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Models of Abnormality A case for Eclecticism “Mental Disorder” The term does not justify complexity of cognitive, emotional, spiritual, behavioral, physical, & relational factors that impact the development/maintenance of psychopathology No universally accepted definition exists, but most share emphases on the 4 D’s: 1. 2. Deviance Distress 3. Dysfunction 4. Danger 1/3 of all Americans will suffer a serious mental health problem at some point Christians appear to be equally susceptible Causes & Risk Factors Etiology – causal pattern A necessary cause must exist for a disorder to occur A sufficient cause is a condition that guarantees the occurrence of a disorder A contributory cause increases the probability of a disorder developing, but is neither necessary nor sufficient Psychopathology is complex and necessary & sufficient causes have not often been determined to date Many contributory causes have been identified Causes occur in time Distal causal factors: occur relatively early in life & may not show their effects for many years; may contribute to a predisposition to develop a disorder (e.g. abuse, loss) Proximal causal factors: operate shortly before the occurrence of the symptoms of a disorder; may trigger the onset of a disorder (e.g. marital problems, unemployment, brain damage); can also serve as a distal contributory cause that sets up a predisposition for another disorder later in life Reinforcing contributory cause: a condition that tends to maintain maladaptive behavior that is already occurring (e.g. depressive behavior that alienates people, leading to a lack of social support, which reinforces the depression; secondary gain) Stress-Diathesis or Diathesis-Stress Diathesis: a predisposition or vulnerability toward developing a disorder; can be biological, psychological, sociocultural, or spiritual; a relatively distal necessary or contributory cause; not generally a sufficient cause because a more proximal event or situation (stress) is required for the disorder to occur (i.e. the stress is usually not sufficient by itself to cause the disorder) Problems develop when inherited or acquired weaknesses or vulnerabilities become strained by internal or external factors (stress) – interaction effect Genotype-Environment Interaction Different genotypes (diatheses) create different sensitivity or susceptibility to environments (stress) e.g. depression – inheriting a particular gene that influences serotonin levels in the brain & experiencing multiple life stressors result in an especially high probability of major depressive disorder – 33%; With the same life stressors, but low-risk versions of the gene, only 17% would become depressed (Sigelman & Rider, p. 472; also see similar information in Butcher, Hooley & Mineka) Reciprocal (bi-directional) influence: To add complexity, the relationship between stress and disorder is reciprocal: life stress influences the expression of disorder, but disorder also influences the characteristics and levels of life stress Cause & effect can be difficult to distinguish, because effects can serve as feedback, influencing causes And, stress and/or disorder early-on (distal causal factor) may lower the stress threshold for the expression of future episodes of disorder by influencing the neurobiology of the stress response system and/or gene activity Risk factors – can be biological, psychological, sociocultural or spiritual; can be diatheses Protective factors – help resist against the effects of a risk factor; can be an experience or a quality or attribute (e.g. easygoing temperament, high intelligence) Protective factors may lead to resilience: the ability to adapt successfully to difficult circumstances A Child’s Resilience According to Butcher, Hooley & Mineka “There is increasing evidence that if a child’s fundamental systems of adaptation (such as intelligence and cognitive development, ability to self-regulate, motivation to achieve mastery, effective parenting, and well-functioning neurobiological systems for handling stress) are operating normally, then most threatening circumstances will have minimal impact on him or her (Masten, 2001)”. 4 Broad Models: 1. Psychosocial 2. Sociocultural 3. Biological 4. Spiritual Psychosocial Model Interprets mental illness as an expression of underlying personality dynamics, environmental factors, internal thinking processes, or learned patterns Psychosocial Risk Factors Early deprivation Trauma (neglect, abuse, etc.) Separation from parents Inadequate parenting styles Parental psychopathology Marital discord/divorce Maladaptive peer relationships Sociocultural Model Concerned with the broad context in which psychopathology is expressed/observed – the influence of social & cultural variables’ contribution to mental illness Many mental disorders are universal, but the forms taken & prevalence may vary with culture Sociocultural Topics demographic variables social norms & values social roles & expectations social conditions prevention interpersonal relationships & social support Sociocultural Risk Factors Low SES, unemployment, subjection to prejudice & discrimination, urban violence, homelessness, and experiencing social change & uncertainty are associated with greater risk for various disorders Biological (Medical) Model All behavior (normal & abnormal) has a biological substrate (i.e. characterized by distinct biological characteristics) Neurotransmitter and hormonal abnormalities in the central nervous system (brain chemistry) Genetic vulnerabilities Temperament Brain dysfunction & neural plasticity (anatomy & functioning) Psychotropic medications Neurotransmitters & Hormones Disorders stem from different patterns of neurotransmitter abnormalities in various brain areas Abnormalities may include excessive production & release, dysfunction in deactivation resulting in less amounts of the neurotransmitter, or overly sensitive or insensitive postsynaptic neurons Medications are believed to work by correcting these abnormalities Hormones – chemicals secreted into the blood stream by the endocrine glands, which impact the nervous system & body Genetics Most mental disorders are influenced by genetics Vulnerabilities to mental disorders are almost always polygenic – influenced by multiple genes or multiple polmorphisms (variations) of genes The vulnerabilities may manifest in structural abnormalities in the CNS, abnormalities in the regulation of brain chemistry and hormonal balance, or excesses or deficiencies in the reactivity of the autonomic nervous system (involved in our emotional responses) Gene expression is complex – influenced by internal and external environment Genotype-Environment Correlation The genotype (genetic endowment) can shape the environmental experiences Examples: Demand characteristics or evocative effect – reactions are evoked from the environment (e.g. aggression, shyness, musical ability) Passive effect – results from the genetic similarity of parents & children (e.g intelligence, antisocial behavior, musical ability) Active effect of niche building – seeking out a congenial environment (e.g. extraversion, musical ability) Genotype-Environment Interaction Different genotypes create different sensitivity or susceptibility to environments e.g. depression – inheriting a particular gene that influences serotonin levels in the brain & experiencing multiple life stressors result in an especially high probability of major depressive disorder – 33%; With the same life stressors, but low-risk versions of the gene, only 17% would become depressed (Sigelman & Rider, p. 472; also see similar information in Butcher, Hooley & Mineka) Methods for Studying Genetic Influences Behavior genetics – focuses on the heritability (degree of genetic influence) of mental disorders – attempts to separate genetic & environmental influences Family history Twin studies Adoption studies Linkage analysis & Associated studies (molecular genetics) Temperament Temperament refers to a child’s reactivity & characteristic ways of self-regulation & is the foundation of personality Temperament is strongly influenced by genetic factors, but prenatal & postnatal environmental factors also play a role Temperament can change, but research shows a moderate degree of stability from 2-3 months of age through at least middle childhood Fearfulness & irritability – correspond to adult neuroticism or disposition to experience negative affect Positive affect & possibly activity level – relate to later extraversion Attentional persistence & effortful control – relate to adult constraint or control Fearfulness or behavioral inhibition - risk factor for anxiety disorders Uninhibited – difficulty learning moral standards & exhibit more aggressive & delinquent behavior (if combined with high levels of hostility, the stage may be set for conduct & antisocial personality disorder) Brain Dysfunction & Neural Plasticity neuroimaging techniques are used to study the function & structure of the brain (e.g. brain mapping & treatment via EEG biofeedback) The brain makes changes in organization &/or function in response to experiences; existing neural circuits can be modified or new neural circuits can be generated The developmental systems approach acknowledges the existence of bidirectional influences between the environment, behavior, neural activity and genetic activity Nervous system dysfunction could have arisen from psychological causes and psychological treatments are often as effective as medications in producing changes in brain structure & function Psychotropic medications Revolution in clinical care -adjuncts to treatment for serious expressions of mental disorders -essential for stabilizing psychoses 3 generations of anti-depressants, anti-anxiety, & anti-psychotic meds Side effects can be problematic Costs Managed care environment Wide-spread knowledge about pharmaceuticals Psychotropic Medications (criticisms) “cure” – reductionism – offered alone assessment is not often carefully done alternatives may not be offered “perfect drug” – no responsibility for selfcare, want benefits without costs interference with character development avoidance of legitimate suffering Spiritual Model Sin Suffering Identity Pride Self-acceptance Coping Worldview Lifestyle Sin & Psychopathology Sin is both an act & state of being act – isolated acts that violate moral standards; willful disobedience state of being – “sin nature”; an on-going force in opposition to God that holds us in bondage Categories of Human Problems 1. Moral evil 2. Natural Evil 3. Finitude (limitedness) Sin (continued) Sin is a violation of law & relationship Sin is individual & corporate Sin is driven by rebellion & anxiety We are in bondage to sin, yet responsible Could Psychopathology Have a Purpose? God’s Providence: God orders the events of a human life for 2 purposes (from Packer’s Knowing God): 1. The individual’s own personal sanctification 2. The fulfilling of the individual’s appointed ministry & service in the life of God’s people Role of Suffering Identification with Christ Spiritual growth Discipline Test of faith Result of walking with Christ (persecution & path of obedience) Revelation to others Trials God means to make something of us that hasn’t yet been attained Strengthen us in patience, good humor, compassion, humility/meekness by giving us extra practice under difficult circumstances Lessons in self-denial & self-distrust Break us of complacency, unreality, pride, or conceit Draw us closer to himself So that we can comfort others, as we have received comfort from God To Discern God’s Purpose Ask what reaction(s) is/are required of us by God’s gospel Seek God’s face about the trial At the least, trials will make & keep us humble & give us new opportunity to show the power of Christ in our lives By The Way… Evolutionary psychologists have also been asking this question about purpose – about the adaptive function of psychological disorders – how they may help people cope with abuse & other stressors or impart other advantages (Life-Span Human Development, 6th ed., Sigelman & Rider, p. 470) e.g. depression – may help us conserve energy & avoid further stress Problem Summary – Spiritual Model We have weaknesses that place us at risk of sinning, and we live in a world that is tainted by sin (as a state of affairs), and these dynamics, taken together with a variety of other factors, may account for a person’s susceptibility to psychopathology. Yarhouse, Butman, McRay p.20 Responsible Eclecticism – pulling it all together A biopsychosocialspiritual viewpoint is also developmental in nature, as it looks at the whole person in context A developmental perspective also views psychopathology as a pattern of adaptation that unfolds over time instead of a “disease”; what is abnormal is determined by comparing and contrasting it with normal and expected changes that occur in the course of development Holistic Dualism Unity of body & mind Life events can have direct effects of neuroanatomy/chemistry Losses/traumas affect mental, emotional, spiritual, & physical well-being Brain/nervous system damage can diminish our ability to function Lifestyle choices can impact brain & behavior connections-diet, exercise, rest, sexual behavior Biology can be primary, precipitating, or contributing cause Virkler’s Model of Psychopathology Etiology- p. 240 MP genetic vulnerability or inheritance mistaken beliefs, interpretations or conclusions about human experience inadequate coping or social skills lack of awareness of one’s thoughts, goals, or feelings our sin nature (e.g. self-centeredness) trauma demonic temptation or oppression demonic possession Responsible Eclecticism Making a case for a biopsychosocial & integrative mindset As a Christian counselor, one must stand on the fundamentals of faith Christian faith does not propose a specific psychology - we need a psychology of humans (explicit & comprehensive understand of people) in order to assist in healing & growth It is impossible to adopt a single model that explains all aspects of abnormality Most cases of mental illness reflect a combination of biological, psychosocial, sociocultural & spiritual factors – multiply determined & multiply maintained The Scripture calls for different responses to different problems (1 Thessalonians 5:14) Dimensions of Comprehensive Christian Counseling A balanced view would appreciate the power of sin and evil, yet respect human freedom and agency The dignity & worth of every human being would be emphasized A deeper understanding of the influence of the spiritual world on day-to-day functioning would be offered Motivated by compassion as mandated in the Scriptures – love grounded in God’s love A vision of our need for a relationship with our Creator through Jesus Christ Dimensions of Comprehensive Counseling continued A balance of emphasis on thinking, feeling & behavior as each has an important role Respect for human freedom & agency, yet recognition of limitations to human choice An appreciation of habit, skill, & learning A balanced attention to within & external influences on human action An understanding of our need for meaning & purpose (including suffering & pursuit of more than personal happiness) Dimensions of Comprehensive Counseling continued An understanding of our fundamentally relational natures & need for love & acceptance A respect for morality and the value of obedience to appropriate authority Recognition of our need to worship and commitment to God A love for the church & commitment to furthering the church’s work in this world Commitment to a holistic view of persons, yet an understanding of components to allow for intervention & change Christian Counseling Must Be Transformed by The Gospel Involved in the work of the church – ultimately focused on salvation Penetrates to the personal core of the life of clients (holistic view) Christ is present in the one seeking help (Matthew 25:31-46) Christ is present in counselors – He is the source of all growth, healing, comfort (2 Corinthians 1:3-5) Imaging God in the counselor role 1. 2. 3. 4. Paraclete – helps, comforts, encourages; an advocate, teacher, provider Reconciler – ambassadors for Christ; bridges from God-to-person & person-toperson Healer – compassion for suffering & passion for wholeness Provider of wisdom Imaging God in Character 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Compassion, empathy, sensitivity Servanthood as motivation Community – life in unity with other believers Accountability to Christ & the church Transparency Love Stewardship Holiness Wisdom Integrity Spiritual depth Role of The Church Strong social support network Meaning to suffering Life skills – coping & adjustment Characteristics of Spiritual Depth A deep hunger for God A love for God based on knowing Him that leads to worship & obedience Being filled with the Holy Spirit & yielding to God’s deepening work of grace and not to the flesh Acknowledging & using the gifts of the Spirit for God’s purposes and glory & manifesting the fruit of the Spirit Development of a world view consistent with God’s view as revealed in the Scriptures Being involved in spiritual warfare with the power and resources available only from God Being attuned to the mystical aspects of faith that defy rational description Imaging God’s Concerns 1. Promotion of clients’ spiritual & psychological maturity 2. Promotion of the welfare of the Church Wholeness vs Holiness Christian goals may not parallel “wholeness” goals of contemporary culture suffering & pain are inevitable one is set apart for God’s purposes & is becoming more & more Christ-like World’s goals – minimizing conflict, living to one’s innate potential (Maslow’s hierarchy), maximizing life satisfaction, well-adjustment to the world, emotional awareness/expression