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. Deviance 3. Dysfunction2. Distress 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 self-

care, 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 DualismUnity 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. Paraclete – helps, comforts, encourages; an advocate, teacher, provider

2. Reconciler – ambassadors for Christ; bridges from God-to-person & person-to-person

3. Healer – compassion for suffering & passion for wholeness

4. Provider of wisdom

Imaging God in Character

1. Compassion, empathy, sensitivity2. Servanthood as motivation3. Community – life in unity with other believers4. Accountability to Christ & the church5. Transparency6. Love 7. Stewardship8. Holiness9. Wisdom10. Integrity11. 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