Ch 11 - Jeff Standen

Models of abnormality
Kraepelin (1855-1926) developed his classification system
of psychological disorders. He distinguished between
psychoses (true 'insanity' where the patient has lost touch
with reality), neuroses (anxiety disorders), personality
disorders, and retardation. All the classification systems used
by psychiatry up to the present day are based on Kraepelin's
original system (Stone, 1998). By the end of the 19th century,
the biological or medical model of abnormality was
dominant. Psychiatrists took control of the asylums and
turned them into 'mental hospitals' housing large numbers of
patients. 'Moral treatment' was seen as too time-consuming
in terms of the attention it paid to the individual needs of
patients. It was largely replaced by more economical
treatments like physical restraint, cold baths, bleeding and
purging - clearing out the stomach and the bowels.
Despite its triumph, however, 19th century psychiatry was
not very optimistic about its chances of curing psychological
disorders (Porter, 1997). The success rate of medical
treatments was poor - psychiatrists claimed this was because
many disorders were inherited and therefore incurable. The
only solution many psychiatrists could see lay in eugenic
programmes of selective breeding and sterilisation. In the
first half of the 20th century, laws were passed in many
Western countries, including the USA and Scandinavia,
permitting the compulsory sterilisation of the mentally 'unfit'
(Summary
In ancient times, an early psychological model of spirit
possession was widespread. This was treated by
exorcism and trepanning.
In classical Greece and Rome, a biological model of
imbalance of humours was favoured. This became
known as the Galenic theory. Abnormality was treated
with diets, exercise and drugs.
During the medieval period, spirit possession and
exorcism revived, and the Galenic biological model
declined.
In the 18th century, new psychological models
emerged. Pinel's approach was influential, seeing
abnormality as the result of stress, and treating it with
'moral treatment'.
Advances in biology and medicine led to the rise of
psychiatry in the 19th century By 1900, the biological
model was dominant.
(Dowbiggin, 1998). In Nazi Germany in the 1930s, mental
patients were gassed. Since then, eugenic programmes have
been much less popular in psychiatric circles.
( Unit 2 The biological (medical) model of abnormality
J
KEY ISSUES
1. What are the main features of the biological model?
2. What are the implications for treatment of this
model?
Main features of the biological model
The biological model is favoured by medicine and
psychiatry - the branch of medicine that specialises in
mental disorders. The biological model was the dominant
view of abnormality at the beginning of the 20th century.
Despite serious challenges from various psychological
models, it remains dominant today. The biological model
uses the medical language of patient, symptoms, diagnosis,
illness, disease, treatment and cure (Maher, 1966).
Psychiatry tends to see abnormality as mental illness,
although many psychiatrists now prefer the term disorder to
illness.
The biological model classifies mental disorders. The
main classification systems in use today are the ICD-10 (the
World Health Organisation's International Classification of
Diseases,
10th edition) published in 1993, and the
American DSM-IV (Diagnostic and Statistical Manual of
Mental Disorders, 4th edition,) published in 1994.
Psychiatric systems classify disorders according to their
symptoms. For example, both the ICD-10 and DSM-IV
place depression in a category of mood disorders. The
symptoms of depression include low mood, fatigue, loss of
concentration, reduced sex drive, change in weight,
disruption of normal patterns of sleep, slowed (or, in some
cases, agitated) mental and physical activity, feelings of
worthlessness or guilt, and preoccupation with death.
The biological model regards psychological disorders as
a sign or symptom of an underlying physical or organic
disorder - usually some dysfunction of the brain or nervous
system. Different psychological disorders are believed to be
caused by different organic disorders. Brain scanning
techniques, such as PET or CAT scans, are often used to find
evidence for the physical basis for psychological
abnormality. In the case of depression, PET scans suggest
that depressives have a lower uptake of glucose in the
brain, which may explain the slower mental functioning
and loss of concentration (Lingjaerde, 1983).
The brain dysfunctions and organic disorders that are
believed to cause abnormality can arise in a number of
ways. Some may be genetically inherited and run in
families. Some may be caused by infection. Some may arise
from damage to the nervous system, as a result of exposure
to environmental pollution, alcohol or drug abuse, or the
impact of life experiences like overwork or child abuse.
Some people may be genetically more vulnerable to being
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