with himself or herself. Finally, the individual is not able to consider alternative ways of thinking, feeling, or doing.

Considering psychopathology from evolutionary and cultural perspectives goes beyond the traditional psychological and physiological considerations. Culture can be seen as a system of inheritance—humans learn a variety of things from others in their culture including skills, values, beliefs, and attitudes. For a more complete understanding of psychopathology, it is important to understand the particular rules a culture has for expressing both internal experiences and external behaviors. Overall, research suggests a close connection between cultural and evolutionary perspectives. Not only can the environment influence genetics; genetics can also in turn influence culture. The evolutionary and cultural perspectives help us ask questions such as these: (1) Can genetic variation influence the manner in which cultural structures formalize social interactions and how this might be related to what is considered mental illness? (2) How long, in terms of our human history, has a particular psychopathology existed? (3) What function might a disorder serve, and how did it come about? (4) How can a basic human process (e.g., the pain of social rejection) develop in relation to an earlier one (e.g., the brain circuits involved in physical pain)?

One of the main themes of the study of evolution is the manner in which organisms are in close connection with their environment. It is this close connection that allows for change—including the turning on and off of genetic processes—to take place. Humans are born less fully developed at birth than many other species and thus are sensitive to changes in their environment as they continue to develop. Unlike animals that live within nature, humans largely live within the backdrop of our culture. Another part of the complexity with humans is our ability to reflect on ourselves and our world. In this way, a layer of thought, including expectation and imagination, is injected between the person and the environment.

Mental disorders have been with us throughout our human history. Since the time that written language became a part of our experience, humans have included descriptions of mental disorders. Examples of historical conceptions of psychopathology include those of Pythagoras and Hippocrates in ancient Greece; Galen from the period of the Roman Empire; advances in anatomy by da Vinci in art and Harvey and Descartes in science from the Renaissance; advances in understanding the brain and nervous system in the 1700 to 1900 period; and Darwin’s description of the theory of evolution and Charcot’s classification of psychological and brain disorders in the 1800s. Historically, the care and treatment of individuals with mental illness also advanced, as did our understanding of the experience of these disorders. Although the Greeks already saw mental illness as a disorder involving the brain, it is only within the past 125 years that scientific support began to clarify this position.

Biological treatment for psychological disorders usually involves psychotropic medications, which have been expanded and improved over the past 60 years. Where medications have not been effective, other techniques are sometimes used, including ECT, TMS, and DBS.

There are currently three broad perspectives for the psychological treatment of mental disorders: the psychodynamic perspective, the existential-humanistic perspective, and the cognitive behavioral perspective. They were developed somewhat independently and often in opposition to one another. Beginning in the 1950s and 1960s, however, there was a movement to determine the effectiveness of psychological treatments in a scientific manner. Researchers and clinicians began to focus more on approaches and principles for which there was scientific evidence of effectiveness. This led to developing effective treatments for particular disorders and greater integration of techniques from the three different approaches as well as from other perspectives.