In what way did the experiments performed by Bernheim and Liebault provide support for the psychogenic perspective of abnormality quizlet?

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- AFFECTS: famous, unknown, rich, poor, celebrities, writers, politicians, and other public figures.
- These problems can bring great suffering, but they can also be the source of inspiration and energy; they are so common and so personal, these problems capture the interest of us all - novels, plays, films, and TV programs have explored what many people see as the dark side of human nature, and self help books flood the market. Mental health experts are popular guests on both TV, radio, and many have their own shows, websites, youtube, and blogs.

- abnormal behavior, thoughts, and emotions are those that differ markedly from a society's ideas about proper functioning.
- each society established norms; behavior that breaks legal norms is considered criminal, behavior thoughts and emotions that break norms of psychological functioning are called abnormal.
- A society's norms grow from its particular culture; its history, values, institutions, habits, skills, technology, and arts.
- A society that values competition and assertiveness may accept aggressive behavior, whereas one that emphasizes cooperation and gentleness may consider aggressive behavior unacceptable and even abnormal.
- A society's values may change over time, causing its views of what is psychological abnormal to change as well. EX: In western society, a woman seeking the power of running a major corporation or leading the country would have been considered inappropriate and even delusional a hundred years ago. Today, the same behavior is valued.
- judgements of abnormality depend on specific circumstances as well as on cultural norms. EX: Someone feeling depressed like the world is going to cave in while they have a family to look after and what seems to be a perfect life. Whereas they are dealing with a life of COVID and are stuck inside not being able to make money, and they catch covid and are sick along with the rest of the family, this would make more sense why she would be so sad and depressed.
- Many human experiences produce intense reactions: financial ruin, large scale catastrophes and disasters, rape, child abuse, war, terminal illness, and chronic pain.

- the ultimate psychological dysfunction is behavior that becomes dangerous to oneself or others.
- individuals whose behavior is consistently careless, hostile, or confused may be placing themselves or those around them at risk.
- although danger is often cited as a feature of abnormal psychological functioning, research suggests that it is actually the exception rather than the rule.
- most people struggling with anxiety, depression, and even bizarre thinking pose no immediate danger to themselves or to anyone else.
- In the absence of distress and dysfunction, dangerous behaviors alone do not signify psychological abnormality; individuals working in professions characterized by everyday risk for injury or even death, such as firefighters or other emergency responders, typically choose their professions for altruistic reasons and out of a sense of duty. Although their particular call to service may place them in routine danger, they typically enjoy a sense of honor, positive mental well being, and satisfying family lives.

- A society selects general criteria for defining abnormality and then uses those criteria to judge particular cases.
- One clinical theorist, Thomas Szasz (1920-2012), placed such emphasis on society's role that he found the whole concept of mental illness to be invalid, a myth of sorts. According to Szasz, the deviations that society calls abnormal are simply "the problems in living," not signs of something wrong within the person.
- A number of todays clinical theorists de-emphasize the role of illness or disorder when defining psychological abnormality, and instead look at the circumstances and coping challenges that bring individuals to treatment.
- If we assume that psychological abnormality is a valid concept and that it can be defined, we may be unable to apply our definitions consistently; if a behavior such as excessive use of alcohol among college students is familiar enough, society may fail to recognize that it is deviant, distressful, dysfunctional, and dangerous.
- thousands of college students throughout the US are so dependent on alcohol that it interferes with their personal and academic lives, causing them great discomfort, jeopardized their health, and often endangers them and the people around them. Yet their problems go unnoticed and undiagnosed. Alcohol is much of a part of the college subculture that it is easy to overlook drinking behavior that has become abnormal.
- A society may have trouble separating an abnormality that requires intervention from an eccentricity.
- EX: every now and then we hear about people who behave in ways we consider strange, such as a man who lives alone with two dozen cats and rarely talks to other people. The behavior of such people is deviant, and it may well be distressful and dysfunctional, yet many professionals think of it as eccentric rather than abnormal.

- James Joyce, Benjamin Franklin, Hetty Green, Alexander Graham Bell, Sarah Lockwood Winchester, and D. H. Lawrence are famous persons who have been called eccentrics.
- dictionary definition: eccentric as a person who deviates from common behavior patterns or displays odd or whimsical behavior.
- Researcher David Weeks (2015) studied 1,000 eccentrics and estimated that as many as 1 in 5,000 persons may be "classic, full time eccentrics". Weeks pinpointed 15 characteristics common to the eccentrics in his study: nonconformity, creativity, strong curiosity, idealism, extreme interests and hobbies, lifelong awareness of being different, high intelligence, outspokenness, noncompetitiveness, unusual eating and living habits, disinterest in others' opinions or company, mischievous sense of humor, nonmarriage, eldest or only child, and poor spelling skills.
- Weeks suggests that eccentrics do not typically suffer from mental disorders. Eccentricity is chosen freely and provides pleasure whereas the unusual behavior of persons with mental disorders is thrust upon them and usually causes them suffering. "In short, eccentrics know they are different and glory in it" - weeks. The thought process of eccentrics are not severely disrupted and do not leave these persons dysfunctional. Weeks found that people in his study had fewer emotional problems than individuals in the general population. Perhaps being an original is good for mental health,

- once clinicians decide that a person is suffering from some form of psychological abnormality, they seek to treat it.
- treatment or therapy is a procedure designed to change abnormal behavior into more normal behavior; it requires careful definition.
- EX: A person is miserable in February. But in July they are feeling better, their symptoms have disappeared. factors such as advice from friends and family could have helped him. This is not considered treatment or therapy!
- According to pioneering clinical theorist Jerome Frank, all forms of therapy have three essential features: 1. A sufferer who seeks relief from the healer, 2. a trained, socially accepted healer whose expertise is accepted by the sufferer and the sufferers social group, 3. a series of contracts between the healer and the sufferer, through which the healer... tries to produce certain changes in the sufferers emotional state, attituded, and behaviors. Franks criteria is still embraced by most of todays clinical theorists, despite his seemingly straightforward definition - clinical treatment is surrounded by conflict and confusion.
- EX: a kid sitting in the NYC subway platform calling himself the advice kid, offering therapeutic advice. He is not a trained healer, therefore not treating with therapy.
- Some clinicians view abnormality as an illness and so consider therapy a procedure that helps cure the illness. Others see abnormality as a problem in living and therapists as teachers or coaches of more functional behavior and thought.
- Clinicians even differ on what to call the person who receives therapy: those who see abnormality as an illness speak of the patient and those who view it as a problem in living refer to the client.

- historians who have examined the unearthed bones, artwork, and other remnants of ancient societies have concluded that these societies probably regarded abnormal behavior as the work of evil spirits.
- people in prehistoric societies apparently believed that all events around and within them resulted from the actions of magical, sometimes sinister, beings who controlled the world. They viewed the human body and mind as a battleground between external forces of good and evil - abnormal behavior was typically interpreted as a victory by evil spirits, and the cure for such behavior was to force the demons from a victims body.
- this supernatural view of abnormality may have begun as far back as the stone age, a half million years ago.,
- some skulls from that period recovered in Europe and South America show evidence of an operation called trephination, in which a stone instrument, or trephine, was used to cut away a circular section of the skull; Some historians have concluded that this early operation was performed as a treatment for severe abnormal behavior, either hallucinations in which people saw or heard things not actually present or melancholia, characterized by extreme sadness and immobility- the purpose of opening the skull was to release the evil spirits that were supposedly causing the problem.
- later societies also explained abnormal behavior by pointing to possession by demons; Egyptian, Chinese, and Hebrew writings all account for psychological deviance this way, and the bible describes how an evil spirit from the lord affected King Saul and how david feigned madness to convince his enemies that he was visited by divine forces.
- the treatment for abnormality in these early societies was often exorcism. The idea was to coax the evil spirits to leave or to make the persons body an uncomfortable place in which to live.
- a shaman or priest, might recite prayers, plead with the evil spirits, insult the spirits, perform magic, make loud noises, or have the person drink bitter potions. If these techniques failed, the shaman performed a more extreme form of exorcism, such as whipping or starving the person.

- in the years from roughly 500 BCE to 500 CE, when the Greek and roman civilizations thrived, philosophers and physicians often offered different explanations and treatments for abnormal behaviors.
- Hippocrates (460-377 BCE), often called the father of modern medicine, taught that illnesses had natural causes. He saw abnormal behavior as a disease arising from internal physical problems. He believed that some form of brain pathology was the culprit and that it resulted like all other forms of diseases in his view from an imbalance of four fluids, or humors, that flowed through the body: yellow bile, black bile, blood, and phlegm.
- EX: an excess of yellow bile caused mania, a state of frenzied activity; Causes a husband to beat his wife. An excess of black bile was the source of melancholia, a condition marked by unshakeable sadness, leaves a man melancholic and sends him to bed.
- to treat psychological dysfunction, Hippocrates sought to correct the underlying physical pathology. He believed that the excess of black bile underlying melancholia could be reduced by a quiet life, a diet of vegetables, temperance, exercise, celibacy, and even bleeding. Hippocrates focus on internal causes for abnormal behavior was shared by the Greek philosopher Plato (427-347 BCE) and Aristotle (384-322 BCE) and by influential Greek and roman physicians.

- the enlightened views of Greek and roman physicians and scholars were not enough to shake ordinary peoples belief in demons. and with the decline of Rome, demonological views and practices became popular once again. A growing distrust of science spread throughout Europe.
- from 500 to 1350 CE, the period known as the middle ages, the power of the clergy increased greatly throughout Europe. In those days, the church rejected scientific forms of investigation, and it controlled all education. Religious belief, which were highly superstitious and demonological, came to dominate all aspects of life. Deviant behavior, particularly psychological abnormality, was seen as evidence of satans influence.
- the middle ages were a time of great stress and anxiety of war, urban uprisings, and plagues. People blamed the devil for these troubled and feared being possessed by him. Abnormal behavior apparently increased greatly during this period. In addition, there were outbreaks of mass madness, in which large numbers of people apparently shared delusions (absurd false beliefs) and hallucinations (imagined sights or sounds). In one such disorder, tarantism (also known as saint vitus dance) groups of people would suddenly start to jump, dance, and go into convulsions. All were convinced that they had been bitten and possessed by a wolf spider, now called a tarantula, and they sought to cure their disorder by performing a dance called a tarantella. in another form of mass madness, lycanthropy, people thought they were possessed by wolves or other animals. They acted woflike and imagined that fur was growing all over their bodies.
- Not surprisingly, some of the earlier demonological treatments for psychological abnormality reemerged during the middle ages. Once again the key to the cure was to rid the persons body of the devil that possessed it. Exorcisms were revived, and clergymen, who generally were in charge of treatment during this period, would plead, chant, or pray to the devil or evil spirit if these techniques did not work, they had others to try, some amounting to torture.
- It was not until the middle ages drew to a close that demonology and its methods began to lose favor. Towns throughout Europe grew into cities, and government officials gained more power and took over nonreligious activities. among their other responsibilities, they began to run hospitals and direct the care of people suffering from mental disorders. Medical views of abnormality gained favor once again, and many people with psychological disturbances received treatment in medical hospitals, such as the trinity hospital in England.

- during the early part of the renaissance, a period of flourishing cultural and scientific activity from about 1400 to 1700, demonological views of abnormality continued to decline.
- German physician Johann Weyer (1515-1588) the first physician to specialize in mental illness, believed that the mind was as susceptible to sickness as the body was. He is now considered the founder of the modern study of psychopathology.
- The care of people with mental disorders continued to improve in this atmosphere. In England, such individuals might be kept at home while their familied were aided financially by the local parish. Across Europe, religious shrined were devoted to the humane and loving treatment of people with mental disorders.
- Perhaps the best known of the shrines was at Gheel in Belgium. Beginning in the fifteenth century, people came to gheel from all over the world for psychic healing. Local residents welcomed these pilgrims into their homes, and many stayed on to form the worlds first colony of mental patients. Gheel was the forerunner of todays community mental healthy programs, and it continues to demonstrates that people with psychological disorders can respond to loving care and respect treatment. Many patients still live in foster homes there, interacting with other residents, until they recover.
- unfortunately, these improvements in care began to fade by the mid sixteenth century. Government officials discovered that private homes and community residences could house only a small percentage of those with severe mental disorders and that medical hospitals were too few and too small. More and more, they converted hospitals and monasteries into asylums, institutions whose primary purpose was to care for people with mental illness. These institutions were begun with the intention that they would provide good care. Once the asylums started to overflow, they became virtual prisons where patients were held in filthy conditions and treated with unspeakable cruelty.
- in 1547, for example, Bethlehem hospital was given to the city of London by henry VIII for the sole purpose of confining the mentally ill. In this asylum, patients bound in chains cried out for all to hear. The hospital even became a popular tourist attraction; people were eager to pay to look at the howling and gibbering inmates. The hospitals name, pronounced "bedlam" by the local people, has come to mean a chaotic uproar.

- as 1800 approached, the treatment of people with mental disorders began to improve once again. historians usually point to la bicetre, an asylum in Paris for male patients, as the first site for asylum reform. In 1793, during the french revolution, philippe pinel (1745-1826) was named the chief physician there. He argued that the patients were sick people whose illnesses should be treated with sympathy and kindness rather than chains and beatings. He allowed them to move freely about the hospital grounds; replaced the dark dungeons with sunny, well ventilated rooms; and offered support and advice. Pinells approached proved remarkably successful. Many patients who had been shut away for decades improved greatly over a short period of time and were released. Pinel later brought similar reforms to a mental hospital in paris for female patients, la salpetriere.
- meanwhile, an english quaker named william turke (1732-1819) was bringing similar reforms to northern england. In 1796 he founded the york retreat, a rural estate where about 30 mental patients lived as guests in quiet country houses and were treated with a combination of rest, talk, prayer, and manual work.

- the methods of pinel and tuke, called moral treatment because they emphasized moral guidance and humane and respectful techniques, caught on throughout Europe and the united states. patients with psychological problems were increasingly perceived as potentially productive human beings who deserve individual care, including discussions of their problems, useful activities, work, companionship, and quiet.
- the person most responsible for the early spread of moral treatment in the united states was Benjamin rush (1745-1813), an eminent physician at Pennsylvania hospital who is now considered the father of American psychiatry. limiting his practice to mental illness, rush developed humane approaches to treatment. for example, he required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading, and talking to them and taking them on regular walks. He also suggested that it would be therapeutic for doctors to give small gifts to their patients now and then.
- rush's work was influential, but it was a Boston schoolteacher named dorothea dix (1802-1887) who made humane care a public and political concern in the united states. From 1841 to 1881, dix went from state legislature to state legislature and to congress, speaking of the horrors she had observed at asylums and calling for reform. Dix's campaign led to new laws and greater government funding to improve the treatment of people with mental disorders. Each state was made responsible for developing effective public mental hospitals, or state hospitals, all of which were intended to offer moral treatment. Similar hospitals were established throughout Europe.

- the somatogenic perspective has at least a 2,400 year history, remember Hippocrates view that abnormal behavior resulted from brain disease and an imbalance of humors? Not until the late nineteenth century did this perspective make a triumphant return and begin to gain wide acceptance.
- two factors were responsible for this rebirth. One was the work of a distinguished German researcher, Emil Kraepelin (1856-1926). In 1883, Kraepelin published an influential textbook arguing that physical factors, such as fatigue, are responsible for mental dysfunction. In addition, he developed the first modern system for classifying abnormal behavior, listing their physical causes and discussing their expected course.
- new biological discoveries also triggered the rise of the somatogenic perspective. One of the most important discoveries was that an organic disease, syphilis, led to general paresis, an irreversible disorder with both mental symptoms such as delusions of grandeur and physical ones like paralysis.
- In 1897, the german neurologist richard von krafft-ebing (1840-1902) injected matter from syphilis sores into patients suffering from general paresis and found that none of the patients developed symptoms of sypilis. Their immunity could have been caused only by an earlier case of syphilis. Since all of his patients with general paresis were now immune to syphilis, krafft-ebing theorized that syphilis had been the cause of their general paresis. The work of Kraepelin and the new understanding of general paresis led many researchers and practitioners to suspect that physical factors were responsible for many mental disorders, perhaps all of them.
- despite the general optimism, biological approaches yielded mostly disappointing results throughout the first half of the twentieth century. Although many medical treatments were developed for patients in mental hospitals during that time, most of the techniques failed to work. Physicians tried tooth extraction, tonsillectomy, hydrotherapy (alternating hot and cold baths), and lobotomy, a surgical cutting of certain nerve fibers in the brain. Even worse, biological views and claims led, in some circles, to proposals for immoral solutions such as eugenic steralization, the elimination (through medical or other means) of individuals ability to reproduce. Not until the 1950s, when a number of effective medications were finally discovered, did the somatogenic perspective truly begin to pay off patients.

- the late 1800s also saw the emergence of the psychogenic perspective, the view that the chief causes of abnormal functioning are often psychological. This view had a long history, but it did not gain much of a following until studies of hypnotism demonstrated its potential.
- hypnotism is a procedure in which a person is placed in a trancelike mental state during which they become extremely suggestible. It was used to help treat psychological disorders as far back as 1778, when an austrian physician named friedrich anton mesmer (1734-1815) established a clinic in paris.
- His patients suffered from hysterical disorders, mysterious bodily ailments that had no apparent physical basis. Mesmer had his patients sit in a darkened room filled with music; then he appeared dressed in a colorful costume, and touched the troubled area of each patients body with a special rod. A surprising number of patients seemed to be helped by this treatment called mesmerism. Their pain, numbness, or paralysis disappeared. Several scientists believed that mesmer was inducing a trancelike state in his patients and that this state was causing their symptoms to disappear. The treatment was so controversial, that eventually mesmer was banished from paris.
- it was not until yeras after mesmer died that many researchers had the courage to investigate his procedure, later called hypnotism (from hypnos, the greek word for sleep), and its effects on hysterical disorders.
- the experiments of two physicans practicing in the city of nancy in france, hippolyte-marie bernheim (1840-1919) and ambroise-auguste liebault (1823-1904), showed that hysterical disorders could actually be induced in otherwise normal people while they were under the influence of hypnosis. That is, the physicians could make normal people experience deafness, paralysis, blindness, or numbness by means of hypnotic suggestion and they could remove these artificial symptoms by the same means. thus they established that a mental process hypnotic suggestion could both cause and cure even a physical dysfunction. leading scientists concluded that hysterical disorders were largely psychological in origin, and the psychogenic perspective rose in popularity.
- among those who studied the effects of hypnotism on hysterical disorders was josef breuer (1842-1925) of vienna. Breuer, a physician, discovered that his patients sometimes awoke free of hysterical symptoms after speaking candidly under hypnosis about past upsetting events. During the 1890s, breuer was joined in his work by another viennese physician, sigmund freud (1856-1939). Freud's work eventually led him to develop the theory of psychoanalysis, which holds that many forms of abnormal and normal psychological functioning are psychogenic. In particular, freud believed that unconscious psychological processes are at the root of such functioning.
- Freud also developed the technique of psychoanalysis, a form of discussion in which clinicians helped troubled people gain insight into their unconscious psychological processes. He believed that such insight, even without hypnotic procedures, would help the patients overcome their psychological problems. Freud and his followers offered psychoanalytic treatment to patients in their offices for sessions of approximately an hour - a format of treatment now known as outpatient therapy. By the early twentieth century, psychoanalytic theory and treatment were widely accepted throughout the western world.

- in the 1950s, researchers discovered a number of new psychotropic medications, drugs that primarily affect the brain and reduce many symptoms of mental dysfunction. They included the first antipsychotic drugs, which correct extremely confused and distorted thinking; antidepressants drugs which lift the mood of depressed people; and antianxiety drugs which reduce tension and worry.
- when given these drugs, many patients who had spent years in mental hospitals began to show signs of improvement. Hospital administrators, encouraged by these results are pressured by a growing public outcry over the terrible conditions in public mental hospitals, began to discharge patients almost immediately.
- since the discovery of these medications, mental health professionals in most of the developed nations of the world have followed a policy of deinstitutionalization, releasing hundreds of thousands of patients from public mental hospitals. On any given day in 1955, close to 600,000 people were confined in public mental institutions across the united stated. Today, the daily patient population in the same kinds of hospitals is between 38,000 and 75,000. In addition, thousands of people receive treatment in private psychiatric hospitals, care that is paid for by the patients themselves and/or their insurance companies. On average, the private facilities offer more pleasant surroundings and more favorable staff patient ratios than the public ones.
- the number of patients now hospitalized in public mental health hospitals in the US is a small fraction of the number hospitalized in 1955.
- without question, outpatient care has now become the primary mode of treatment for people with severe psychological disturbances as well as for those with more moderate problems. When severely disturbed people do need institutionalization these days, they are usually hospitalized for a short period of time. Ideally, they are then provided with outpatient psychotherapy and medication in community programs and residences.
- A philosophy called the community mental health approach has been helpful for many patients, but too few community programs are available to address current needs in the US. As a result, hundreds of thousands of persons with severe disturbances fail to make lasting recoveries, and they shuttle back and fourth between the mental hospital and the community. After release from the hospital, they at best receive minimal care and often wind up living in decrepit rooming houses or on the streets. Around 140,000 people with such disturbances are homeless on any given day; another 440,000 are inmates of jails and prisons. Their abandonment is truly a national disgrace.

- the treatment picture for people with moderate psychological disturbances has been more positive than that for people with severe disorders. Since the 1950s, outpatient care has continued to be the preferred mode of treatment for them, and the number and types of facilities that offer such care have expanded to meet the need.
- before the 1950s, almost all outpatient care took the form of private psychotherapy, in which individuals meet with a self employed therapist for counseling services.
- since the 1950s, most health insurance plans have expanded coverage to include private psychotherapy, is that it is now more widely available to people of all incomes.
- today, outpatient therapy is also offered in a number of less expensive settings, such as community mental health centers, crisis intervention centers, family service centers, and other social service agencies. Surveys suggest that around 43 percent of people with psychological disorders in the US receive treatment in the course of a year.
- outpatient treatments are also becoming available for more and more kinds of problems. When freud and his colleagues first began to practice, most of their patients suffered from anxiety or depression. almost half of todays clients suffer from those same problems, but people with other kinds of disorders are also recieving therapy. In addition, at least 20 percent of clients enter therapy because of milder problems in living, problems with marital, family, job, peer, school, or community relationships.
- yet another change in outpatient care since the 1950s has been the development of programs devoted exclusively to specific psychological problems. We now have such as suicide prevention centers, substance abuse programs, eating disorder programs, phobia clinics, and sexual dysfunction programs. Clinicians in these programs have the kind of expertise that can be acquired only by concentration in a single area.

- we are a society of multiple cultures, races, and languages. Members of racial and ethnic minority groups in the US collectively make up 40 percent of the population, a percentage that is expected to grow to 52 percent by the year 2055. This change is due in part to shifts in age structure, birth rates, and immigration.
- For example, only 42 percent of adult non Hispanic white women in the US today are of childbearing age, while 62 percent of adult minority group women fall into this age range. Moreover, on average, non Hispanic white women in the US give birth to fewer than two children during their lifetime, while minority group women give birth to more than two children.
- in response to this growing diversity, an area of study called multicultural psychology has emerged. multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically. The field of multicultural psychology has begun to have a powerful effect on our understanding and treatment of abnormal behavior.

- according to the US census bureau, 67 percent of Americans have private health insurance, purchased directly or through an employer, while the remained are either uninsured (9% of Americans) or enrolled in a public supplemented insurance program such as Medicare, Medicaid, children's health insurance program (CHIP), or military insurance. So many people now seek mental health services that most private and public insurance programs have changed their coverage for these patients in the recent decades. The dominant form of insurance now consists of managed care programs, programs in which the insurance company determines such key issues as which therapists its clients may choose, the cost of sessions, and the number of sessions for which a client may be reimbursed.
- managed care coverage for mental health treatment follows the same basic principles as coverage for medical treatment, including a limited pool of practitioners from which patients can choose, preapproval of treatment by the insurance company, strict standards for judging whether problems and treatments qualify for reimbursement, and ongoing reviews. In the mental health realm, both therapists and clients typically dislike managed care programs. They fear that the programs inevitably shorten therapy (often for the worse), unfairly favor treatments whose results are not always lasting (drug therapy), pose a special hardship for those with severe mental disorders, and result in treatments determined by insurance companies rather than by therapists.
- a key problem with insurance coverage, both managed care and other kinds of insurance programs, is that reimbursements for mental disorders tend to be lower than those for physical disorders. This places persons with psychological difficulties at a distinct disadvantage. Thus, in 2008, the US congress passed a federal parity law that directed insurance companies to provide equal coverage for mental and physical problems, and in 2014 the mental health provisions of the affordable care act (the ACA) referred to colloquially as "obama care" went into effect and extended the reach of the earlier parity law. Moreover, the ACA designated mental health care as 1 of 10 types of essential health benefits that must be provided by all insurers.
- the parity laws have brought about some important improvements in mental health insurance coverage. For example, insurance programs can no longer charge their members high deductibles for mental health services than for physical health services. Nor can the programs set annual or lifetime limits on the mental health costs they will help pay for.
- despite the parity laws, many insurance companies still manage to shortchange the mental health claims on their members. In 2019, a federal court rules that united health, one of the nations largest health insurers, discriminates against its members with mental health needs by covering only enough mental health treatment to stabilize the patients, while ignoring coverage for the effective treatment of the members underlying conditions. Insurance coverage for physical problems does not typically make such a distinction.
- similarly, a report by the health care cost institute 2019, revealed that over the past 5 years, out of pocket patient expenses for inpatient mental health care (psychiatric hospitalizations and specialized nursing facilities) have actually grown 13 times faster than out of pocket patient expenses for all other kinds of inpatient health care.
- thus, although parity laws have made a difference in certain aspects of mental health coverage, such coverage remains far from equal to that for physical problems. moreover, it is worth noting that many mental health advocates worry that current efforts in congress and various state legislatures to change or repeal the ACA may if successful, negatively affect mental health parity, as well as other aspects of mental health insurance coverage.

- one of the most important developments in the clinical field has been the growth of numerous theoretical perspectives that now coexist in the field. Before the 1950s, the psychoanalytic perspective, with its emphasis on unconscious psychological problems as the cause of abnormal behavior, was dominant. Since then, additional influential perspectives have emerged, particularly the biological, cognitive behavioral, humanistic existential, sociocultural, and developmental psychopathology schools of thought. At present, no single viewpoint dominates the clinical field as the psychoanalytic perspective once did. In fact, the perspective often conflict and compete with one another.
- in addition, a variety of professionals now offer help to people with psychological problems. before the 1950s, psychotherapy was offered only by psychiatrists, physicians who complete three to four years additional training after medical school (residency) in the treatment of abnormal mental functioning. After world war II, with millions of soldiers returning home to countries throughout north America and Europe, the demand for mental health services expanded so rapidly that other professional groups had to step in to fill the need.
- among those other groups are clinical psychologists, professionals who earn a doctorate in clinical psychology by completing four to five years of graduate training in abnormal functioning and its treatment as well as a one year internship in a mental health setting. Psychotherapy and related services are also provided by counseling psychologists, educational and school psychologists, mental health counselors, psychiatric nurses, marriage therapists, family therapists, and the largest group, clinical social workers. Each of these specialties has its own graduate training program. Theoretically, each conducts therapy in a distinctive way, but in reality clinicians from the various specialties often use similar techniques.
- a related development in the study and treatment of mental disorders since World War II has been the growth of effective research. Clinical researchers have worked to determine which concepts best explain and predict abnormal behavior, which treatments are most effective, and what kinds of changes may be required. Well trained clinical researchers conduct studies in universities, medical schools, laboratories, mental hospitals, mental health centers, and other clinical settings throughout the world. Their work has produced important discoveries and has changed many of our ideas about abnormal psychological functioning.

- the breathtaking rate of technological change that characterizes todays world has begun to have significant effects both positive and negative on the mental health field, and it will undoubtedly affect the field in the coming years.
- Our digital world provides new triggers for abnormal behavior. for example, many individuals who grapple with gambling disorder have found the ready availability of Internet gambling to be all too inviting. Similarly, social media, the Internet, and texting have become convenient tools for those who wish to stalk or bully others, express sexual exhibitionism, or pursue pedophilic desires. Likewise, some clinicians believe that violent video games may contribute to the development of antisocial behavior. And, in the opinion of many clinicians, constant texting, social media posting, tweeting, and Internet browsing may become an addictive behavior or may help lead to shorter attention spans.
- A number of clinicians also worry that social networking can contribute to psychological dysfunction in certain cases. On the positive side, research indicates that, on average, social media users are particularly likely to maintain close relationships, receive social support, be trusting, and lead active lives. But, on the negative side, there is research suggesting that social networking sites may increase peer pressure and social anxiety in some adolescents. The sites may, for example, cause some people to develop fears that others in their network will exclude them socially. Similarly, such sites may facilitate shy or socially anxious people's withdrawal from valuable face-to-face relationships.
- In addition, our digital world has greatly expanded the amount of mental health information available to the public. Indeed, countless websites offer such information. When accurate, material of this kind can be very useful to people in search of mental health answers, help, and guidance. Unfortunately, however, along with this wealth of online information comes an enormous amount of misinformation about psychological problems and their treatments, offered by persons and sites that are far from knowledgeable.
- The face of clinical treatment is also changing in our fast-moving digital world. For example, computerized intervention programs and Internet-based support groups are now widely available. Moreover, there are hundreds of smartphone apps devoted to relaxing people, cheering them up, giving them feel-good advice, helping them track their shifting moods and thoughts, or otherwise improving their psychological states. Increasingly, therapists are even including wearable technologies in their treatment (for example, "smart" watches/bands and "smart" glasses) to help monitor key psychophysiological processes that unfold throughout individuals' lives, such as sleep quality, physical activity, respiration, and heart rate.
- Finally, telemental health, the use of remote technologies (such as long-distance videoconferencing) to provide real-time therapy sessions without the therapist being physically present, is growing by leaps and bounds. Enthusiasm for telemental health services had been gaining momentum among clinicians and clients for over a decade, but it was the COVID-19 pandemic and related social distancing that truly propelled such services into the clinical mainstream. Prior to the pandemic, certain barriers were preventing telemental health from being practiced on a large scale. For example, a number of insurance providers were refusing to reimburse this form of treatment, rendering it unaffordable for many individuals. Moreover, in the years prior to the pandemic many clinicians were reluctant to offer telemental health, fearing that technology-related confidentiality breaches, such as hacking incidents, could result in significant personal or professional penalties.
- When the United States took steps to reduce the spread of COVID-19 in March 2020 by shutting down business activities and issuing stay-at-home orders, traditional office-based mental health care became abruptly out-of-reach for most individuals. To counter this negative impact and ensure continuity of care for persons with mental health problems, federal and state policymakers acted to remove the previous barriers to telemental health care. They immediately mandated that all insurance plans provide coverage for telemental health services. In addition, they waived all penalties against clinicians for unintended confidentiality violations that might arise from the use of remote communication technologies. These policy changes empowered therapists to practice telemental health without concern for personal or professional consequences.
- Within weeks of these mandates, the vast majority of mental health services in the United States were being conducted online. As the advantages of online mental health services unfolded over the ensuing months — greater affordability, accessibility, convenience, and outreach — it became clear that telemental health would, to one degree or another, remain a permanent part of the clinical field, extending well beyond the COVID-19 pandemic.

- by examining the responses of past societies to abnormal behavior, we can better understand the roots of our present views and treatments and the impressive progress that the clinical field has made. At the same time, we must recognize the impressive progress that the clinical field has made. Without question, our current understanding of abnormal behavior represents a work in progress. The clinical field's most important insights, investigations, and changes are yet to come.
- How, then, should you proceed in your study of abnormal psychology? To begin with, you need to learn about the basic tools and perspectives used by today's scientists and practitioners. This is the task we turn to in the next several chapters. Later chapters will then help you to appreciate in depth the major categories of psychological abnormality as well as the leading explanations and treatments for each of them. In the final chapter, you will see how the science of abnormal psychology and its professionals interact with legal, social, and other institutions in our world.

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