MODULE 1

ABNORMAL PSYCHOLOGY: AN OVERVIEW

Abnormal Psychology
“The field of psychology that studies, understands, and addresses mental disorders, including
their nature, causes, and treatments, as seen in everyday life through media, personal
accounts, and clinical cases involving issues like substance abuse, eating disorders,
depression, schizophrenia, and other psychological difficulties.”
“Abnormal psychology is a branch of psychology that studies, diagnoses, and treats unusual
patterns of behavior, emotions, and thoughts that could signify a mental disorder.”
Abnormal psychology studies people who are “abnormal” or “atypical” compared to the
members of a given society.
Remember, “abnormal” in this context does not necessarily imply “negative” or “bad.” It is a
term used to describe behaviors and mental processes that significantly deviate from
statistical or societal norms.

Normality
Normal is seen as a good thing, something that is natural, regular, or routine.
The absence of illness and presence of state of wellbeing called Normality.
“Normality has been defined as patterns of behavior or personality traits that are typical or
the confirms to some standard of proper and acceptable ways of behaving and being.”
State of complete physical, mental and social wellbeing.
Hawker (2008), states that normal means standard, usual, ordinary, conventional, expected,
typical common, regular, unremarkable, of sound mind and compos mentis.
The WORLD HEALTH ORGANIZATION (WHO) considers normality to be a state of
complete physical, mental, and social well-being.
It is really difficult and challenging to define the concept of normality in comparison to
abnormality, but there are certain characteristics which when possessed by a normal
individual, reflects emotional well-being. The following are the traits that a normal person
possesses to a greater degree than an individual who is diagnosed as abnormal.
 Appropriate perception of reality
 Ability to exercise voluntary control over behaviour
 Self-esteem and acceptance
 Ability to form affectionate relationships
 Productivity

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Concept of Normality
A behavior can be normal in a society or culture but in other society and culture it can be
abnormal.
What’s normal today may be “abnormal” in the future. The concept of normal is not an
uncontroversial topic in psychiatry.
If something conforms to a general pattern, standard, or average, we describe it as normal,
but of course that standard can change over time.
According to G. W Kisker, “The word normal comes from the Latin name normalis which
means a carpenter’s square. A norm, therefore becomes a rule or pattern or standard, and it
was in this sense that the word introduced into the language.”
Normality implies a dynamic adaption to the changing environmental condition but also the
variations from a media considered normal in social and cultural milien.
Normality-notion used in psychology to define a complex functional and dynamic
equilibrium in a totality of active interference and interdependence with the environment.

Abnormality
Abnormal is any kind of activity that a person sees as bad behavior or something that is not
common, it can be defined as a birth defect to a mental illness.
Abnormality is the significant deviation from commonly accepted patterns of behaviors,
emotion or thought.
abnormality describes behaviour that differs from what is normal or expected within a
particular group of people. It is abnormal, dysfunctional, and socially unacceptable
behaviour. When a person behaves abnormally, it usually results in distress for them or others
inhibits their capacity to operate effectively in their surroundings, and makes it difficult for
them to cope with everyday responsibilities. For instance, people aren’t expected to wish for
their own death, cry themselves to sleep each night, or listen to voices that no one else can
hear.
Abnormality is the significant deviation from commonly accepted patterns of behavior,
emotion or thought, while normality is the absence of illness and the presence of state of well
-being otherwise called normalcy
Abnormal psychological phenomenon are simply exaggeration or disguised development of
the normal psychological phenomenon.
J F Brown (1940)
Human behavior and experiences which are strange, unusual, or different ordinarily are
considered abnormal.
G W Kisker (1949)

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Abnormality is a behavior, that is not socially confirmed and developed by a sad or stressful
condition and distorted cognition.
Reiger (1998)

Concept of Abnormality
The term abnormal was derived from the word “Anomelos”, that was formed by adding two
words Ano + Melos which means “Not Regular”.
It means a behavior that is not regular can be called abnormal.
Another mean of the term Abnormal is “Away from Normal”. It means, if a behavior is so
differ from normal behavior then it can be called abnormal behavior.

Criteria of Normality
Sheldon J. Korchin (1986) has based his views of normality on the survey conducted by Offer
and Sabshin (1966) on the varied meanings of normality in the different fields of study such
as psychology, anthropology, sociology, and psychiatry:
● Normality as Health
It means absence of sickness is normal. Thus, a person who does not have any pathology,
i.e., who is symptom-free and is not hospitalized or underwent treatment is normal. It implies
that most of the people are normal, while only some are abnormal.
● Normality as Ideal (Utopia)
It goes a step further from viewing normality as health, i.e., as being symptom free. It says
that normality does not mean, ‘only being free from disease but it means achieving the ideal
state, such as Roger’s fully functioning person, or Maslow’s self-actualized person, or
Allport’s mature personality. However, you must have noticed the term, ‘utopia’ in
parentheses. Utopia means an imagined place or state of thing in which everything is perfect
or ideal. This raises another question, i.e., what is perfect or ideal? There is no clear-cut and
single answer to this question, as what is perfect for one person may not be so for another.
People’s values define ‘perfect’ or ‘ideal’ state. Since values entail biases so is has not been
possible to conclusively define the ideal or perfect state. Thus, being in an ideal state is
imaginary and impossible to achieve. Freud, therefore, has referred to normality as
idealfiction. Nevertheless, it is an important criterion as the goal of psychologist is to help
people achieve health and optimum level of functioning.
● Normality as Average
Nature tends to distribute a given attribute or phenomenon in the world in such a way that
most of the cases representing that attribute have similar values, while only a few cases have
extreme values. If a mean or average is calculated of these values, then most of the cases tend
to cluster around the mean, while those with extreme values tend to fall away from the mean
or average. In statistics, such a distribution of cases is known as normal distribution and is
graphically represented by a bell-shaped curve, called the normal probability curve. The cases
clustering around average are conceptualized as normal while the cases at the extreme as
abnormal.

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According to statistical theory, cases clustering around average are normal while the cases
falling away from average at either side are abnormal. Moreover, the farther away a case is
from average, the more abnormal it is.
Statistical description is believed to be scientific. However, it is not valuefree since we do not
describe both the extremes equally as abnormal. For example, a person can have an IQ, which
deviates from average on either side of the normal probability curve, i.e., it can be
significantly above or below average, but we describe only the IQ significantly ‘below’
average as abnormal. Nonetheless, the concept of normality as average is utilized widely in
clinical practice for diagnosis and assessment.
● Normality as Socially Acceptable
Social norms determine normality, i.e., behavior which confirms to the social norms is
normal. This implies that we should neither seek not accept the universal definitions of
normality. Rather, normality is a socially specified concept. According to Ralph Linton
(1956), “The tests of absolute normalcy are the individual’s ability to apprehend reality, as
understood by his society, to act in terms of this reality, and to be effectively shaped by his
society during his developmental period. The test of relative normalcy is the extent to which
the individual’s experience has given him a personality conforming to the basic personality of
his society.”
In 1930s anthropologists gave the concept of cultural relativism to describe the role of
society in defining the normal behavior of an individual. According to cultural relativism,
what may be considered as normal in one society may be considered as abnormal in another
society, e.g., possession by a goddess is normal in some Asian societies while it may be
considered as a mental disorder by western societies. A problem, however, in defining
normality as socially acceptable is that it entails a risk of encouraging conformity and non-
conformity as a criterion for normality and abnormality, respectively. Conformity to social or
cultural norms is taken as a sign of normality, however, rigid conformity may be pathological.
For example, rigid conformity to social norms laid down by an autocrat is pathological,
whereas non-conformity to such behavior is normal.
This has been clearly illustrated by Milgram’s classical study. In his study, Milgram showed
that the participants were ready to give electric shocks (participants were made to believe that
they were giving actual electric shocks) to the other participants (confederates) in the other
room despite listening their screams. Most of the participants showed conformity to the
researcher’s instructions even if it meant hurting others. Very few participants showed non-
conformity. Thus, we can see that conformity to social norms may not always be ‘normal’.
● Normality as a Process
Normality defined as a process defines it temporally. That is, over the time, as an individual
passes through different developmental phases, his/ her behavior is evaluated according to the
given phase. Thus, babbling is considered to be normal for an infant, but as an abnormal
behavior for a 5-year-old child or for an adult.

Criteria of Abnormality
1. Subjective distress

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If people suffer or experience psychological pain we are inclined to consider this as indicative
of abnormality. People with depression clearly report being distressed, as do people with
anxiety disorders. But what of the patient who is manic and whose mood is one of elation?
He or she may not be experiencing any distress. In fact, many such patients dislike taking
medications because they do not want to lose their manic “highs.”

You may have a test tomorrow and be exceedingly worried. But we would hardly label your
subjective distress abnormal. Although subjective distress is an element of abnormality in
many cases, it is neither a sufficient condition (all that is needed) nor even a necessary
condition (a feature that all cases of abnormality must show) for us to consider something as
abnormal.

2. Maladaptiveness
Maladaptive behavior is often an indicator of abnormality. The person with anorexia may
restrict her intake of food to the point where she becomes so emaciated that she needs to be
hospitalized. The person with depression may withdraw from friends and family and may be
unable to work for weeks or months. Maladaptive behavior interferes with our well-being and
with our ability to enjoy our work and our relationships.

But not all disorders involve maladaptive behavior. Consider the con artist and the contract
killer, both of whom have antisocial personality disorder. The first may be able glibly to talk
people out of their life savings, the second to take someone’s life in return for payment. Is
this behavior maladaptive? Not for them, because it is the way in which they make their
respective livings. We consider them abnormal, however, because their behavior is
maladaptive for and toward society.
3. Statistical deviancy
The word abnormal literally means “away from the normal.” But simply considering
statistically rare behavior to be abnormal does not provide us with a solution to our problem
of defining abnormality. Genius is statistically rare, as is perfect pitch. However, we do not
consider people with such uncommon talents to be abnormal in any way.

Also, just because something is statistically common doesn’t make it normal. The common
cold is certainly very common, but it is regarded as an illness nonetheless. On the other hand,
intellectual disability (which is statistically rare and represents a deviation from normal) is
considered to reflect abnormality. If something is statistically rare and undesirable (as is
severely diminished intellectual functioning), we are more likely to consider it abnormal than
something that is statistically rare and highly desirable (such as genius) or something that is
undesirable but statistically common.
4. Violation of the standards of society

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All cultures have rules. Some of these are formalized as laws. Others form the norms and
moral standards that we are taught to follow. Although many social rules are arbitrary to some
extent, when people fail to follow the conventional social and moral rules of their cultural
group, we may consider their behavior abnormal.

Much depends on the magnitude of the violation and on how commonly the rule is violated
by others. Driving a car or watching television would be considered highly abnormal for the
Amish of Pennsylvania. However, both of these activities reflect normal everyday behavior
for most other Pennsylvania residents. A behavior is most likely to be viewed as abnormal
when it violates the standards of society and is statistically deviant or rare. Yet when a mother
drowns her children there is instant recognition that this is abnormal behavior.

5. Social discomfort
Not all rules are explicit. And not all rules bother us when they are violated. Nonetheless,
when someone violates an implicit or unwritten social rule, those around him or her may
experience a sense of discomfort or unease. Imagine that you are sitting in an almost empty
bus. There are rows of unoccupied seats. Then someone comes in and sits down right next to
you.

How do you feel? Is the person’s behavior abnormal? Why? The person is not breaking any
formal rule. He or she has paid for a ticket and is permitted to sit anywhere he or she likes.
But your sense of social discomfort (“Why did this person sit right next to me when there are
so many empty seats available?”) will probably incline you to think that this is an example of
abnormal behavior. If the person who gets on the bus is someone you know well, it might be
more unusual if he or she did not join you.
6. Irrationality and unpredictability
We expect people to behave in certain ways. Although a little unconventionality may add
some spice to life, there is a point at which we are likely to consider a given unorthodox
behavior abnormal. If a person sitting next to you suddenly began to scream and yell
obscenities at nothing, you would probably regard that behavior as abnormal.

It would be unpredictable, and it would make no sense to you. The disordered speech and the
disorganized behavior of patients with schizophrenia are often irrational. Such behaviors are
also a hallmark of the manic phases of bipolar disorder. Perhaps the most important factor,
however, is our evaluation of whether the person can control his or her behavior. Few of us
would consider a roommate who began to recite speeches from King Lear to be abnormal if
we knew that he was playing Lear in the next campus Shakespeare production—or even if he
was a dramatic person given to extravagant outbursts. On the other hand, if we discovered
our roommate lying on the floor, flailing wildly, and reciting Shakespeare, we might consider
calling for assistance if this was entirely out of character and we knew of no reason why he
should be behaving in such a manner.
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7. Dangerousness
It seems quite reasonable to think that someone who is a danger to him- or herself or to
another person must be psychologically abnormal. Indeed, therapists are required to
hospitalize suicidal clients or contact the police (as well as the person who is the target of the
threat) if they have a client who makes an explicit threat to harm another person.

But as with all of the other elements of abnormality, if we rely only on dangerousness as our
sole feature of abnormality, we will run into problems. Is a soldier in combat mentally ill?
What about someone who is an extremely bad driver? Both of these people may be a danger
to others. Yet we would not consider them to be mentally ill. Why not? And why is someone
who engages in extreme sports or who has a dangerous hobby (such as free diving, race car
driving, or keeping poisonous snakes as pets) not immediately regarded as mentally ill? Just
because we may be a danger to ourselves or to others does not mean we are mentally ill.
Conversely, we cannot assume that someone diagnosed with a mental disorder must be
dangerous. Although people with mental illness do commit serious crimes, serious crimes are
also committed every day by people who have no signs of mental disorder. Indeed, research
suggests that in people with mental illness, dangerousness is more the exception than the rule
(Corrigan & Watson, 2005).

Historical views of Abnormal Behavior

Demonology
* Writings show that the Chinese, Egyptians, Hebrews, and Greeks often attributed such
behavior to a demon or God who had taken possession of person.
* Whether the "possession" was assumed to involve good spirits or evil spirits usually
depended on the affected individual's symptoms.
* If a person's speech or behavior appeared to have a religious or mystical significance, it was
usually thought that he or she was possessed by a good spirit or God. Such people were often
treated with considerable awe and respect, for people believed they had supernatural powers.
* The primary type of treatment for demonic possession was exorcism, which included
various techniques for casting an evil spirit out.
* These techniques varied but typically included magic, prayer, incantation, trephining (stone
age treatment for mental disorders involving chipping away a circular section of skull),
noisemaking, the use of horrible - tasting concoctions made from sheep's dung and wine.

Greeks
1. Hippocrates
A Greek physician who believed that the brain was the central organ of intellectual
activity and that mental disorders were due to brain pathology. He also emphasized
the importance of heredity and predisposition. Hippocrates classified all mental
disorders into three general categories—mania, melancholia, and phrenitis (brain
fever) The four essential fluids of the body are—blood (sanguine), phlegm, bile

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 (choler), and black bile (melancholic). The fluids combined in different proportions
within different individuals, and a person’s temperament was determined by which of
the humors was dominant.

2. Plato
A Greek philosopher who studied individuals with mental disturbances who had
committed criminal acts and how to deal with them. He wrote that such persons were,
in some “obvious” sense, not responsible for their acts and should not receive
punishment in the same way as normal persons. Plato viewed psychological
phenomena as responses of the whole organism, reflecting its internal state and
natural appetites. Emphasized the role of socio- cultural factors.

3. Aristotle
A Greek philosopher and a pupil of Plato who believed in the Hippocratic theory that
various agents, or humors, within the body, when imbalanced, were responsible for
mental disorders. Aristotle rejected the notion of psychological factors as causes of
mental disorders.

4. Galen
A Greek physician who made a number of original contributions concerning the
anatomy of the nervous system. Galen also took a scientific approach to the field,
dividing the causes of psychological disorders into physical and mental categories.
Among the causes he named were injuries to the head, excessive use of alcohol,
shock, fear, adolescence, menstrual changes, economic reversals, and
disappointment in love.

Romans
In Rome, physician Asclepiades (124-40 BC) and philosopher Cicero (106-43 BC) rejected
Hippocrates’ idea of the four humors and instead stated that melancholy arises from grief,
fear, and rage; not excess black bile. Roman physicians treated mental disorders with
massage and warm baths, with the hope that their patients be as comfortable as possible.
They practiced the concept of “contrariis contrarius”, meaning opposite by opposite, and
introduced contrasting stimuli to bring about balance in the physical and mental domains. An
example would be consuming a cold drink while in a warm bath.

Indian
Ancient Indian psychology has its roots in the Vedas and Upanishads, which describe various
mental health concepts and theories. Key aspects include: Triguna Theory: This theory
describes three fundamental qualities or gunas that make up human personality - sattva
(balanced), rajas (passionate), and tamas (dull). These gunas influence mental capacity and
determine one's dominant personality type. Systems of Psychological Medicine In India.

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Ayurveda:
Mental disorders are represented in Ancient India in various types of literature. The aetio-
genesis of these disorders was thought to be endogenous because of provoked humours like
vatonmad, Pittonmad & Kaphonmand. Exogenously the causes were attributed to sudden fear
or association with ill influence of certain mythological gods or demon, Charak Samhita
designated Psychiatry as ‘Bhuta Vidya’.

Unani System:
Najabuddin Unhammad (1222 A. D), an indian physician, described seven types of mental
disorders viz :- Sauda-a- Tabee (Schizophrenia); Muree Sauda (depression); Ishk (delusion of
love); Nisyan (Organic mental disorder); Haziyan (paranoid state); Malikholia-a-maraki
(delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine.

Siddha System:
‘Siddhi’ means achievement and Siddhas are men who have achieved results in medicine, as
well as yoga and tapas. The great saga ‘Agastya’, one of the 18 Siddhas has contributed
greatly to the Siddha system of medicine of the South. He formulated a treatise on mental
diseases called as ‘Agastiyar kirigai Nool ‘, in which 18 psychiatric disorders with
appropriate treatment methods is described.

Middle Age
1. Middle East
In the medieval period (A.D. 5001500), Greek forms of medicine were maintained
and refined in the Islamic world. The initial mental facility was constructed in
Baghdad in 792 A.D., soon others could be found in Damascus and Aleppo. Mentally
ill persons were treated well in such hospitals. The Canon of Medicine, written by a
renowned Iranian doctor, Avicenna, is one of the most-read medical literature in
history. He identified such conditions as hysteria, depression and epilepsy. In one of
the cases, he cured a prince who thought that he was a cow through his innovative
psychological approach.
2. Europe
Europe in the Middle Ages, on the contrary, was full of superstition and religion and
there was no scientific knowledge on the mental [Link] disorders were widely
thought to be caused either by sin or demons but it was not always so. An unusual
phenomenon, mass madness, took place when whole groups of people started doing
strange things sometimes they danced wildly (tarantism or Saint Vitus Dance) or
thought they were animals (lycanthropy). Such episodes most probably could be
caused by stress, fear and other sufferings, such as famine and the Black Death.

The Church commonly took care of mentally sick people in [Link] place of
treatment was prayer, holy water, and physical visits to sacred places and mild
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 exorcism. Remedies by herbs were also applied. Although people were supposed to
think that mentally sick people were always suspected of being witches, contemporary
studies reveal otherwise since the definite majority of the witches were unwell
women, who did not even have mentally sick [Link] was some overlap of
mental illness and possession that was confused, but it was not as extensive as
previously imagined.

Near the Middle Ages, humanism emerged as a new tradition of [Link]

emphasized human needs and interests prompting the reversion to scientific thinking
and a more humanitarian way of treating the mentally ill.

Humanitarion approach
1. Paracelsus
Philippus Aureolus Theophrastus Bombastus von Hohenheim who called himself
Paracelsus (1490–1541), a Swiss physician, was among the early critics of
superstitious explanations for possession. He argued that the dancing mania was not
due to possession but was instead a medical condition that required treatment. He also
proposed that human beings experience a conflict between their instinctual and
spiritual sides, introduced the idea that mental illness could have psychological
causes, and supported the use of “bodily magnetism”—later known as hypnosis—as a
treatment method (Mora, 1967). While Paracelsus dismissed demonology, his
understanding of abnormal behavior was still influenced by his belief in astral forces.
For instance, he believed the moon had a supernatural effect on the brain—an idea
reflected in the origin of the word “lunatic” (from the Latin luna, meaning “moon”)
and one that still lingers today.
Paracelsus considered himself an alchemist, however his ideas on poison led to the
introduction of chemistry into medicine in the sixteenth century. His ideas were even
used to cure Louis XIV. Paracelsus is also given credit for the invention of
laudanum, or tincture of opium.
2. Johann Weyer
Johann Weyer, a 16th-century German physician, is considered a pioneer in the field
of abnormal psychology. He challenged the prevailing view that attributed mental
illness to demonic possession, arguing instead that "witches" were often individuals
with mental disorders who needed medical, not theological, treatment. Weyer's work
emphasized psychological factors and disturbed interpersonal relationships as
potential causes of psychological disorders.

Establishment of Asylums
The establishment of asylums as dedicated institutions for the care of individuals with mental
illness, represents a significant shift in how society has addressed mental health challenges
throughout history. Initially, individuals with mental health conditions were often cared for
within their families or communities, with some ending up in almshouses, workhouses, or
even prisons. The asylum movement, which gained momentum in the 19th century, aimed to
provide more specialized care in a structured environment
Early Forms of Care:

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*Family and Community:
Historically, families and communities were the primary caregivers for individuals with
mental illness.
*19th Century Reform:
The 19th century saw a growing movement to establish dedicated asylums for the mentally
ill.
The establishment of asylums represents a complex and evolving chapter in the history of
mental health care. While they aimed to provide specialized care, they also faced challenges
related to overcrowding, changing treatment approaches, and criticisms of their custodial
nature.

Pinel
Philippe pinel was a French physician who played a significant role in the development of
abnormal psychology by advocating for more humane treatment of individuals with mental
illness. He is particularly known for his work in the late 1700s, where he introduced "moral
treatment" and challenged the prevailing view of mental illness as incurable and requiring
harsh treatment.
Philippe Pinel's work marked a significant turning point in the history of mental health,
shifting the focus from punishment and neglect to understanding, compassion, and the
potential for recovery.

Tuke
William Tuke, an English Quaker, played a crucial role in transforming the care of the
mentally ill in England. Disturbed by the harsh and degrading treatment in asylums, he
founded the York Retreat in 1796, a facility where patients were treated with dignity, rest, and
kindness. His approach became known as moral treatment, which emphasized humane care,
respect, and productive activities. Tuke’s work influenced psychiatric care throughout Europe
and laid a foundation for modern psychological treatment.

Benjamin Rush
In the United States, Benjamin Rush (1746–1813), known as the “Father of American
Psychiatry,” introduced moral treatment principles inspired by Tuke and Pinel. Rush believed
that mental illness had biological causes, and while he supported humane care—such as clean
environments and occupational therapy—he also used medical treatments like bloodletting
and the tranquilizing chair, which were later seen as outdated. Despite this, he made
significant efforts to improve the condition of patients in mental institutions and emphasized
the need for medical study of mental illness.

Benjamin Franklin
Benjamin Franklin (1706–1790) was not a psychologist, his contributions were influential in
shaping scientific thinking in psychology. He supported the early use of electricity as a
treatment for depression (an early form of electrotherapy), and he encouraged scientific and
rational approaches to understanding human behavior. Franklin also played a role in founding

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hospitals and supported the humane treatment of people with mental illnesses, indirectly
influencing the development of psychological care.

Dorothea Dix
Dorothea Dix (born April 4, 1802, Hampden, District of Maine, Massachusetts [now in
Maine], U.S.—died July 17, 1887, Trenton, New Jersey) was an American educator, social
reformer, and humanitarian whose devotion to the welfare of the mentally ill led to
widespread reforms in the United States and abroad.

Dix left her unhappy home at age 12 to live and study in Boston with her grandmother. By
age 14 she was teaching in a school for young girls in Worcester, Massachusetts, employing a
curriculum of her own devising that stressed the natural sciences and the responsibilities of
ethical living. In 1821 she opened a school for girls in Boston, where until the mid-1830s
periods of intensive teaching were interrupted by periods of ill health. She eventually
abandoned teaching and left Boston.
After nearly two years in England Dix returned to Boston, still a semi-invalid, and found to
her amazement that she had inherited a sum of money sufficient to support her comfortably
for life. But her Calvinist beliefs enjoined her from inactivity. Thus in 1841, when a young
clergyman asked her to begin a Sunday school class in the East Cambridge House of
Correction in Massachusetts, she accepted the challenge. In the prison she first observed the
inhumane treatment of insane and mentally disturbed persons, who were incarcerated with
criminals, irrespective of age or sex. They were left unclothed, in darkness, without heat or
sanitary facilities; some were chained to the walls and flogged. Profoundly shocked, Dix
traveled for nearly two years throughout the state, observing similar conditions in each
institution she examined. In January 1843 she submitted to the Massachusetts legislature a
detailed report of her thoroughly documented findings. Her dignity, compassion, and
determination were effective in helping to pass a bill for the enlargement of the Worcester
Insane Asylum. Dix then moved on to Rhode Island and later New York.
In 1845 Dix published Remarks on Prisons and Prison Discipline in the United States to
advocate reforms in the treatment of ordinary prisoners. In 1861 she was appointed
superintendent of army nurses for Civil War service. She was ill-suited to administration,
however, and had great difficulty with the post. After the war she returned to her work with
hospitals. When she died, it was in a hospital that she had founded.

Deinstitutionalization
Deinstitutionalization is a word that conjures up different meanings. In the 1970s it had a
positive connotation: the term referred to the discharge of long-term psychiatric patients from
obsolete custodial mental hospitals that had seemingly outlived their usefulness. The
presumption was that seriously mentally ill persons could make a successful transition to
community life with appropriate social and psychiatric support systems. Two decades later,
deinstitutionalization has a more ambivalent character, for it suggests an image of homeless
former mental patients who inhabit the streets of virtually every major urban area and seem to
threaten the community as well as themselves.

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Emil Kraeplin
Emil Kraepelin (born Feb. 15, 1856, Neustrelitz, Mecklenburg-Strelitz [Germany]—died Oct.
7, 1926, Munich, Ger.) was a German psychiatrist, one of the most influential of his time,
who developed a classification system for mental illness that influenced subsequent
classifications. Kraepelin made distinctions between schizophrenia and manic-depressive
psychosis that remain valid today.
After receiving his M.D. from the University of Würzburg (1878), Kraepelin continued his
studies under several German neuroanatomists as well as with the experimental psychologist
Wilhelm Wundt. Kraepelin employed Wundt’s experimental techniques to study the effects of
drugs, alcohol, and fatigue on psychological functioning and in 1881 published a study of the
influence of infectious diseases on the onset of mental illness. He then began his
Compendium der Psychiatrie (1883), in which he first presented his nosology, or
classification of disorders. Kraepelin divided mental illnesses into exogenous disorders,
which he felt were caused by external conditions and were treatable, and endogenous
disorders, which had such biological causes as organic brain damage, metabolic dysfunctions,
or hereditary factors and were thus regarded as incurable.
Appointed professor at the University of Dorpat (now Tartu, Estonia) in 1885 and then at the
University of Heidelberg six years later, Kraepelin continued to refine his classification,
issuing several revisions of his psychiatry textbook, which has grown to several volumes. In
the sixth edition (1899), he first made the distinction between manic-depressive psychosis
and dementia praecox, now called schizophrenia. He believed that manic-depressive
disorders and melancholia (depression) were exogenous and thus were treatable, while
dementia praecox fell among the endogenous, incurable illnesses. Kraepelin attributed
dementia praecox to organic changes in the brain. He further distinguished at least three
clinical varieties of the disease: catatonia, hebephrenia, and paranoia.

Kraepelin became professor of clinical psychiatry at the University of Munich in 1903 and
remained there until 1922, when he became director of the Research Institute of Psychiatry in
the same city. Throughout his career, he continued to refine his classification and was
working on the ninth edition of his textbook when he died.
The concepts embodied in Kraepelin’s classification system did not originate with him, but he
was the first to synthesize them into a workable model that could be used to diagnose and
treat mental patients. His classification was particularly influential during the
early 20th century.

Contemporary Phase
The contemporary phase in abnormal psychology relies on a combined approach known as
the biopsychosocial model. It highlights that mental disorders emerge from biological,
psychological, and sociocultural factors. This viewpoint moved beyond one-sided
explanations and contributed to a fuller understanding of abnormal behaviour.
Major turning points include the finding that some mental disorders, like general paresis,
have biological roots such as infections. This established a solid link between brain issues

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and mental illness. Emil Kraepelin’s work to classify disorders also set the foundation for
today’s diagnostic systems.
Alongside biology, psychological views began to change, particularly through Freud’s work,
which introduced the role of the unconscious mind. Later, psychology took on a more
scientific and experimental approach, leading to objective ways of understanding behavior.
Today, the field keeps progressing through brain imaging, genetic studies, and updated
classification tools like the DSM-5.

How Common Are Mental Disorders?

Knowing how often mental disorders happen is crucial for planning treatments, allocating
resources, and creating public health policies.

Epidemiology
Epidemiology examines how mental disorders spread across populations and the factors that
affect their occurrence. It includes large surveys and research to gather data on mental health
trends.
For instance, big national studies like the National Comorbidity Survey have found that
anxiety disorders are the most commonly reported mental health issues in the United States,
affecting nearly one-third of the population at any point of their lives.
Through the identification of patterns and risk factors, epidemiology assists researchers in
determining who is at risk, which types of disorders are on the rise or decline, and how to
implement interventions more effectively.

*Prevalence
The term prevalence refers to the number of active cases in a population during any given
period of time. Prevalence figures are typically expressed as percentages (i.e., the percentage
of the population that has the disorder). Furthermore, there are several different types of
prevalence estimates that can be made.

1. Point Prevalence
Refers to the estimated proportion of actual, active cases of a disorder in a given
population at a given point in time. For example, if we were to conduct a study and
count the number of people who have major depressive disorder (i.e., clinical
depression) on January 1 of next year, this would provide us with a point prevalence
estimate of active cases of depression. A person who experienced depression during
the months of November and December but who managed to recover by January 1
would not be included in our point prevalence calculation. The same is true of
someone whose depression did not
begin until January 2.
2. 1 year Prevalence
we would count everyone who experienced depression at any point in time throughout
the entire year. As you might imagine, this prevalence figure would be higher than the
point prevalence figure because it would cover a much longer time. It would
moreover include those people who had recovered before the point prevalence

14
 assessment as well as those whose disorders did not begin until after the point
prevalence estimate was made.
3. Life time Prevalence
we may also wish to obtain an estimate of the number of people who have had a
particular disorder at any time in their lives (even if they are now recovered).
This would provide us with a lifetime prevalence estimate. Because they extend over
an entire lifetime and include both currently ill and recovered individuals, LIFE TIME
PREVALENCE estimates tend to be higher than other kinds of prevalence estimates.

*Incidence
Incidence refers to the number of new cases of a disease or condition that occur in a specific
population during a defined time period. It reflects the risk of individuals in a population
developing the disease. This measure helps identify how often a disease arises and is essential
for public health planning and tracking disease outbreaks.
why it's Matters because incidence is crucial for understanding the current risk of a disease in
a community. For example, a decrease in chickenpox incidence after widespread vaccination
shows the effectiveness of prevention programs. On the other hand, incidence may rise with
changes in behavior or environment, like the increase in traffic accidents due to phone use.
How it calculated
• Incidence = New cases / (Population × Time)
• Expressed per 1,000 or 100,000 person-years
• Measures risk of disease, unlike prevalence, which shows total burden
• Affected by population at risk—must include only individuals susceptible to the disease
• Helps in resource allocation, prevention strategies, and epidemiological tracking
Let's see an example , suppose 25 people in a town of 5,000 are newly diagnosed with
diabetes over five years. The incidence is calculated as:
25 / (5,000 × 5) = 0.001 or 1 per 1,000 person-years.
This means that, on average, one new case of diabetes is expected per 1,000 people each year.

*COMORBIDITY
Comorbidity refers to the presence of one or more additional diseases or disorders co-
occurring with a primary disease or disorder. The most commonly cited definition was
introduced by Feinstein in 1970, who described comorbidity as any distinct clinical condition
that exists or occurs during the clinical course of a patient who has an index disease. This
means that when a patient is diagnosed with a primary illness, any other condition that
develops or is present at the same time is considered a comorbidity. The key feature in this
concept is that one disease is identified as the "main" or "index" disease, and the others are
understood in relation to it. Comorbidities can complicate diagnosis and treatment because
they can mask symptoms, influence treatment decisions, and increase the risk of poor health
outcomes.

15
 1.A common example of comorbidity is in patients with diabetes. If a diabetic patient also
suffers from hypertension, then hypertension is considered a comorbidity of diabetes.
[Link] example is a patient who has had a stroke and subsequently develops depression—
here, the depression is a comorbidity of the stroke.
[Link] instance, treating cancer in a patient who also has chronic kidney disease may be more
difficult because of limitations in the use of chemotherapy drugs due to reduced kidney
function.

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