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An overview This topic looks at abnormal behaviour, in particular the following aspects:
Some titbits to hopefully grab your attention and set you thinking?
A case study in abnormality? (Courtesy of Gross & McIlveen) William Buckland (1784-1856) was an interesting man. He was Oxford University’s inaugural professor of geology and the first person in England to recognise that glaciers had once covered much of the northern parts of the UK. Buckland supervised the laying of the first pipe drains in London and was responsible for introducing gas lighting to Oxford. He also ate bluebottles, moles and, having been shown it by a friend, the embalmed heart of the executed King Louis XIV of France!
Is this abnormal behaviour? Most of us would consider it odd at the very least! However, when I say ‘us’ who am I referring to? Western society is about the only culture on Earth that does not consume insects. Other people would find it odd that we do not eat such invertebrates, since we consider their watery cousins (prawns, cockles etc.) such a delicacy! Similarly moles are a mammal. We eat cows, pigs, sheep, how are moles any different? We find it disgraceful that cat or dog is so favoured in some parts of the World whilst other cultures find it appalling that we eat cows or pigs! Many of these tastes are culturally relative and are due to conditioning and the way we have been brought up! However, I reserve judgement on Louis XIV’s heart! I spent some of my mid twenties in Mansfield, Notts. (a town famed itself for its strange and often aggressive inhabitants). I spent many a happy evening in a bar called the Brig-o-doon, oft chatting to a ruddy faced old chap Mick Grimmer. He was famed locally for his bizarre fund raising activities, one of which I read about some years later in an old copy of the Daily Mirror! Mick had spent two weeks in a local public house sat on a toilet, wearing a woman’s nightgown, eating nothing but cold baked beans (hence the toilet presumably) and listening to Des O’Connor records. Was Mick abnormal. Even if we consider it abnormal does it constitute mental illness… lots of questions; so few answers!
Why do we bother? You’d think that it would be obvious, and in some cases perhaps it. However, there are lots of cases when things are not so clear cut; William Buckland (above) for example. We all feel down from time to time or have swings in mood or feel anxiety at times when we wouldn’t expect to. At what point does this become depression, manic depression or clinical anxiety? The issue is further clouded by cultural differences and history. Behaviours we find odd in this country don’t get a second look in others and behaviours that were once seen as abhorrent are now accepted by the vast majority. Similarly actions requiring immediate institutionalisation in the lower classes are seen as merely eccentric in the upper classes! In less ‘enlightened’ times abnormal behaviour was considered the work of the devil and of being possessed by evil. Techniques such as exorcism (still practised) were developed. During the Dark Ages abnormality was attributed to witchcraft with the person being cursed. Odd people were tried (sometimes by dubious techniques) and if found guilty burnt at the stake; a sure-fire cure!
In more recent times we have seen the advent of asylums to house the abnormal or mentally ill. These have given way in the West to hospitals for the mentally ill or clinics. Admission to these places is governed by at least doctors and by a third person such as a social worker. When defining ‘abnormality’ we will consider the way definitions differ between cultures (even within Western Societies), how definitions change over time and how what is considered ‘abnormal’ and worrysome in one place at a particular time is considered ‘normal’ or even desirable elsewhere at a different time. We shall start this topic by looking at possible ways of defining ‘abnormal’ none of which, on there own, really tell the whole story.
Deviation from statistical norms Put simply, if few people in a given population behave like you then you’re abnormal! This appears to have ‘face validity’ in that it appears to make obvious sense at first sight. However when we dig a little deeper it fails miserably. Let’s start with a physiological example. If we take 5’ 9’’ as the average height of an adult male in the UK, surely it is safe to assume that 4’ or 7’ is abnormal since a tiny percentage of the population fall into these categories. However, when we consider psychological characteristics things are not so clear cut. Let’s consider IQ (intelligence quotient). Within a population this is normally distributed. When plotted on a graph it assumes the familiar ‘bell-shaped’ curve. The average IQ in the UK is maintained at 100 with a standard deviation of 15. For the innumerate amongst you that means in simple English that 67% of the population have an IQ of between 85 and 115 (one standard deviation below the average and one standard deviation above the average). By the time we reach 3 standard deviations below the norm, an IQ of 55 (3 x 15 =45 and 100 -45 =55), are you still with me, we are talking less than 1% of the population. Surely we can consider these to be abnormal since they are so rare.
Evaluation
1. Where do we draw the line? If we assume that an IQ of 100 is normal and one of 45 is abnormal at what point between do we cease to be normal, 75, 65, 60…? Our decision has to be arbitrary and will probably be on mathematical grounds such as standard deviation. 2. Is the behaviour desirable? We tend to associate abnormality with undesirable or unwanted behaviour, but statistically rare will encompass desirable characteristics such as genius, very low levels of stress and anxiety etc. 3. Rare or not reported? It is thought that some disorders appear rare in a culture simply because they are not reported. Cohen (1988) believes that few mental illnesses are reported in India because mental illness is seen as a curse so sufferers are looked down upon. Similarly, Rack (1982) believes that depression is far more prevalent in Asian culture than the figures would suggest. Asians tend to report physical illness but mental illness is dealt with within the family to avoid stigmatisation. One final point to ponder. In 1994 Kessler et al reported that 48% of Americans had suffered a period of mental illness. Using the statistical infrequency definition it can only be a matter of time before that figure reaches and exceeds 50% meaning that those without mental illness are in a minority… and presumably as a result abnormal!
Deviation from social norms In some ways this is similar to the previous definition and has some of the same advantages and drawbacks. It considers a behaviour abnormal if ‘Society’ considers it unacceptable or undesirable. In this way it appears to overcomes the ‘desirability’ criticism of the statistical infrequency approach. For example a genius, although statistically rare is not considered abnormal by this approach since their defining characteristic is not out of line with social norms. Evaluation
As an activity consider behaviours seen as acceptable today that may been seen as deviant or abnormal in a hundred years time.
Failure to function adequately Most people suffering from psychiatric illness are in some way unhappy.
Society (that word again), recognises or sets the standard for how people should lead their lives, a failure to meet this standard of functioning could therefore be regarded as abnormal. Some see this approach as the most humane since it is left to either the person themselves, or those close to them, to decide if professional help is required. Sue et al (1994) believed that most people seeking psychiatric help are suffering from a sense of distress or discomfort as a result of their problem. This is supported by the view of Miller & Morley (1986) who saw distress as the primary motivation behind seeking help. However distress alone is not a good indicator of abnormality:
Rosenhan & Seligman (1989) decided on seven criteria for ‘failing to function’. It is important to remember that any one, or even small number of these, is by no means unusual. However, if a person is experiencing many or all of them, then this would constitute cause for concern. Many of these depend upon context, brightly coloured hair would be fine at a fancy dress or punk reunion, exposing body okay on a nudist beach or rugby club! At various times most of us will adopt at least some of these behaviours, swearing in a pub, behaving in a dangerous way, showing mood swings, talking to ourselves etc. Deciding on abnormality using this method is very subjective, open to interpretation and very context dependent.
Deviation from ideal mental health This is the approach adopted by the humanist branch of psychology. How shall we describe humanists? I think of them as the Lib Dems. of psychology. They are fundamentally nice people with a positive outlook on human development and have lots of useful and interesting ideas, but they are so dull! No Freudian sex, no behaviourist experiments and certainly no drugs or surgical procedures! There approach to abnormality is different to the others considered so far. Being so positive about life they prefer to first of all outline what is normal and healthy. If a person then doesn’t fit this description we shall consider them abnormal. Maslow’s hierarchy of needs If you do PE or Business Studies chances are you’ve already come across this one. I won’t bore you with detail but basically Abraham Maslow believed that the healthy person is looking to better their lot by striving for higher and higher goals or targets. We start with the basic needs such as food and drink. Having satisfied these we move onto personal safety and so on. Eventually, having satisfied all of our needs for love, knowledge, self esteem and aesthetics we may acquire the elusive self actualisation, the Holy Grail of contentment!
Marie Jahoda (1958) incorporated Maslow’s work into her six characteristics of ideal mental health: Self attitudes These should be positive and include self respect, self reliance, self confidence and self esteem. However these need to be realistic. Many very bright, attractive, socially fluent people lack self confidence and self esteem. Disorders such as depression, anxiety and eating disorders appear to be associated with low self esteem. Self actualisation As mentioned above. Integration (resistance to stress) t is important to consider that Jahoda means our ability to cope with stress not the amount of stress we endure. Those unable to cope with stress are more prone to disorders such as depression. Autonomy A person should be independent and not reliant on others for their well being. They should accept responsibility for their own actions and not look for excused elsewhere. This is the most culture-bound of Jahoda’s criteria. Independence like this is very much a product of individualistic (Western) societies in contrast to Asian/African cultures were the emphasis is placed more on cooperation with others and on responsibility via the extended family. Perception of reality Jahoda stressed a realistic outlook on life, i.e. not overly optimistic or pessimistic. Being overly optimistic is likely to lead to abuse by others and to disappointment whereas being overly pessimistic could lead to morbidity and depression. However, some psychologists and philosophers argue that ‘reality’ is a product of our own making and is therefore not an objective measure. Speak to Miss Brooker for more details! Adaptability The ability to change to suit the conditions (physical, social etc.) that you find yourself in. As an example can you imagine ‘Tim…nice but dim’ lasting more than a few minutes in a Barnsley public house on Friday night?
Evaluation
In its favour it does adopt a positive outlook seeking first to define ‘normal.’ Deviation from this is then seen as abnormal. But Subjective: The characteristics measured such as self esteem and self actualisation are very difficult to measure. Questionnaires abound but these are notoriously subjective and not always valid or reliable. Culture-bound: The measures adopt a very western approach to ‘normality.’ As already mentioned autonomy is seen as far from ideal in other cultures. Similarly the emphasis on self attitudes would seem alien to them. As a result, using these criteria, it would be likely that those from other cultures would be more likely to be judges as abnormal.
Culture, sub-culture, race and gender The blue book isn’t so hot on this section of the course so I will provide an overview, that as well as being interesting in its own right may also help with your deeper understanding of ‘abnormality’ has an issue in psychology. As we have already seen culture plays an important part in our understanding of abnormality. An apparently normal and acceptable behaviour in one culture can be seen as unacceptable in others. Think of the HSBC advertisements on television. In some countries it is considered rude to show the soles of your feet in public. In East Africa it is not considered odd to pick your nose whilst talking to someone. Even turning and having a pee mid conversation is seen as acceptable. To this extent normal and abnormal is very much a social invention (or more correctly construct) and as a result will change between cultures and over time.
a. Culture and abnormality Clearly a broken leg or heart disease is a universal disorder and can be observed or measured using objective and physical measures. However, psychological illness is not so clear cut or well defined. Depression is very rarely reported in Asian culture. Does this mean that they are a happy and contented lot or are there other explanations? Rack (1982) reports that Asians rarely consult their doctor with emotional problems, preferring to sort these out within the extended family unit. When they do visit the doctor they only report the physical symptoms of stress such as tiredness, lack of sleep and appetite etc. Because mental illness carries such a stigma it is very unusual for Chinese doctors to diagnose such disorders in their patients (Rack 1982).
Culture-bound syndromes Koro: confined to SE Asia, this is the morbid fear that the penis or nipples will grow inwards and cause death. Amok: characterised by furious outbursts of anger and aggression followed by sleep and a forgetting of the act. Again the diagnosis is confined to SE Asia but can perhaps be recognised as the symptoms of some infamous western killings such as Dunblane, Hungerford and Columbine. In the west however, this sort of behaviour is more likely to be attributed to schizophrenia. (Note: the term to run amok is derived form this). Anorexia nervosa is a particularly interesting one in that it is confined almost entirely to western culture. However, the twins of anorexics who themselves do not suffer the same disorder often show signs of other psychiatric illnesses such as depression. This has led to the idea that our genes may predispose us to psychiatric illness but the precise from that takes may be determined by cultural issues. A little evidence for the claims made by Szasz 1960) and mentioned earlier: In 1851, the psychiatric condition ‘drapetomania’ was constructed by an American psychiatrist to control black slaves. The symptom was ‘running away!’
b. Social class and abnormality In the UK the middle classes are far more likely to be diagnosed with depression and eating disorders whereas the lower classes are more likely to be diagnosed with schizophrenia. Possible explanations for schizophrenia: Diagnosis: Johnstone (1989) found that doctors were far more likely to diagnose psychotic illnesses such as schizophrenia in the lower classes even when they reported similar symptoms to those from higher social groups! Social causation hypothesis: the higher levels of stress due to poverty, poor housing etc., experienced by the poor is more likely to lead them to psychiatric illness. Social drift hypothesis: Perhaps psychiatric illness such as schizophrenia causes people to become poorer since they can’t hold down responsible jobs etc. Good example of cause and effect: is the poverty causing illness or is the illness causing poverty!!!
c. Gender and abnormality Anorexia nervosa: over 90% of sufferers are women (in fact young girls). Depression:
Autism: about 80% of sufferers are boys. Possible explanations for the sex differences: Different diagnosis Perhaps doctors and psychiatrists have different expectations for the sexes. Certainly doctors seem to describe the healthy characteristics of men and women differently. According to Boverman et al (1981) doctors believe that men should be assertive and decisive and women should be dependent and emotional. Perhaps their ideas on abnormal characteristics vary similarly. Look at Sandra Bem’s gender inventory as a perfect example of this! Physiology An obvious difference between the sexes is their hormones, women with their oestrogen and men with our dreaded testosterone. Oestrogen has been implicated in some forms of depression. Traditional roles (the feminist explanation) Women traditionally stayed at home and looked after the children whereas men were out at work and socialising. Perhaps isolation like this is a factor in depression for women. A similar explanation relating to media has also been suggested as a possible explanation of eating disorders. Diet Recent studies have suggested a possible link with teenage diets and later depression. Low calorie diets can deprive the body of certain amino acids. At least one of these has been implicated in the production of serotonin, the brains ‘feel-good’ neurotransmitter!
These seek to explain how psychological disorders develop. Broadly speaking with mental disorders explanations can be split into two types: Biological or medical explanations: These see psychological illnesses as similar to physical illnesses in that they have a physical cause. Psychiatrists tackle mental illness from this perspective. Psychological explanations: These adopt the view that psychological illnesses have their root cause in the mind and seek to explain them using a variety of different psychological theories, some of which we have come across before. The main psychological approaches are:
Each has its own unique perspective and we shall consider each in more detail later. For each explanation, medical and psychological we shall consider: It is worth mentioning that no one model offers a perfect explanation of any disorder and that often a combination of theories offers the best way forward. Until recently the medical model has been dominant but psychological models are being used more and more. In a clinical setting the psychiatrist would normally employ the medical approach whereas the clinical psychologist would adopt one of the psychological methods.
Medical model (also referred to as biological) 1. Assumptions
The medical model believes that psychological illness can be caused by one of the following physical causes: 2. Explanations Genetic Put simply, mental illness is inherited from parents. This could be shown if there is a tendency for an illness to run in the family or if a particular gene can be identified as being responsible for the disorder. Usual methods of study include family, twin or adoption studies that look for links between individuals with a similar genetic make up. However, this is psychology, and nothing is ever that simple! At best what we can say is there appears to be a genetic predisposition in some people to develop a particular disorder. For example if one twin has schizophrenia there is on average about a 42% chance that their identical brother or sister will also develop the disorder. This obviously suggests that schizophrenia is not 100% genetic, but it also suggests that there is a genetic element to it. Biochemistry The brain relies on various chemicals to help it communicate, these are called neurotransmitters. Examples include adrenalin, serotonin and dopamine. Perhaps an imbalance in these chemicals can lead to psychological disorders. We know that LSD can cause similar symptoms to being schizophrenic and we know that LSD is chemically similar to the brain chemical dopamine. Dopamine hypothesis of schizophrenia It appears that the schizophrenic brain is overly sensitive to this neurotransmitter so as a result messages get passed on that would be blocked out in a ‘normal’ brain. Drugs such as chlorpromazine, used to treat some of the symptoms of schizophrenia make the brain less sensitive to dopamine. Prozac, used to treat depression appears to work by increasing the brain’s levels of serotonin. Neuroanatomy This approach considers the possibility that abnormal behaviour may be caused by a problem with the structure of the brain. We know that brain damage can cause catastrophic alterations to performance and behaviour, for example Clive Wearing or Phineas Gage. But can more subtle alterations to structure lead to mental illness? Generally speaking there is less evidence to support this aspect of the theory. Possible exceptions are a link between enlarged ventricles (fluid filled chambers in the brain) and some of the symptoms of schizophrenia, and a possible link between the hypothalamus (yes again) and eating disorders. Infection Infections can clearly cause physical illness such as colds, flu, meningitis etc., but can they cause psychological illness? In the 19th century it was found that the syphilis bacterium was responsible for a disorder known as general paresis which resulted in delusions and forgetfulness. Today there is a viral theory of schizophrenia. Some evidence has suggested that influenza during the middle section of pregnancy (second trimester), can lead to an increased incidence of schizophrenia when the child reaches maturity. 3. Treatments If the problem is caused by a physical problem then we require a physical procedure to put it right. If there is a problem with brain structure then perhaps surgery. If the problem is caused chemically the perhaps a drug can redress the balance.
Typically psychoactive drugs take at least three to four weeks to start working. Surgery ECT or electroconvulsive therapy is still used in emergencies to treat depression. The patient is anaesthetised and given a muscle relaxant before an electric current is passed through one lobe of the brain (although it used to be both). How the treatment works is not fully understood and their can be side effects such as memory loss. More extreme measures include removing or cutting brain areas. Frontal lobotomies were widely used in America to calm violent men. Again there can be drastic side effects ranging from apathy to death!!! Various techniques have been used over the years to treat epilepsy. Today surgery and drugs are usually accompanied by psychological treatments.
4. Evaluation of the medical model The model has lead to a number of widely used and effective treatments for various disorders. Drugs have the added bonus of being quick and easy to take compared to psychological treatments that can take months and be very costly. With much of the research there is the problem of cause and effect. For example if we carry out a post mortem on a schizophrenic and find enlarged ventricles, can we be certain that these caused the schizophrenia? Perhaps the schizophrenia has caused enlargement of the ventricles. ‘Treatment aetiology fallacy.’ Sounds complicated!! You have a headache so you take aspirin. As if by magic the headache disappears. Conclusion lack of aspirin must have caused the headache! Unlikely, but that is what the medical model suggests time and time again with its research. Prozac increases the levels of serotonin therefore lack of serotonin must have been the cause of the depression. There is the danger that if we concentrate on physical definitions and physical treatments that we ignore the root causes of psychological illness such as poverty, stress and inequality (Szasz).
5. Ethics of the medical model (philosophical) If we decide that schizophrenia is a physical disorder caused by a person’s genetic make up or the structure of their brain, then can we hold them responsible for their illness any more than for example we can blame a diabetic for their inability to control their blood sugar levels? If that is the case then what happens on those rare occasions when a schizophrenic harms someone? Surely the person cannot be blamed! The flip side to this however is that it does label people, this can be unhelpful, particularly since generally speaking schizophrenics do not have a good press. Come to think of it sometimes neither do depressives (think of the appalling treatment of Frank Bruno by the Sun!). Additionally, the behaviourist approach (considered later) believes that once a person has been labelled they begin to take on the characteristics of that label. This can be subtle: I’m a Libran. I know from books, magazines etc. how I am supposed to behave because of this label. As a result I look for those tell tale characteristics in my personality. I notice if I play devil’s advocate in a discussion or try to see both sides of an argument. I take particular pride in my appearance (but perhaps not noticeably so lol!). As a result I start to behave as a Libran should. Labelling theory believes that happens with people who have been labelled depressed or overly anxious etc. In a similar vein, if you know that a particular disorder is partly genetic and there is a history of it in the family then it is only natural that you will start to look for signs of it in your own behaviour. We have a self-fulfilling prophecy!
These methods are generally used by clinical psychologists working alongside psychiatrists in psychiatric hospitals and institutions. Each method is based on one of the psychological models of abnormality seen briefly in attachments. Psychologists attempt to explain human behaviour (normal and abnormal) with one or more of these methods. Psychodynamic Model of abnormality The approach originally proposed by Sigmund Freud in the late nineteenth century and the first attempt to explain the complexities of human behaviour. Other psychologists have based their theories around Freud’s original. 1. Assumptions
2. Explanations The explanations tend to be based around:
The Id, Ego and Superego revisited! Freud believed there are three components to personality. The id is the selfish, uncaring aspect that seeks satisfaction and pleasure at whatever cost. The superego is the caring, socially aware aspect that acts as our moral conscience. The Ego is the ‘piggy in the middle’ that operates using the reality principle to keep the other two aspects happy. Think of situations were you have a strong desire to behave in a selfish or socially unacceptable way but your conscience is giving you severe pangs of guilt so as a result you plump for a compromise action. According to Freud if the Ego is weak then either the Id or Superego can become dominant and cause abnormal behaviour. A dominant Id will result in a disobedient child or a psychopathic adult whereas a dominant Superego will result in neurotic behaviours such as over anxiety.
The psychosexual stages of development in brief The child is born into the oral stage and in possession of an id, no ego or superego at this stage. The child is therefore pleasure seeking and selfish and the id derives pleasure by eating and sucking. During the anal stage the child is potty trained and for the first time its actions may bring it into conflict with its parents if it fails to behave appropriately. The Id is demanding instant gratification and pleasure (now centred on pooing!) and parents would rather the child follows protocol and waits for potty time! The Ego develops to resolve this conflict. The Superego develops during the Phallic stage to resolve the Oedipus Complex in boys or the Elektra Conflict in girls. We each, according to Freud, develop an unconscious desire for the opposite sex parent and eventually realise that must identify with the same sex parent in order to grow up and satisfy our lust. Defence mechanisms The anxiety caused by unconscious conflict can be damaging to the Ego which as a result develops various methods of protection. These include: repression (as seen in memory) were unpleasant or traumatic thoughts and experiences are hidden in the unconscious mind. regression were the adult may during stressful times return to an earlier psychosexual stage of development such as the oral stage. reaction formation where a person becomes ashamed of a particular desire and as an extreme form of denial takes an outward stance that is very anti to their desire. Usual examples are men with homosexual desires developing very homophobic behaviours.
3. Treatments The basis of all treatments is giving the patient an insight into their unconscious mind. Once a person had gained access they would be able to integrate or come to terms with whatever was at the root of their problem and cope with life better. Freud collaborated with Josef Breuer, another physician and physiologist. Breuer had a patient, known as Anna O, suffering from hysteria, which apparently paralyzed her. During her treatment, Freud and Breuer discovered that recalling traumatic experiences with the help of hypnosis would help relieving her symptoms. In 1895, Freud and Breuer published Studies in Hysteria, which documented "the cathartic method", also known as the "talking cure". Initially Freud used hypnosis as a way of tapping into the patient’s unconscious mind but later went on to use dream therapy. In 1901 Freud published his classic book ‘The Interpretation of Dreams,’ in which he outlined how the mind disguises unconscious desires behind symbols while we sleep. Freud called dreams ‘the Royal road to the unconscious.’
4. Evaluation A positive point for starters. Freud’s theory was the first to consider psychological illness as having psychological causes. Prior to Freud mental illness was considered to be the result of possession by the devil or earlier still due to witchcraft. However, there are a number of problems with Freud’s theory, method and treatments.
5. Ethical implications of the psychodynamic approach Like the medical model it is deterministic. It sees the abnormal behaviour as being out of control of the individual who Freud sees as a prisoner of their past and of their unconscious forces. As a result people should not be blamed for their psychological illness. However, since childhood experience is crucial in determining psychological well being later in life then surely parents, according to this approach, are partly to blame for disorders. This can cause problems for the patient undergoing therapy. As mentioned in memory, there is also the issue of false memory syndrome were repressed material has been uncovered using psychoanalytic techniques and led to accusations of child abuse etc. that cannot be independently verified. Behaviourist approaches:
Behaviourist model of abnormality This approach to explaining human behaviour developed out of an unhappiness with the psychodynamic approach, particularly the lack of scientific methods used. Early behaviourists included Ivan Pavlov and John Watson of ‘Little Albert’ fame. Later BF Skinner and others added their thoughts. (Note; very really used the BF stands for Burrhus Frederic).
1. Assumptions Behaviourists believe that all behaviour is learned and that includes abnormal behaviour Learning occurs through the processes of conditioning or modelling (imitating). Behaviours can be unlearned, which is the method used for treatment.
2. Explanations Classical conditioning (learning by association) We learn by associating things together. Classic (pardon the pun) examples include Pavlov’s dogs and Little Albert. Pavlov’s dogs learned to associate a bell with food so that eventually the sound of the bell alone would cause the dogs to salivate. Little Albert learned to associate white rabbits with loud and frightening noises so that eventually furry toys would cause fear too. In
this way, according to behaviourists we can learn undesirable or strange
responses to all sorts of situations. The most common application of this
aspect of behaviourist psychology is to the explanation of phobias.
Picture yourself as a child in the kitchen with mummy (sorry bit of sexist
stereotyping going on here, first why isn’t daddy in the kitchen and
secondly…), mummy sees a spider and
Evaluation This approach offers a simple and testable theory of learning. However it is seen as far too simplistic. It may offer an explanation of phobias but how can you learn delusions, depression or hallucinations by association? Even in the case of phobias it is often not possible for people to think of any incident like this that may have triggered the phobia in the first place. Menzies & Clark (1993) reported that only 2% of children who had hydrophobia (a fear of water, not necessarily rabies!) had suffered a traumatic event involving water. Operant conditioning (reward and punishment) If we’re rewarded for a behaviour we are more likely to repeat it in future, if we’re punished we’re less likely to do it in future. (Who says psychology isn’t rocket science?). This is the method used to teach sniffer dogs, dolphins in wildlife parks and of course students to behave appropriately in class! Lewinsohn (1974) believed that depression could result from lack of social support or hostility from others. People may see this as punishment for the way they were behaving so avoid social situations. As a result they get even less positive feedback and eventually they become depressed. Not one of the better theories of depression it has to be said! Learned helplessness, as seen with Seligman’s dogs may also contribute to depression, as people realise that they have little or no control over their situation. Evaluation It does concentrate on current events rather than childhood, but according to this approach removing the punishment or providing reinforcement should stop abnormal behaviour. Social Learning Theory (Modelling) The idea that we acquire behaviour by copying others. It also has elements of operant conditioning since it recognises the importance of vicarious conditioning. If a person is observed behaving in a certain way and is then rewarded for their behaviour then the observer is far more likely to copy that behaviour. The classic experiment in this area is Bandura’s bobo doll procedure in which children watched adults beating up a rubber doll!!! The most useful applications in explaining psychological disorders has been in phobias and in eating disorders. Mineka et al (1994) showed monkeys video footage of other monkeys who were clearly frightened of snakes. When exposed to snakes it was found that the observers had also developed a fear of snakes. We shall return to the role of modelling in development of eating disorders in the critical issue. However, the hysterical media coverage of slim superstars such as Kate Moss and Victoria Beckham (aaaaaaaaaarghhh… sorry lost the will to live briefly there!) may help explain the desire to be thin in teenage girls. 3. Treatments Basically since the abnormal behaviour has been learned (according to behaviourists) then treatment concentrates on unlearning inappropriate behaviour and replacing it with the learning of new behaviours. a. Behaviour therapies (based on classical conditioning) These are often used to treat phobias and involve the patient learning (that word again) to associate (that word again too) their phobic stimulus (spider or whatever) with relaxation. Systematic desensitisation is a nice way of doing this. The patient undergoes relaxation therapy, perhaps involving muscle relaxation and breathing exercises. They are then exposed to a photograph of a small spider and relaxed. Gradually over sessions the pictures are of bigger spiders and eventually a real (but small) spider is introduced. At each step the patient goes through the relaxation procedure. Eventually the person sits with a huge tarantula perched on their hand. Flooding is the nasty way. Imagine a scene from ‘I’m a nonentity…’ in which the patient may be locked in a small cupboard full of spiders. The theory is that the person suffers massive panic (3 Fs at its worst) but that this can only last so long. The adrenal response is short lived and soon the person calms due to lack of adrenaline. Hopefully in future they will associate this chilled response with spiders rather than panic. Not one to use on children or old people though! Aversion therapy is probably the most controversial method since it teaches the person to associate their undesirable behaviour with something unpleasant. For example teaching an alcoholic to associate their favourite tipple with being violently ill. Usually this involves an emetic (a drug that induces vomiting) being added to their drink. Controversially this technique was used in early attempts to ‘cure’ homosexuals. They were shown male pornography and then given the drug. Needless to say it is mostly ineffective as a treatment. b. Behaviour modification techniques (based on operant conditioning) These reward people for appropriate behaviour in the hope that it will be repeated. Token economy is a method used in psychiatric hospitals and prisons. If a patient or inmate (or both!) behaves in a desirable way they are given a token that can be used to purchase tobacco or some other luxury item. Paul & Lentz (1977) found that schizophrenics treated in this way were more cooperative and needed less medication. Modelling is based on SLT and can be used to treat phobias. The patient watches the therapist or other person coping well with a phobic situation such as using a lift or holding spiders. Afterwards the patient may feel far more comfortable in doing the same. 4. Evaluation The behaviourist approach has had some successes, most notably in the treatment of phobias. It does adopt a scientific approach to studying behaviour in that it concentrates on aspects of life that are observable and measurable, i.e. our behaviour. It does not for example try to make sense of our thoughts and emotions like the psychodynamic approach. This is also seen as one of its downfalls. It is reductionist. It takes complex human behaviour and attempts to explain it away in very simple terms often using laboratory experiments that lack ecological validity! (Two ‘all weather’ evaluation comments!). Another frequent criticism is that behaviourists only consider surface characteristics or symptoms. Treating a phobic response such as fear or panic is not getting to grips with the root cause of the problem that may for example originate in childhood. The remit of the behaviourists is rather like the Hutton Report, very narrow. They do offer reasonable explanations for phobias and even for eating disorders but there attempts to explain depression and particularly schizophrenia have not been successful. How can you develop delusions or hallucinations by learning or imitation?
5. Ethical implications Crucially, since it assumes that mental illness is caused by events around us, it believes that the patient is not to blame for their behaviour. Also since it sees the problem as merely a collection of inappropriate behaviours it doesn’t even see psychological disorders as ‘illnesses’ in the traditional sense of the word. As we shall see when we tackle eating disorders it also considers the cultural, sub-cultural and gender issues relating to psychological disorders. Ethically, the criticisms are reserved for the treatments it suggests. Aversion therapy involves unpleasantness such as inducing sickness or inflicting pain and behaviour modification techniques have been criticised because they can be used to control people.
Cognitive model of abnormality We have come across the cognitive model twice so far. Firstly memory is a topic from cognitive psychology and in stress we considered cognitive therapies aimed at reducing stress. Cognitive aspects of psychology are those that concentrate on thinking and processing of information. Assumptions of the cognitive model Psychological disorders are caused by faulty or irrational thoughts or perceptions. A person can overcome their disorder by replacing their ‘faulty’ thoughts with more realistic ones. Therapists are useful in helping patients to replace their faulty thoughts. Explanations Faulty learning, thoughts or perceptions are the basis of psychological disorder. The cognitive psychologist would explain depression in terms of an overly pessimistic outlook on life. Beck (1967) for example describes the ‘cognitive triad’ in which a depressed patient has a negative view of themselves, the world and the future. We saw in stress that unrealistic perceptions of stress and coping ability were treated by Meichenbaum to manage stress. Schizophrenia is a gift for the cognitive approach since its symptoms are a combination of faulty perceptions (hallucinations) and faulty thoughts (delusions). Here the cognitive approach views the symptoms as the causes! Ellis (1962) suggested that faulty perceptions were due to ‘mustabation’ (e.g. ‘I must get grade As or I’ll be seen as stupid) and ‘awfulizing.’ (e.g. ‘I didn’t get grade As so I must be stupid’). Newmark et al (1973) found that patients suffering clinical anxiety were far more likely to suffer from negative self image.
3. Treatments As we saw with Meichenbaum and stress inoculation, the cognitive therapist aims to replace faulty cognitive processes with more favourable or realistic ones. A number of cognitive therapies have become popular including Beck’s imaginatively titled ‘cognitive therapy’ and Ellis’ rational emotive therapy (RET). They all work in a similar way, getting the patient to recognise their distorted perception of the situation, agreeing on a more realistic approach and then putting this to practice in a real-life situation. Evaluation of treatments Treatments such as RET appear to be most effective when treating patients who have high self expectations such as those suffering from anxiety or eating disorders. 4. Evaluation of the cognitive model We have the issue of cause and effect yet again. Are faulty perceptions such as very pessimistic outlook on life a cause of depression or are they a symptom. Similarly with schizophrenia, are faulty thoughts such as thinking your Napoleon the cause of schizophrenia (as the cognitive model suggests) or are they a symptom caused by faulty brain chemistry? As with the behaviourist model genetic factors are not considered even though we know there appears to be a genetic component to most psychological disorders most prominent with bipolar (or manic) depression. It is also worth mentioning the overlap with behaviourist theories. Behaviourists consider learning to be crucial. Faulty learning is likely to give rise to faulty thoughts and perceptions and the cognitive-behavioural approach to treating abnormality has become popular in recent years. 5. Ethics of the cognitive approach Unlike the other approaches seen so far, this one puts the blame for their situation with the patient since they have developed their faulty thinking and with appropriate effort can therefore also put it right. This may appear cruel particularly if their negative perceptions are actually based on the reality of the situation that they find themselves in.
Diathesis stress approach Imagine yourself in May having just completed a part c question on psychological or medical explanations of abnormality. You have stated the pros and cons of each and have three minutes left for that all important concluding last paragraph designed to impress via the recency effect. This is what you use!!! Is psychological illness due to genes or psychological reasons? Easy: both! Diathesis refers to the genetic predisposition to develop a particular disorder. If your parents suffer from schizophrenia then research suggests that offspring are also most likely to get it too. However there is still only a 17%, meaning that 83% of offspring of schizophrenics won’t! Stress refers to the environmental factors such as family situation, learning, childhood experience or viral infection that may then trigger the disorder. But the key factor is that it takes both! This can also explain why if one twin gets schizophrenia there is only a 42% chance that their identical sibling will also develop it. In your conclusion emphasise the importance of both medical and psychological components of all mental disorders (with the possible exception of some phobias).
Critical issue: eating disorders This is a relatively short critical issue that first of all looks at the clinical characteristics of anorexia and bulimia nervosa and then at the possible causes. For this second section we will revisit each of the models from the second section, medical, psychodynamic etc. and see how they attempt to explain eating disorders. It might be a useful exercise at the outset to read about these models and come up with your own explanations based upon them. In fact this is not as difficult as it seems! We tend to think of eating disorders as a relatively new phenomena; they certainly appear to have become more common in recent times (Sue et al 1994), although even this is questionable. However, anorexia nervosa was first recorded as a disorder in 1694 and the phrase coined in 1874. Bulimia nervosa has possibly been around even longer. Certainly the Romans had a ‘vomitorium’ (I kid ye not!) in which revellers could eat to excess without gaining weight. Mcdonalds would be a modern day equivalent! The DSM-IV (diagnostic and statistical manual-version 4) describes eating disorders as ‘physically and/or psychologically harmful eating patterns, of which there are a number. By far the most common two are bulimia and anorexia.
Anorexia Nervosa Anorexia nervosa means ‘nervous loss of appetite’ and according to the DSM-IV there are four main characteristics:
Incidence
Figures on how widespread the disorder is vary. In America it is estimated at 4 in every thousand (or 0.4%) of women. It appears to be more common in the UK with figures varying from between 10 in every thousand to 40 (4%). Estimates for mortality rate also vary from 5 to 15%. Deaths are due either to suicide or to complications caused by emaciation and lack of nutrition. Physical symptoms may include low blood pressure and body temperature, constipation and dehydration. Bizarrely, despite not eating, anorexics are usually totally preoccupied with the thought of food. They may collect and be constantly reading cook books and may even cook meals for friends. They may also be fitness fanatics and despite their lack of nutritional intake still play many sports. They will also go to great lengths to convince people that they are eating normally, for example hiding food that they have not eaten or placing crumbs on plates to make it look as though they’ve eaten when they have not.
Bulimia nervosa Bulimia means ‘hungry as an ox’ and is characterised by one of two patterns of eating: Purging: in which the person eats and then gets rid of the food either by enforced vomiting or use of a laxative. Some will even swallow a dye before the binge starts and then vomit until the dye emerges, indicating that all the food has been regurgitated! Non-purging: in which binging is followed by excessive exercise or by periods of not eating to ensure that weight is maintained. Again the DSM-IV describes four main characteristics:
Similarities with anorexia Both are far more common in women Both far more common in Western and industrialised societies Both far more common in middle class families Preoccupation with body image and weight
Differences with anorexia Bulimics is likely to start later in life, twenties being most common. Bulimia is more common than anorexia Bulimics tend to remain closer to their normal body weight (usually within 10%) Bulimics tend to be more social Bulimics are more likely to have a history of mood swings
Other symptoms of bulimia The continual vomiting causes various physical side effects such as deterioration of tooth enamel due to the acid nature of vomit. Calluses may develop on the back of the hand where there has been chaffing against the teeth and finally the face may appear swollen as vomiting has caused the parotid glands to swell. There have also been reports of self mutilation in bulimics including blood letting. Mitchell et al (1982) believes that binge-purge habits are far more common than the figures suggest and estimated that over 50% of U.S. College students do engage in the behaviour from time to time. Be sure to learn the characteristics of both main eating disorders and be able to outline the main differences and similarities between them.
Explanations of eating disordersIn section two we looked at the main models used to explain abnormal behaviour. We shall now look to see how each of these models attempts to explain eating disorders. With a little thought and imagination you should be able to predict some of these attempts in advance.
Medical ModelThe approach favoured by psychiatrists that looks for physical causes as an explanation of psychological disorders. This model is widely used in explaining and treating schizophrenia and depression but generally has not been so successful in explaining eating disorders. Genetic explanation Genes for specific behaviours have not yet been identified, but anecdotally there is a tendency for the disorders to run in families (like noses!) which may suggest a genetic component to the disorder. Strober et al (1990) found that the female relatives of women with eating disorders are up to 10 times more likely to develop an eating disorder themselves compared to the incidence in the general population. But studies like this pose a problem. Can we be certain that disorder that shows a family pattern does so because of genes. Perhaps you become more susceptible to a disorder like anorexia simply by living with one. Think of a condition like obesity. This appears to run in families but is it genetic or is it simply that an overweight parent is providing a poor diet and not encouraging exercise in their children? Genes and environment are very difficult to separate out and this becomes a very repetitive problem in psychological research. Get used to this argument! Twin studies (compare concordance rates between MZ (identical twins) and DZ (fraternal twins). If the concordance rate is higher for MZ than DZ it is evidence for a possible genetic component. The argument is that DZ twins share a family environment just like MZ twins. If MZ twins are more alike then the difference must be due to genes. Holland et al (1984) MZ twins: concordance rate 55% DZ twins: concordance rate 7% On the face of it this appears to be sound evidence for a genetic component to eating disorders but even here there are problems MZ twins usually have similar environments, i.e. often dress similarly, have the same friends, in similar classes at school and are often mistaken for one another so will be treated in a similar fashion. Therefore it could be environmental factors that account for the disorder being present in both twins.
Other issues and evaluation comments Perhaps it is not the disorder per se that is inherited but a personality type that predisposes people to the disorder. For example, many families with anorexics have a history of mood disorders such as depression. Genetics models cannot explain why the disorder is on the increase. Our genes change over thousands or millions of years, not over the space of a few generations. One thing that can be concluded is that the disorder is not entirely genetic otherwise the concordance rate for MZ twins would be 100%!
2. Biochemical explanationMy favourite neurotransmitter seems to be the most likely candidate since eating foods containing lots of starch are known to increase levels of serotonin in the brain. Serotonin is associated with happiness and good mood. Serotonin has been implicated in both anorexia and bulimia and appears to suppress appetite. Another neurotransmitter, noradrenalin appears to trigger appetite. Research has concentrated on these two chemicals. Anorexia
Bulimia· Jimerson et al (1997) found differences in serotonin pathways between the brains of bulimics and non-bulimics. These are connections between nerve fibres that rely on serotonin for communication.
However Any evidence like this suffers from that other old chestnut, cause and effect. How do we know if strange levels of brain chemicals have caused the eating disorders, as the researchers assume, or have occurred as a result of starvation diets? In fact evidence suggests that altered brain chemicals may be a result of anorexia. Fichter & Pirke (1995) starved healthy participants resulting in chemical changes similar to those with eating disorders. There is related research into the causes of depression in women which suggests that diets in the teenage years starve the brain of essential amino acids. One of these is tryptophan (found in eggs, meat and nuts). We know that the body needs this to manufacture serotonin. Therefore it is not surprising that severe malnutrition as a result of anorexia results in lower levels of serotonin. Additional comment out of interest: anorexics often complain of feeling full after a small meal and further reduces the urge to eat. It seems that digestion in anorexics does slow right down possibly in an attempt to squeeze as much nutrition out of the little food that is there.
3. Neuro-anatomical Everyone’s favourite brain structure, the hypothalamus, is the most likely candidate here, since it is known to be involved with control of eating. Animals with damage to the hypothalamus often stop eating and will even starve themselves to death. Animals with damage to their ventro medial hypothalamus will not stop eating. · Lateral hypothalamus (LH) produces hunger · Ventro-medial hypothalamus (VMH) suppresses hunger.
Evaluation The hypothalamus controls hormones including those involved in the menstrual cycle. One of the defining characteristics of anorexia is amenorrhoea. Perhaps this is due to a fault with the endocrine system. Nineteen-year-old anorexics typically have the hormone levels of the average 9 year old. However Post mortems on the brains of anorexics has not shown any damage to the hypothalamus. Again cause and effect, eating disorders could cause damage to the hypothalamus! Psychological explanations
Psychodynamic These bear all the telltale signs of Freudian origin although some have been updated by some of the many post-Freudian theorists. Ideas based on sexual development Regression to the oral stage: In case you’d forgotten, Freud believed that we are born into the oral stage of development and are completely dependent on others, especially the mother. Early theories suggested that in adolescence some girls become afraid of the adult role that faces them and in an attempt to remain secure they regress to the oral stage where they felt safe and protected. Anorexia does bring the mother and daughter closer and ensures the child remains dependent Fear of sexual development causes the girl to starve herself and so prevent outward signs of sexual maturity and also stop menstruation (amenorrhoea). This idea put forward by Hilde Bruch (not Hilda), is again based on a Freudian idea that sex and eating are seen as related. Bruch believes that this is a two way process, since the daughter can continue to rely on the mother for security and the mother in turn is able to keep their daughter safe and in the home. Oral impregnation is a related idea taking the association of sex and eating to the limit, in which the girl associates eating with sex and believes she can become pregnant by eating. Again cessation of eating prevents this and stops her from becoming fat (associated with pregnancy). Evaluation As with all psychodynamic theories it is impossible to test scientifically because it is based on the workings of the unconscious mind. However, McClelland et al (1991) found that 30% of anorexics have been sexually abused as children. In Psychodynamic terms, this would be repressed into the unconscious mind. At adolescence these repressed thoughts express themselves through disgust and rejection of their body. Additionally, it has to said that starving oneself does result in a pre-pubescent and sexually immature appearance.
Family Systems Theory This believes that anorexics are products of enmeshment. This is the tendency by some families to be over-protective of their children and prevent any sort of independence. One way the child can rebel is to stop eating. Another feature of this kind of family is an inability to resolve conflicts which causes anxiety, (classic psychodynamic concept). In order to deal with their anxiety, parents of the anorexic are able to take on the role of caring for their ‘sick’ child. Hilde Bruch (1973) interviewed the parents of anorexics and generally found that they were middle class and very ‘achievement orientated.’ Pressure was placed on children to succeed not for the good of the child but for the benefit of the parents. As a result children tended to be high achievers but lacked independence. (Not to be quoted but for me a perfect example of this is the American beauty pageants in which very young girls are paraded like models for parental gratification). Evidence for Kalucy et al (1977) found that the families of anorexics tend to be unable to resolve conflicts and blame others for their problems (external locus of control). But · There is the issue of cause and effect! Does the strange family situation cause anorexia or is the strange family situation caused by having an anorexic in the family? · Since families like this have presumably always existed, why is the incidence of eating disorders on the increase? · It is unable to explain why eating disorders are so rare in boys who are also brought up in similar sorts of family. Behaviourist explanation The approach is based on the portrayal of women in the media, particularly over the past twenty years. In this time, the ideal shape has shifted from the rounded size 12/14 of the Sixties, as exemplified by Marilyn Monroe, to the emaciated, twig like form of today, for example Kate Moss and Victoria Beckham. (I think of the episode of 2D TV in which Kate Moss faxes herself from location to location!) This very thin ‘ideal image’ is seen as the starting point for the behaviourist model. Classical conditioning (or learning by association). Because of media portrayal of slim women being successful and happy the slim form becomes associated with success and happiness. To be successful you must be slim! Eating on the other hand, causes weight gain and anxiety. As a result eating becomes associated with anxiety. Classical conditioning explains why we want to lose weight.
Operant conditioning (or learning by reward and punishment) Having lost weight people tell us how good we look. This acts to reinforce or reward our weight losing behaviour. As a result we are likely to continue trying to lose weight. Operant conditioning explains why we keep losing weight The behaviourists often use the two types of conditioning in this way: classical to explain the initial learning of a behaviour, and operant to maintain it later. It is worth mentioning that severe weight loss and abstinence from food also punishes parents, which to the adolescent can be very rewarding in itself! Evaluation Girls with interests in areas with the most reward for weight loss are the most likely to develop an eating disorder, for example dancers, models, gymnasts etc. Garner et al (1987) found that 25% of a group of 11 to 14 year old ballet dancers developed anorexia during a 2 year course. The behaviourist model is also successful in explaining recent trends in eating disorders: 1. Increases in the last 20 or 30 years as the portrayal of women in the media has changed. 2. Increases in the number of men as the portrayal of the ideal body shape for men (in the media) becomes increasingly thinner. 3. Confined mostly to Western society because this is where thin is portrayed as being ideal. However Behaviourist models do not explain why anorexics continue to diet even after they stop receiving compliments and are even told how awful they look. Behaviourist models do not explain individual differences, i.e. why some people develop the disorder and others do despite all of us being exposed to the same media pressures. Social Learning Theory or modelling This is based on similar ideas of reward but here the reinforcement is vicarious. Let me explain! Successful women as seen in the press and on TV are seen as slim, be they models, pop singers, dancers, athletes, news reporters, footballers’ wives etc. Over 50% of former Miss America contestants are thin enough to be classed as anorexic! Vicarious reinforcement is seeing others being rewarded for their behaviour or characteristics. When we see this we are driven to behave in a similar way or develop similar characteristics. This is imitation or modelling. Evaluation Once again this can explain trends such as increasing numbers and the more common occurrence in women but once again it cannot explain why it is that some girls develop eating disorders when others don’t, given that we are all exposed to the same media images.
Social and cultural factors I’ll mention these now because they are related to many of the issues mentioned above. We keep coming back to this fact that eating disorders are confined to Western culture. Evidence for this was provided by Nasser’s (1986) study on Egyptian women living in England. He compared the incidence of eating disorders in 50 Egyptian women studying in London with that of Egyptian women studying in Cairo. None of the Cairo group developed an eating disorder whereas 12% of those in London. Warning: a boring page coming up! Possible reasons for cultural differences 1. Chinese culture sees ‘thin’ as a sign of ill-health. Being overweight is still seen as a sign of prosperity. 2. The fatty diet of western cultures predisposes westerners to be overweight. As a result being slim is seen as a sign of a strong will and so desirable. 3. In contrast the Chinese diet tends to be much healthier, being lower in fat and higher in fibre. As a result people in China are less likely to become clinically obese in the first place. This is important as it reduces some of the risk and some of the guilt associated with being overweight. 4. The success of a woman in China is measured in terms of traditional roles within the family. As a result there are not the same pressures that are placed on Western women either to be successful in careers or to be of perfect appearance. Possible reasons for sex differences Behar et al (2001) suggest that the feminine gender identity may be more important than biological sex per se. In English that means that being of a feminine personality may be a greater risk factor in developing an eating disorder than being a girl. Background: In 1974 Sandra Bem developed her infamous ‘Sex role inventory’ that was designed to assess how masculine or feminine we are. In psychology ‘biological sex’ refers to whether we are male or female (XY or XX) and gender refers to the characteristics associated with being male or female. Traditionally masculine characteristics would include aggressive and assertive whereas femininity is associated with caring and knitting (only joking lol). Reminded of a joke here… sex chromosomes can be explained in terms of biblical characters: XX would be Eve, XY Adam and YYY Delilah! Meanwhile back at the study: Behar et al used the BEM sex role inventory (BSRI) to measure the gender of 63 girls with eating disorders and 63 girls with no eating disorders (the control group). Results 43% of anorexics were classed as ‘feminine’ 24% of the control group were classed as ‘feminine.’ Controls were far more likely to be classed as ‘androgynous’ (a mixture of masculine and feminine characteristics) or undifferentiated (not fitting masculine, feminine or androgynous). This suggests that being feminine is more important in developing eating disorders than being female. However, the results are correlational. At best we
can say there is an association between eating disorders and femininity.
We cannot say that femininity causes eating disorders! Cognitive explanation This has obvious face validity as an explanation since we know from research that anorexics typically have a distorted body image. The cognitive approach to abnormal behaviour is based on distorted thinking and perception. Distorted body image Bemis-Vitouesk & Orimoto (1993) (no really missus that is their real names) found that anorexics consistently have a distorted body image and believe that they must continually lose weight in order to be in control of their bodies. Typical thoughts included: 'I must lose more weight I am not yet thin.' Similarly, Garfinkel and Garner (1982) found that anorexics overestimate their weight and body size. Cooper and Taylor (1988) reported similar findings in bulimics. Perfectionist Fairburn et al (1999) identified perfectionism and negative self-image as the greatest risk factors in developing an eating disorder. It seems likely that a combination of these two factors are crucial. Lovell et al (1997) found that people who had recovered from anorexia nervosa two years earlier still had distorted body images and odd views about food and other 'adolescent issues.' Evaluation The cognitive explanation is good in that it considers the disorder from the perspective of the patient and tries to explain how their distorted body image does make sense to them even if it makes no sense to others. Yet again however, we have the issue of cause and effect. Do the distorted ideas pre-date the onset of anorexia, so offer a possible causal explanation, or do the distortions arise because of the anorexia?
Eating disorders: a feminist perspective Looks at the individual and society. Why women need to be thin: Men, especially white, middle class men, hold power in Society and they define the ideal image for women, for example through advertising. Other examples include what is termed the 'gaze' in films, i.e. the portrayal of life from a male perspective. In films men tend to play the lead roles and usually the woman is very much in a supporting role, often something pretty for the male audience to look at! Feminists therefore suggest that since women are unable to exercise power in other areas they exercise it over their bodies. Feminists also criticise the image of women portrayed to young girls. Cartoon characters tend to be thin, I think of Penelope Pitstop and Olive Oyle, you can probably think of contemporary examples. Barbie and Cindy dolls are appallingly thin, and mis-shaped if you imagine one blown up to real size. A thought experiment for the boys. (Sorry, was forgetting this is a feminist perspective!).
To conclude There is no one obvious model to explain eating disorders. The medical model suggests a genetic predisposition to eating disorders which is now widely accepted. However, this is clearly only part of the story. Much research has centred on the psychodynamic and family models with the work of Hilde Bruch being particularly influential. This is one of the rare recent success stories for the psychodynamic approach. A combination of behaviourist and cognitive seem to offer a reasonable compromise. The behaviourist model is powerful in explaining how the desire to be thin is triggered and also how the various trends such as sex and culture differences may arise. The cognitive model then fills in the gap, explaining why in that case certain individuals due to their perfectionist ideals and distorted body image are more susceptible to this pressure than other.
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