EVALUATE THE MEDICAL MODEL AND THE BEHAVIOURAL MODEL OF ABNORMALITY

by davaders (student)

EVALUATE THE MEDICAL MODEL AND THE BEHAVIOURAL MODEL OF ABNORMALITY.

The Biological Model:

The Biological model also referred to as the medical, biomedical, physiological or somatic model of abnormality is probably the most interesting model of abnormal behaviour to understand. Within psychiatry it is by far the most influential theory in use in the western world today. The biological model assumes that the cause of mental disorders or illness is down to physical malfunctions of the brain and nervous system and that mental disorders or illness can be treated in the same way as a physical disease. As a result treatment can vary from drugs to surgery in order to solve the problem. Assuming that mental illness is a result of biological factors is not without its problems, as the classification of physical illnesses involves observation and measurement of actual symptoms such as broken bones, fever or blood pressure, whereas with mental illnesses the symptoms are much more subjective such as feelings of despair, lack of energy, hearing voices, mood swings and grandiose thoughts. These cannot be easily measured so a clinician/doctor must make a judgement based largely on experience and usually with the help of the Diagnostic and Statistical Manual of mental disorders. With the biological model doctors will usually diagnose the patient, giving some indication as to what is the problem or cause of the problem which then leads to a prognosis of what could or is likely to occur which then results in treatment being effected to help stabilise or cure the illness.

The biological model puts forward the following possible causes of abnormality, the first being genetics where genes inherited from our parents provide the blueprint for our bodies and brain, if there is any irregularity with the genetic makeup then it could result in abnormalities within brain functioning resulting in abnormal behaviour. The idea that disorders such as schizophrenia and autism have been linked to genetics, with bad genes being passed down the hereditary line.

The second possible cause looks at the link between biology and mental illness, where a physical illness such as malaria if untreated would eventually cause mental health issues. We know the brain has no immune response and relies on the body to provide a barrier against infection (bacteria or viruses), however if this barrier is breached, it could result in serious brain damage. This was recognized in explaining “General Paresis” where syphilis left untreated over a period of time would eventually damage the brain resulting in mental illness. A good example of the link between biology and mental health is that of Clive Wearing (1985) who after contracting a Herpes Simplex virus (what normally causes cold sores) lost the ability to form new memories as a result of the damage caused to his brain by the virus and left him with a memory span of about thirty seconds.

The third possible cause looks at chemical imbalances in the brain, in order for the brain to function effectively it relies on many different chemicals being in the correct balance. These chemicals, neurotransmitters and hormones are used to send messages round the brain and central nervous system and if there is an imbalance, either too much or not enough then it results in brain not functioning properly. An example of chemical imbalance is looking at low levels of the neurotransmitter “serotonin” which has been linked to depression, anxiety and obsessive compulsive disorders. Another neurotransmitter is “dopamine”, which is produced in the substantia nigra, a small region in the brain stem just above the spinal cord. It is one of the centres that help control movements. Damage to the substantia nigra has been linked to the onset of Parkinson’s disease as cells within the substantia nigra can no longer produce and release dopamine the neurotransmitter that controls movement and balance which is essential to the proper functioning of the central nervous system. Similarly hormones which are chemical messengers secreted in the bloodstream by glands have also been implicated in abnormal functioning. Chronic stress has been attributed to high levels of cortisol produced by the adrenal cortex.

The fourth possible cause that the biological model addresses is that of environmental factors. Whilst the biological model focuses on internal biological processes it does not ignore the possibility of the environment be it physical or natural, playing a role in abnormality. Looking at an individual experiences such as stress for example, can cause biological knock on effects on the functioning of the brain. Also there are toxins and pollution in the environment that may affect functioning of the brain directly, mercury poisoning has been linked to irrational behaviour, anxiety and memory loss. A case that showed the effects of physical damage to brain was that of an American railway worker Phineas Gage (1848), described as hard working pleasant individual before having an accident working on the railway line where an iron rod roughly a meter long impaled his skull just under his left eye. Miraculously Phineas survived the accident but was a changed man, he was now described as disinhibited, unreliable, aggressive and impulsive as a result of damage to the frontal lobes of the brain. Another example of physical damage causing psychological damage is the case study done by Ellis and Szulecka (1996), the subject referred to as Miss C believed she was being stalked by her ex-partner and his girlfriend who used a variety of disguises. Miss C would approach strangers, demand they take off their disguise and reveal themselves. This false recognition of people was treated successfully with drugs, however the delusions remained. After having a CAT scan of her brain, showed damage as a result of a stroke had severely damaged the cerebral cortex which resulted in the false recognition and delusions.

Those that argue the case for the biological model point out that the model is objective and based on established sciences such as medicine and evidence to support their research is derived from empirical scientific research. The role of hormones and neurotransmitters is more widely understood with evidence to show biochemical as well as genetic factors associated with some mental disorders. Furthermore the biological model provides a structured and logical method of diagnosis and treatment which is quick and cheap to administer. Treatment of people with schizophrenia for example has proved effective in controlling a serious mental illness, whilst allowing ...

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The biological model does have weaknesses, the difference between physical and mental illness is that diagnosis of physical illness can normally correlate to the causes of the problem known as aetiology. For example measuring blood sugar levels could confirm a diagnosis of diabetes, whilst the causes of many mental illnesses are unknown. This has an important consequence for treatments based on the biological model, as they can be criticised as focusing only on the symptoms of mental disorders and not the causes. Another criticism of this model is research is not always reliable or valid take the study of Rosenhan (1973). Rosenhan and seven other normal people presented themselves to different psychiatric hospitals to try and gain admission by stating they could hear voices, once admitted they behaved as they normally would and stopped claiming they were hearing voices with the exception of one all the rest were diagnosed as schizophrenic. During the study Rosenhan asked his team to take notes and record their experiences as patients, the note taking in one case was described in the nursing notes as ‘writing behaviour’. Rosenhan and his team found the actual patients in these hospitals suspected them of being sane, whilst the staff treated them as if they were schizophrenic, when they were finally discharged the diagnosis was schizophrenia in remission was used and it was never acknowledged that they were sane. This also identifies another weakness with the biological model in labelling of patients which has a negative perception of how you are treated by others, and the fact that once a person has been labelled they begin to take on the characteristics of that label. A major critic of the biological model was Thomas Szasz, according to him the concept of mental illness is fundamentally flawed as it is based on the foundation that it is caused by nervous system disorders, in particular brain disorders which establish themselves via abnormal thought patterns and behaviour. Szasz argued most cases of "mental illness" are routed within the social environment of an individual, and are in fact problems of living and should therefore be recognised as so. Furthermore, humanistic and existentialist biased therapists often point out that the medical model in encouraging the view that people who suffer from mental disorders are patients, transfer responsibility over to doctors and other professionals and in this way discourage them from taking control of their own life and as a consequence the problems will ultimately remain unresolved.

Although the biological model has been criticised there has been undeniable progress that has been made in understanding the biological basis of many mental disorders especially schizophrenia and the successful development of biomedical treatments. Mental illness does not show up in blood tests or x-rays and there are no bodily symptoms as it is all in the head. As there are no physical tests it does pose problems for doctors in diagnosing the problem in some cases, as they can only treat according to the symptoms presented to them. The medical model has been the one that has been most influential in determining the way that mentally ill people are treated, but most psychologists would say that at best, it only provides a limited explanation and may even be totally inapplicable.

References:

Pete Waring (2006). Abnormality. [ONLINE] Available at: http://psychology4a.com/Abnormal%206.htm. [Last Accessed 5 January 2013].

McLeod S (2008). The Medical Model. [ONLINE] Available at: http://www.simplypsychology.org/medical-model.html. [Last Accessed 6 January 2013].

Tobin S (). Understanding Abnormality. [ONLINE] Available at: http://highered.mcgraw-hill.com/sites/dl/free/007337069x/666309/haL7069X_ch01.pdf. [Last Accessed 5 January 2013].

The Behavioural model:

The behavioural model of abnormality was the dominant model in psychology in the first half of this century. The behavioural mode assumes that all behaviour whether normal or abnormal can be learned or unlearned through the processes of classical and operant conditioning. The model further argues all species learn in the same way which is referred to as ‘General Process Learning’. From the beginning behaviourists argue that psychology is a science and support it with scientific evidence which can be observed. However behaviourists tend to ignore a person’s thoughts or feelings as they cannot be observed. We learn by interacting with the world around us, especially by the way our environment operates on us. Classical conditioning was first proposed by Ivan Pavlov in the late 19th century. Classical conditioning is a form of learning in which the conditional stimulus (CS) comes to signal the event of a second stimulus, the unconditioned stimulus (US). A stimulus is a factor that causes a response in an organism. The unconditional stimulus (US) is usually a stimulus such as food or pain that provokes a response from the beginning, this is called the unconditioned response (UR). The conditional stimulus (CS) usually produces no particular response at first but after conditioning it provokes the conditioned response (CR). Classical conditioning differs from in that behaviour produced by the subject is strengthened or weakened by its consequences either by reward or punishment. Conditioning is usually done by pairing the two stimuli, as in classic experiments. Pavlov presented dogs with a ringing bell followed by food. The food provoked salivation (UR), and after repeated bell-food pairings the bell also caused the dogs to salivate. In this experiment, the unconditioned stimulus is the dog food as it produces an unconditioned response, saliva. The conditioned stimulus is the ringing bell and it produces a conditioned response of the dogs producing saliva. It was originally thought that the process underlying classical conditioning was one where the conditioned stimulus becomes associated with, and eventually provokes the unconditioned response. The individual learns to associate a neutral stimulus with an automatic reflex response such as fear or pleasure. Another example of classical conditioning was research done by Watson & Raynor (1920). A baby Little Albert was conditioned to associate the sight of a white rat or anything similar with a fear response. In other words, Albert had been conditioned to be scared of something he had previously found pleasant and even attractive. In conditioning terms the loud noise Albert heard was the unconditioned stimulus (UCS), his fear response of crying was the unconditioned response (UCR), the white rat was the conditioned stimulus (CS) and his fear of the white rat was the CR (conditioned response).

Operant conditioning is learning through the consequences of behaviour. If behaviour is rewarded or reinforced then the likelihood is it will be maintained or increased. If it is punished, it will weaken and more than likely stop. An example, if we are praised for polite behaviour when we are young we will learn that polite behaviour brings rewards, and we will behave politely without thinking about it. Burrhus Frederic Skinner developed the theory of Operant Conditioning essentially based on Thorndike’s theory of Law and Effect after studying animals in puzzle boxes. Skinner introduced a new term ‘Law of effect-reinforcement’ where behaviour which is reinforced tends to be repeated and behaviour that is not reinforced tends to die out. Skinner proposed that reinforcement works in two ways positive and negative, with positive and negative reinforcers the goal in both cases is for behaviour to increase. Positive reinforcers are favourable events or outcomes that are given to the individual after the desired behaviour has been displayed such as praise or rewards when a task is done, negative reinforcers are where the removal of a undesired or unpleasant outcome after the desired behaviour has been shown like the removal of a electric shock when pressing a lever thus the response is strengthened as the shock which is negative is remove. Skinner also proposed positive and negative Punishment, with the goal in both positive and negative punishment for behaviour to decrease. With positive punishment unfavourable events or outcomes are given in order to weaken the response that follows an example if you stroke a cat in a manner that the cat finds unpleasant, the cat may attempt to bite you therefore the presentation of the cat's bite will act as a and decrease the likelihood that you will stroke the cat in that same manner in the future. . Negative punishment is characterised when a favourable event or outcome is removed after undesired behaviour occurs, when a child talks back to his mother, the child may lose the privilege of watching their favourite television program or even going out with their friends, the loss of these benefits to the child will act as a deterrent and reduce the likelihood of the child talking back in the future.

Operant conditioning can explain abnormal behaviour, a good example where a person’s fear or phobia of heights would be explained through the process of classical conditioning, sometime in the past the patient would have learned to associate the emotion of fear through the stimulus of being in a high place through a chance association between the two stimuli, as a result the patient would avoid heights and therefore not have the opportunity to relearn the association in a more adaptive way. Abnormal behaviour can also be unlearned using the same conditioning principles. Watson & Rayner (1920) proposed to rid Little Albert of his fears by pairing a reward with the sight of a rat until his fear was extinguished but unfortunately Albert was adopted from the institution where he was being raised and nothing is known of him since.

An important follow on from the behaviourist approach is known as Social learning theory, which emphasizes that we learn through experience by observing others ‘observational learning’ and as you watch others you are more likely to imitate them. Bandura & Ross (1961) did a study into observational learning, where three groups of young children who watched a video of an adult behaving aggressively towards a Bobo doll with different consequences. One group saw the adult get punished for the behaviour while another saw the adult rewarded for the behaviour the other group saw the adult have no consequence for the behaviour. The children were then taken to a room identical to the one in the video. The children who had seen no consequence and reward for the behaviour imitated the adult’s behaviour and were rewarded when they imitated the behaviour. The children who had seen the adult punished for their behaviour did not imitate the behaviour, however when they saw the other children getting rewarded they also started to imitate the behaviour. Bandura argued that observation and imitation also known as modelling are important forms of learning which were neglected by the early behaviourists. Bandura went on to argue that while maladaptive behaviour can be learned through imitation it can also be treated by therapies based on modelling. A good example of the social learning theory is that of eating disorders such anorexia and bulimia, which have risen as a result of media influence, which promotes beauty in women associated with looking slim. Teenage girls learn that to be accepted as attractive there is a need to be slim and girls who most identify with these models are most likely to get anorexia. Fearn & Becker (1999) studied young women living on the island of Fiji, who before 1995 were not exposed to western TV channels. Yet when these channels were introduced a change took place and by 1998, 74% of young Fijian women surveyed said they were ‘too big or fat’, and eating disorders, previously unknown on the island had begun to surface.

Like the psychodynamic theorists, behaviourists have a deterministic view of mental illnesses, they believe that our actions are largely determined by our experiences in life. Though unlike the psychodynamic model, they see abnormal behaviour is a learned response through conditioning and not as the result of mysterious unconscious processes. While much of our behaviour is adaptive in helping us to cope with a changing world, it is also possible to learn behaviours that are abnormal and undesirable. This model states that maladaptive learning can be treated by changing the environment so that unlearning of the particular behaviour can take place. Those that argue for the behavioural model also point out the model has led to therapies which have had high success rates in their approach to treating abnormal behaviour. Another positive of the model is there is supporting research to back the claims its makes, such as Fearn & Becker’s research in the eating habits of the Fijian girls.

The aims of behavioural model were to move psychology towards a scientific model which focused on the observation and measurement of behaviour. Its assumptions were that behaviour is largely the result of the environment rather than genetics or instincts, and in doing so the behavioural model rejects the view that abnormal behaviour has a biological basis which many critics argue. A major criticism of this model is it does not try to make sense of our thoughts and emotions and looks at the mind as a blank slate (tabula rasa) unlike the psychodynamic approach, this is seen as one of its downfalls as it is seen as reductionist it taking complex human behaviour and attempting to explain it in very simple terms, often using laboratory experiments that lack ecological validity. The model has frequently been criticised as behaviourists only consider surface characteristics or symptoms, when treating a phobic response such as fear or panic for example the behaviour model does not address the underlying cause of the problem. Attempts made to explain depression and in particular schizophrenia have not been successful as the model ignores genetics or brain chemistry which from studies and drug treatments have shown plays a part. Those that argue ask how delusions or hallucinations can be developed through learning or imitation. Importantly the behavioural model assumes that mental illness is caused by events around us, it believes that the patient is not to blame for their behaviour and therefore the illness is accountable for their actions. The final criticism of the behaviourist is that of ‘General Process Learning’ which argues that all species learn in the same way but does not take into account factors such as language or socialisation.

References:

McLeod S.A (2007). Behaviorism. [ONLINE] Available at: http://www.simplypsychology.org/behaviorism.html. [Last Accessed 8 January 2013].

Pete Waring (2006). Behaviourist model of abnormality. [ONLINE] Available at: http://psychology4a.com/abnormal%209.htm. [Last Accessed 12 January 2013].

(1999). Health 'TV brings eating disorders to Fiji' . [ONLINE] Available at: http://news.bbc.co.uk/1/hi/health/347637.stm. [Last Accessed 10 January 2013].

Skinner B. F (). Operant Conditioning (Skinner). [ONLINE] Available at: http://www.learning-theories.com/operant-conditioning-skinner.html. [Last Accessed 10 January 2013].