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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
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1/3 of all Americans will suffer a serious
mental health problem at some point
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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
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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
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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
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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
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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)
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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
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The developmental systems approach acknowledges the existence of
bidirectional influences between the environment, behavior, neural
activity and genetic activity
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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
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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)
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“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
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Sin
Suffering
Identity
Pride
Self-acceptance
Coping
Worldview
Lifestyle
Sin & Psychopathology
Sin is both an act & state of being
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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
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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
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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
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Ask what reaction(s) is/are required of us by
God’s gospel
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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…
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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
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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
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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
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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
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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
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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
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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.
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3.
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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
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Strong social support network
Meaning to suffering
Life skills – coping & adjustment
Characteristics of Spiritual Depth
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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
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suffering & pain are inevitable
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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