Rationality of Psychological Disorders--论文代写范文精选

在这本书的前三章,心理障碍的合理性,三大精神病理学的理论运动，在行为障碍的治疗遇到越来越多的困难。许多研究问题的存在压迫精神分析理论的基石。下面的report代写范文进行详述。

Abstract
This article presents a concise formulation of Psychobizarreness Theory (PBT) of neuroses, published by Rofé (2000) in his book The Rationality of Psychological Disorders. PBT distinguishes between bizarre behaviors, consisting of neuroses and psychoses, and non-bizarre behavioral deviations, such as simple phobia. Patients consciously and rationally select neurotic symptoms when confronted with unbearable levels of stress. The symptoms enable patients to block/repress stress-related thoughts from attention and enhance their control over their social environment. Patients become unaware of their deliberate involvement due to sophisticated self-deceptive mechanisms. This theory also integrates the various forms of therapy into one theoretical framework.

Introduction
In the first three chapters of his book, The Rationality of Psychological Disorders: Psychobizarreness Theory (PBT), Rofé (2000) demonstrates that the three major theoretical movements in psychopathology (i.e., psychoanalysis, behavioral-cognitive theories and biological models) encounter increasing difficulties in accounting for the development and treatment of behavioral disorders. Many studies question the existence of repression the cornerstone of the psychoanalytic theory and recommend that this concept be abandoned (Rofé 2000, Chapter 1). Other studies demonstrate that behavioral concepts do not adequately explain the development of behavioral disorders (Rofé 2000, Chapter 2). For example, anxiety disorders, such as agoraphobia and panic disorders, and often, simple phobia (e.g., spider phobia) develop in the absence of conditioning events. Similarly, cognitivists assumption that behavioral deviations are caused by catastrophic thoughts lacks empirical support, as extreme levels of anxiety are often experienced in the absence of catastrophic thoughts. Additionally, when behavioral deviations are accompanied by these thoughts, it does not necessarily reflect a causal relationship. In the same way, while the validity of biological theories for psychoses is not yet conclusive, most of the evidence indicates that neuroses are not biologically determined. Moreover, like cognitivists, biological investigators present mainly correlational data.  Not only is most evidence relating to neuroses inconsistent with biological theories, but even with regard to psychoses the etiology is still an open question (Rofé 2000, Chapter 3).

In addition, traditional theories lack adequate concepts to integrate certain basic observations within their theoretical frameworks. For example, these theories have difficulty in accounting for sex differences, such as the fact that nearly all neurotic disorders (e.g., conversion disorder, dissociative disorders, eating disorders, agoraphobia and panic disorder) are far more prevalent among women. Similarly, they do not address age differences (e.g., the low prevalence of neuroses among children and their tendency to develop only certain neurotic disorders, such as school phobia and conversion disorder), socio-culture variability (e.g., differences in the prevalence of neuroses between western and non-western countries and among social classes within the same country) and diagnostic fluctuations in the prevalence of certain disorders. These fluctuations include the dramatic increase in eating and multiple personality disorders and the inflation in the number of personalities displayed by MPD patients, currently ranging between 2-60 (average 13.3) personalities (Putnam et al., 1986), as against the decline in conversion disorders, particularly in its classic forms (see Rofé 2000, Chapter 5).

Another fundamental problem common to all traditional theories concerns their inability to integrate the therapeutic efficacy of various methods. Power and Brewin (1997) expressed these problems as follows:Some therapists simply bury their heads in the sand and continue their favorite techniques.  Others, like ourselves, are puzzled and are asking if there are common mechanisms that apply across different therapies that might explain both their effectiveness and their (sometimes) lack of effectiveness (p. xi)?

Nevertheless, these theories have maintained significant scientific credibility, mainly because of the theoretical necessity for certain concepts and partial empirical support for some of their theoretical ideas and therapeutic techniques. For example, it is simply impossible to abandon the concept of repression, despite evidence that questions its validity, as no alternative concept can adequately account for patients unawareness regarding the underlying causes for sudden and bizarre behavioral changes (e.g., compulsive counting rituals and chocolate phobia; Neale et al. 1982 and Rachmann & Seligman 1976, respectively). Similarly, behavioral-cognitive therapeutic methods are the most effective therapeutic interventions for anxiety disorders (see Rofé 2000, Chapter 7). This alone justifies the maintenance of these theories despite their chronic empirical difficulties in accounting for the development of these disorders (see Rofé 2000, Chapter 2). The same rule applies to biological models, as no genuine theory of psychopathology can ignore the significant involvement of genetic and biological factors in the development of behavioral disorders and the efficacy of drug treatment.

In an attempt to resolve the aforementioned theoretical difficulties and to synthesize the important conceptual and empirical contributions of traditional theories into one theoretical paradigm, a new theory of psychopathology, termed PBT was proposed (see Rofé 2000, Chapters 4-10). Although PBT addresses neuroses, psychoses and simple phobia, this article will present the basic concepts of PBT and will focus on the development and treatment of neuroses.

The concept of bizarreness
A prerequisite for understanding neuroses is an operational definition of their abnormal component, so that these disorders can be distinguished from other behavioral deviations. Indeed, the lack of an operational definition for unconscious/repressed anxiety by which this concept was originally defined (e.g., Bayer & Spitzer 1985) led the authors of DSM-III (American Psychiatric Association 1980) to disperse its sub-classes among new diagnostic categories. Eventually, DSM-IV (American Psychiatric Association 1994) altogether excluded it as a diagnostic class. However, while it is undoubtedly correct that the classification of behavioral disorders should be made on a descriptive level, abandoning the concept of neuroses was too drastic a measure and could further complicate our understanding of behavioral deviations. It does not seem reasonable that senseless and disruptive behavioral disorders such as agoraphobia, panic disorder and OCD, should be classified together with simple phobia (e.g., spider phobia), in the category of anxiety disorders, as suggested by DSM. The former disorders have much more in common with other neurotic disorders, such as conversion disorder, dissociative disorders and eating disorders, despite their superficial similarity of anxiety with the latter type of deviations. This common characteristic can be defined in descriptive terms, thus justifying the reinstatement of neuroses as an independent diagnostic category. The fundamental descriptive characteristic of neurotic disorders is what laypeople would call craziness and PBT terms bizarre. Bizarreness is defined by the following five operational criteria:
1. Impact on attention and Functioning: Bizarre behaviors daily preoccupy individuals attention and severely disrupt their functioning, regardless of the presence or absence of certain stimuli, and constitute a burden on the family and society.
2. Mode of onset: Usually the onset of bizarre behaviors is sudden, whereby the individual displays a dramatic disruptive behavioral change in the absence of a contingent event that is exclusively associated with and can account for the behavior. Even in cases where the onset is gradual, the patient demonstrates a progressive deterioration to the point of severe disruption, resembling sudden onset. Here, too, there is no unique observable event that coincides with or can account for the dramatic behavioral change.
3. Rarity: The prevalence of bizarre behaviors is low, usually below 2-3%.
4. State of unawareness: The individual is unaware of the underlying causes of the behavioral change and sometimes has no knowledge that this behavior is deviant even when questioned immediately after onset.
5. Social judgment: People stigmatize the deviant behavior as a reflection of a mental or physical illness.

As a rule, a behavior is diagnosed as bizarre if it meets all the above five criteria, and non-bizarre (e.g., simple phobia, depression and PTSD) if it fulfils fewer, usually no more than two, criteria (see Rofé 2000, Table 1, p. 104). Bizarre neurotic behaviors (e.g., see four case studies by Rofé 2000, pp. 107-115) may be manifested in all spheres of psychological functions, such as motor (e.g., conversion disorder), emotional (e.g., agoraphobia and panic disorder), eating (e.g., anorexia nervosa), memory (e.g., dissociative fugue) or thought (e.g., obsessive ruminations) responses or combinations of these behaviors. However, neurotic patients do not suffer from thought disorders, expressed by hallucinations, delusions and illogical verbalizations (e.g., disorganized speech), which are exclusive to psychoses. Although neurotics, and even normal individuals may sometimes display thought disturbances (e.g., visual hallucinations; Andreasen 1979; Tien 1991), they do not fulfill PBTs five criteria for bizarreness.
Given the severe impact of bizarre behaviors on daily functioning, their sudden onset and patients state of unawareness, the traditional axiomatic belief that neuroses are the consequence of irrational mechanisms (e.g., the unconscious, conditioning or adverse neuro-chemical changes) was the most plausible assumption. However, in light of the increasing theoretical and empirical difficulties challenging the validity of traditional theories, PBT suggests that this assumption be abandoned. Instead, bizarre behaviors are viewed as pathological coping mechanisms, which are consciously and rationally chosen to enhance the individuals coping abilities. This is achieved through two basic aspects of bizarre behaviors: 1) High attentional demands (criterion no. 1), which eliminate/repress stress related thoughts from attention; and 2) The social stigma of sickness (criterion no. 5), which allows patients to avoid/escape stress and manipulate the environment to increase social rewards. Yet patients are unaware of their self-involvement in adopting and maintaining the symptom through sophisticated self-deceptive processes. Thus patients state of unawareness does not reflect irrationality, as claimed by mechanistic theories, but is rather an expression of the individuals creative ability.

Discussion:
Although PBTs conscious, rational approach to psychopathology radically differs from traditional mechanistic theories, it synthesizes some basic concepts of these models, modifying them in accordance with research and clinical data. Thus, like psychoanalysis, PBT emphasizes the crucial importance of repression and unawareness in understanding neuroses. However, based on Holmess (1974; 1990) experimental findings and in accordance with Freuds essence of repression (e.g., Erdelyi 1993; Erdelyi & Goldberg 1979), PBT defines repression as a conscious distraction. A more basic distinction is PBTs claim that repression is the consequence rather than the cause of behavioral disorders. Similarly, unawareness is viewed as a rational maneuver that plays no etiological role in the development of neuroses. Hence, PBTs concept of repression excludes the Freudian component of memory and denies the existence of the unconscious. The modified concept is therefore not vulnerable to the criticism, generated by the increasing evidence showing that people remember rather than forget traumatic incidents (e.g., Pope et al., 1999), or that there is no evidence for the existence of an omnipotent autonomous entity functioning outside the conscious (e.g., Greenwald 1992; Gross 1978).
The new theory also acknowledges cognitivists claims that the individuals belief system plays a vital role in the development and treatment of neuroses (e.g., Clark1986; 1988). However, PBT accounts for this effect in conscious, rational, rather than mechanistic terms. Likewise, biological factors may contribute to the development of neuroses either by aggravating the negative impact of stress or motivating patient to utilize their available biological weaknesses when these are suitable to their pathological needs.(report代写)

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