Brief Lecture Notes for Unit 5
Chapters 3 and 4 of the text are so thorough and comprehensive that I don't feel much need to type in a lot of supporting information here... for once, I can avoid a case of carpal tunnel syndrome by just telling you to read the book! However, I will add some supportive information below.
The five major schools of thought to be covered in this class are the psychodynamic, phenomenological (discussed in the text under the rubric of "existential and humanistic"), behavioral, cognitive, and biomedical. The text portrays the first four as falling within the "psychological level of explanation", in contrast to the fifth, which operates at the "biological level of explanation". For more about the concept of levels of explanation and its links to reductionism, as well as a reminder of why (psychology being a nonparadigmatic science) the different schools exist, click here (many of the hyperlinks on this page will take you to PSY 202 notes, so please use the Back/Forward buttons of your Web browser to navigate back and forth... I'll not be inserting all the possible hyperlinks). The main point is that reality can be addressed at more than one level of explanation; the different levels are complementary, not contradictory. As your book puts it (p. 123), "[A]s modern research shows, mental disorders are never a matter of psychological versus biological [factors], but always reflect the interaction of both." (This statement leaves unexplained the question of how this interaction might take place, but one common answer is the diathesis-stress model that states that two conditions are necessary for a mental disorder to develop: a (presumably genetic or biological) predisposition or innate tendency, plus a (presumably environmental or psychological) set of triggering conditions or experiences. In some versions of this model, either state alone can produce some degree of mental disorder, but the odds or severity or both are dramatically (exponentially) increased if both conditions are present: this fact represents the interaction.
Of the five schools of thought mentioned above, three (the psychodynamic, phenomenological, and behavioral) are well covered in this hyperlink, though details of the phenomenological approach are a bit sketchy (partly because that school of thought is the least cohesive of the five, as your text also indicates). Be sure you understand the basics as outlined there. If it's been awhile since you were exposed to behaviorism, you might want to check out this link also (but you won't have to know all the technical details outlined there).
The text's discussion of cognitive approaches is excellent, and I don't think I could better it by typing my own notes. Please note that it is not so easy as the text may imply to determine what is meant by "rationality" versus "irrationality".
As for the biomedical school, I won't be expecting you to master all the details in Chapter 3. I'll skip over technical issues in genetics (if you are interested in that topic, click here) as well as the details of how the nervous system works at a neural level (for details on that, click here, but please pay close attention to the text discussion of details about neurotransmitters, pp. 137-139; this is important).
I'll be talking in my own way about higher brain structures and their relationship to mental disorders (pp. 143-150). No notes here now because I have to figure out exactly how I want to approach that... but if you aren't familiar with the basics of hemispheric lateralization as it might be related to temperament, click here (a non-technical discussion; I'll provide some more technical -- and, some would say, more scientifically irrefutible -- information here later).
What's the main point of all this? As we move into the study of specific clinical syndromes, it's important to recognize that the different schools of thought will provide different (sometimes complementary, sometimes competing) perspectives on them. You'll want enough familiarity with the "language" of each school to be able to think in those terms about the syndromes.
Those who attempt to borrow the "best" from all schools of thought -- treating them as a sort of methodological smorgasbord -- are called eclecticists. Eclecticism can mean (on the positive side) a greater openness to differing ideas, and a greater flexibility of response to problems. But (on the negative side) it can come at the cost of logical inconsistency (if not, at times, downright muddle-headedness) and lack of definable commitment to any point of view. Between the extremes of rigidity and sheer confusion, all counselors must chart their course in determining how much eclecticism to admit to their thinking; the issue isn't an easy one, but I note Chesterton's famous saying, "The purpose of an open mind is to close it on something."
The five schools of thought can be compared and contrasted along a huge number of dimensions (some, but not all, of which I'll probably decide to discuss in class); here are some of them, and at a minimum, these terms should be (or become) familiar to you:
1. View of human nature (optimistic, pessimistic, neutral, or dialectic)
2. Continuity vs. discontinuity of development, and the special role (if any) of early childhood in the development of personality whether normal or abnormal
3. Active vs. passive view of human nature (including the freedom-determinism dispute, and the role, if any, of the unconscious)
4. Focus on past vs. present influences
5. Focus on nativist vs. empiricist influences
6. Focus on idiographic vs. nomothetic influences
7. Focus on mechanism vs. teleology
8. Reductionistic vs. noetic orientation
9. Experimental vs. clinical focus
The major ways that the five schools of thought can be compared and contrasted... or at least the three issues that I most want you to understand for our purposes... are the following.
1. Key idea underlying each school of thought
The key idea of the psychodynamic school of thought is unconscious or intrapsychic conflict (sometimes called unconscious determinism). See the hyperlink above (here it is again) for details about the Freudian structural model of the mind, which is important if this notion is to be properly understood.
The key idea of the phenomenological school of thought is authenticity -- related terms that are sometimes used to express this same idea are congruence and the internal frame of reference. This school views human beings as freely choosing agents, and emphasizes this capacity of choice. Inasmuch is this is probably the least cohesive (or least monolithic, anyway) of the five schools of thought, different proponents phrase these concepts in varying ways.
The key idea of the behavioral school of thought is external contingencies (e.g., rewards and punishments, stimulus cues) that initiate and/or maintain behavior.
The key idea of the cognitive school of thought is mediated emotionality (sometimes called by the simpler term self-talk): namely, that how a person thinks about or interprets external reality is the primary determinant of her/his emotional life and behavioral responses.
The key idea of the biomedical school of thought is psychophysical parallelism: namely, that organic or physiological events or causes, many (though not all) of which are genetic in origin, cause -- or at least mirror -- psychological states. Most (not all) proponents of this view tend to some extent to be more reductionistic than those in other schools of thought for this reason.
2. The question of etiology
Etiology, as you may recall, means (essentially) causation: what, in this case, is responsible for the existence of mental illness, for the form it takes, and for the course of the disorder. Questions of etiology can be specific to a particular diagnosis, and often are; in this unit, however, we are asking a more general etiological question, "What causes (or what is responsible for) mental illness in general or in the abstract?"
Psychodynamicists view mental illness as an indirect result of unresolved, repressed intrapsychic conflict. An issue that is repressed cannot be resolved by direct, conscious, rational means since the conscious mind no longer has access to that information. Thus, it comes out in indirect, unconscious, irrational ways -- the symptoms and clinical syndromes of mental illness. Repression is therefore the "culprit" of the drama.
Phenomenologists view mental illness as a consequence of inauthenticity, whether viewed in terms of needless conformity to external conditions of worth, failure to admit certain facts about oneself into one's self-image (incongruence), failure to come to terms with one's mortality and one's responsibility for personal choices, or in some other form.
Behaviorists are perhaps unique in suggesting that there is nothing "special" about mental illness as such. (In contrast, all other schools of thought explain mental illness using constructs that are not drawn purely from theories of "normal" personality.) As with any other behaviors, those we label as "abnormal" or as evidence of "mental illness" are caused and maintained by the same sets of situational contingencies that underlie all behavior.
Cognitivists generally blame irrational thinking for mental illness, claiming that emotional disturbances arise from faulty interpretations of life events. (Unfortunately to some extent this involves some degree of circular reasoning, since when asked to define what irrationality means, many will say that a thought is irrational if it causes emotional or behavioral pathology. If X is defined in terms of Y and Y is defined in terms of X, one has an enjoyable infinite regress.)
Biomedical theorists attribute mental illness to a host of specific organic or physiological causes, ranging from genetic abnormalities to brain lesions to imbalances in neurotransmitter processes. In general, though, they would point to abnormal neurological functioning (structural or functional deviations from the state of the normally functioning brain) as causal factors.
3. The basic approach to treatment
Understand the problem, and the solution practically writes itself: for each school of thought (and, one might say, for every known human philosophy, viewpoint, or worldview), the solution flows logically from a particular diagnosis of the problem or of the human condition.
Psychodynamicists attempt to undo repression or (to put it conversely) help clients to achieve insight into previously repressed conflicts. Once the conflict is again made conscious, the rational mind can use normal conscious processes to solve it.
Phenomenologists -- in diverse ways depending on their specific viewpoint, for this school is rather inchoate -- attempt to undo inauthenticity or (to put it conversely) foster authenticity. Once an individual again faces her/his responsibility for making personal choices and has the courage to do so, the illness subsides.
Behaviorists attempt to alter the situational contingencies that maintain maladaptive behavior: change the environment, they believe, and behavior (including mental "behavior" -- that is, patterns of thinking and feeling) will automatically change.
Cognitivists attempt to teach people how to think more rationally: to replace maladaptive patterns of self-talk with healthier ones.
Biomedical theorists apply medical treatments -- including but not limited to pharmacological (drug) treatments -- to restore proper brain functioning and hence eliminate the psychological symptoms.
What about the spiritual side of human experience?
For millennia, the Western philosophic tradition viewed the human person as comprised of three interlocking parts or elements: body, mind (or soul), and spirit. Other cultural traditions used different terms but to a greater or lesser extent maintained something similar to this threefold division. (When I get around to it, hopefully soon, I'll put an interesting article on "Ethnopsychologies" on reserve in the library that explores the question of cultural unity vs. diversity in how human personhood is viewed. Watch for it.)
In recent times, however, academic psychology (including clinical psychology) has shied away for the most part from the third of these categories. The most reductionistic, such as the behaviorists and many biomedical theorists, emphasized only the body; less reductionistic theorists admitted the existence and influence of the mind, though probably shying away from the religious implications of the word "soul". But most have assiduously ignored the spirit, for reasons partly explored in my discussion of personality and values.
Partly this stems from debates about what is meant by the spiritual side of the human person or human condition. Partly it stems from a reluctance to engage issues that seem more the province of religion than of science. Some phenomenologists (perhaps most notably Viktor Frankl and his followers, though he might eschew the label of phenomenology) have done some impressive work in this area; however, it remains a debated issue within psychology.
Whatever else is meant by the spirit, if it means free (unconstrained) choice -- and the accountability that comes with that choice -- then the phenomenological school probably comes the closest to dealing with at least the fringes of that concept. However, it's obviously difficult to address these issues without dealing with a host of metaphysical issues that would seem more the province of philosophy or theology than science. The desire to mimic the success and status of the natural sciences may have caused psychologists to shy away from these issues. For more, see the library reserve reading (a discussion written by Swiss psychiatrist Paul Tournier) in which he attempts to explore, in a generally neutral and nonsectarian sort of way, the possible role that this last level of explanation might play within clinical psychology. Of course, Tournier, being human, is not totally without bias. Neither am I. Neither, come to think of it, are you. "You are committed; you must wager" (Pascal).
Study Guide
1. Compare and contrast the five schools of thought with regard to such key issues as (a) the key idea that underlies each school, (b) the approach each school takes to the question of etiology, (c) the approach each school takes to treatment, (d) what, if anything, that school might say about the structure of human personality, (e) how that school might differentiate abnormal and normal processes.
2. What is meant by the notion of levels of explanation? By the idea that the differing levels are complementary, not contradictory? What relevance do these concepts have to the practice of clinical psychology? To the question of reductionism? To the nonparadigmatic nature of psychology?
3. What is the "diathesis-stress model" of mental illness? Explain by means of a concrete example. What relationship does this idea have to the levels of explanation controversy above?
4. What is eclecticism? Discuss some arguments for, and against, the eclectic perspective in psychology.
5. Discuss some differing approaches to the role of spirituality in clinical psychology.
On to Unit 6