Module 01 · Introduction to Abnormal Psychology

Module 1: What is Abnormal Psychology?模块 1：异常心理学概述

3rd edition as of July 2023
截至 2023 年 7 月的第三版

Module Overview 模块概述

Cassie is an 18-year-old female from suburban Seattle, WA. She was a successful student in high school, graduating valedictorian and obtaining a National Merit Scholarship for her performance on the PSAT during her junior year. She was accepted to a university on the opposite side of the state, where she received additional scholarships giving her a free ride for her entire undergraduate education. Excited to start this new chapter in her life, Cassie’s parents begin the 5-hour commute to Pullman, where they will leave their only daughter for the first time in her life.
凯西是华盛顿州西雅图郊区的 18 岁女孩。她在高中时是一名成功的学生，以优秀成绩毕业并获得国家优秀奖学金，这是她在高二时在 PSAT 考试中取得的。她被州另一边的大学录取，在那里她获得了额外的奖学金，使她能够免费完成整个本科教育。对于开始人生新篇章感到兴奋，凯西的父母开始了长达 5 小时的通勤，前往普尔曼，在那里他们将第一次将他们的独生女留在家中。

The semester begins as it always does in mid to late August. Cassie meets the challenge with enthusiasm and does well in her classes for the first few weeks of the semester, as expected. Sometime around Week 6, her friends notice she is despondent, detached, and falling behind in her work. After being asked about her condition, she replies that she is “just a bit homesick,” and her friends accept this answer as it is a typical response to leaving home and starting college for many students. A month later, her condition has not improved but worsened. She now regularly shirks her responsibilities around her apartment, in her classes, and on her job. Cassie does not hang out with friends like she did when she first arrived for college and stays in bed most of the day. Concerned, Cassie’s friends contact Health and Wellness for help.
学期通常在八月中旬到下旬开始。凯西以热情迎接挑战，在学期前几周的表现如预期一样良好。大约在第六周左右，她的朋友们注意到她情绪低落、疏远，并且在学习上落后。在被问及她的状况后，她回答说“只是有点想家”，她的朋友们接受了这个答案，因为这许多学生离家上大学时的典型反应。一个月后，她的状况没有改善反而恶化。现在她经常逃避在公寓、课堂上和工作中应尽的责任。凯西不像刚上大学时那样和朋友出去玩，大部分时间都躺在床上。凯西的朋友们担心地联系了健康与福祉部门寻求帮助。

Cassie’s story, though hypothetical, is true of many Freshmen leaving home for the first time to earn a higher education, whether in rural Washington state or urban areas such as Chicago and Dallas. Most students recover from this depression and go on to be functional members of their collegiate environment and accomplished scholars. Some students learn to cope on their own while others seek assistance from their university’s health and wellness center or from friends who have already been through the same ordeal. These are normal reactions. However, in cases like Cassie’s, the path to recovery is not as clear. Instead of learning how to cope, their depression increases until it reaches clinical levels and becomes an impediment to success in multiple domains of life such as home, work, school, and social circles.
凯西的故事，虽然假设，但许多第一次离家求学的大学生都经历过，无论是在华盛顿州的农村地区还是在芝加哥和达拉斯等城市地区。大多数学生都能从这种抑郁中恢复过来，成为他们大学生活中的功能性成员和有成就的学者。一些学生学会了自己应对，而另一些学生则寻求他们大学健康和福利中心或已经经历过同样困境的朋友的帮助。这些是正常的反应。然而，在凯西的情况下，康复的道路并不那么清晰。他们不是学会如何应对，而是抑郁加剧，直到达到临床水平，成为生活中多个领域的成功障碍，如家庭、工作、学校和社交圈。

In Module 1, we will explore what it means to display abnormal behavior, what mental disorders are, and the way society views mental illness today and how it has been regarded throughout history. Then we will review research methods used by psychologists in general and how they are adapted to study abnormal behavior/mental disorders. We will conclude with an overview of what mental health professionals do.
在模块 1 中，我们将探讨展示异常行为的意义，什么是精神疾病，以及社会如何看待当今的精神疾病以及它在历史上的看法。然后，我们将回顾心理学家通常使用的研究方法以及它们如何适应研究异常行为/精神疾病。最后，我们将概述精神健康专业人士的工作。

Module Outline 模块大纲

Module Learning Outcomes 模块学习成果

Explain what it means to display abnormal behavior.
解释显示异常行为的意义。
Clarify how mental health professionals classify mental disorders.
明确心理健康专业人士如何对精神疾病进行分类。
Describe the effect of stigma on those who have a mental illness.
描述污名对患有精神疾病的人的影响。
Outline the history of mental illness.
概述精神疾病的历史。
Describe the research methods used to study abnormal behavior and mental illness.
描述用于研究异常行为和精神疾病的研究方法。
Identify types of mental health professionals, societies they may join, and journals they can publish their work in.
识别心理健康专业人员的类型、他们可能加入的协会以及他们可以发表作品的期刊。

1.1. Understanding Abnormal Behavior 1.1. 理解异常行为

Section Learning Objectives 章节学习目标

Describe the disease model and its impact on the field of psychology throughout history.
描述疾病模型及其对心理学领域历史影响。
Describe positive psychology. 描述积极心理学。
Define abnormal behavior. 定义异常行为。
Explain the concept of dysfunction as it relates to mental illness.
解释心理疾病中功能障碍的概念。
Explain the concept of distress as it relates to mental illness.
解释与精神疾病相关的压力概念。
Explain the concept of deviance as it relates to mental illness.
解释与精神疾病相关的偏差概念。
Explain the concept of dangerousness as it relates to mental illness.
解释与精神疾病相关的危险性概念。
Define culture and social norms.
定义文化和社会规范。
Clarify the cost of mental illness on society.
明确精神疾病对社会的影响。
Define abnormal psychology, psychopathology, and mental disorders.
定义异常心理学、心理病理学和精神疾病。

1.1.1. Understanding Abnormal Behavior 1.1.1. 理解异常行为

To understand what abnormal behavior is, we first have to understand what normal behavior is. Normal really is in the eye of the beholder, and most psychologists have found it easier to explain what is wrong with people then what is right. How so?
要理解什么是异常行为，我们首先必须理解什么是正常行为。正常实际上完全取决于观察者，大多数心理学家发现解释人们的问题比解释他们的优点更容易。为什么会这样？

Psychology worked with the disease model for over 60 years, from about the late 1800s into the middle part of the 20th century. The focus was simple – curing mental disorders – and included such pioneers as Freud, Adler, Klein, Jung, and Erickson. These names are synonymous with the psychoanalytical school of thought. In the 1930s, behaviorism, under B.F. Skinner, presented a new view of human behavior. Simply, human behavior could be modified if the correct combination of reinforcements and punishments were used. This viewpoint espoused the dominant worldview of the time – mechanism – which presented the world as a great machine explained through the principles of physics and chemistry. In it, human beings serve as smaller machines in the larger machine of the universe.
心理学与疾病模型合作了 60 多年，从 19 世纪末到 20 世纪中叶。重点是简单的——治愈精神疾病——包括弗洛伊德、阿德勒、克莱因、荣格和埃里克森等先驱。这些名字与心理分析学派同义。20 世纪 30 年代，在 B.F.斯金纳的领导下，行为主义提出了关于人类行为的新观点。简单地说，如果使用正确的强化和惩罚的组合，人类行为可以被改变。这种观点宣扬了当时占主导地位的世界观——机械论——它将世界描绘成一个巨大的机器，通过物理和化学原理来解释。在其中，人类作为宇宙更大机器中的小机器存在。

Moving into the mid to late 1900s, we developed a more scientific investigation of mental illness, which allowed us to examine the roles of both nature and nurture and to develop drug and psychological treatments to “make miserable people less miserable.” Though this was an improvement, there were three consequences as pointed out by Martin Seligman in his 2008 TED Talk entitled, “The new era of positive psychology.” These are:
进入 20 世纪中后期，我们对精神疾病进行了更科学的调查，这使我们能够研究自然和养育的作用，并开发药物和心理治疗方法来“让痛苦的人不那么痛苦”。尽管这是一个进步，但正如马丁·塞利格曼在其 2008 年 TED 演讲《积极心理学的新时代》中所指出的，有三个后果：

“The first was moral; that psychologists and psychiatrists became victimologists, pathologizers; that our view of human nature was that if you were in trouble, bricks fell on you. And we forgot that people made choices and decisions. We forgot responsibility. That was the first cost.”
“第一个是道德上的；心理学家和精神病学家变成了受害者学家、病理学家；我们看待人性的观点是，如果你遇到麻烦，砖头就会砸到你。我们忘记了人们会做出选择和决定。我们忘记了责任。这是第一个代价。”
“The second cost was that we forgot about you people. We forgot about improving normal lives. We forgot about a mission to make relatively untroubled people happier, more fulfilled, more productive. And “genius,” “high-talent,” became a dirty word. No one works on that.”
第二次成本是我们忘记了你们这些人。我们忘记了改善普通人的生活。我们忘记了让相对无忧无虑的人更快乐、更满足、更有效率的目标。而“天才”、“高才”变成了一个脏词。没有人再从事这方面的工作。
“And the third problem about the disease model is, in our rush to do something about people in trouble, in our rush to do something about repairing damage, it never occurred to us to develop interventions to make people happier — positive interventions.”
并且关于疾病模型的第三个问题是，在我们急于帮助陷入困境的人，在我们急于修复损害的过程中，我们从未想过要开发让人们更快乐的干预措施——积极的干预措施。

Starting in the 1960s, figures such as Abraham Maslow and Carl Rogers sought to overcome the limitations of psychoanalysis and behaviorism by establishing a “third force” psychology, also known as humanistic psychology. As Maslow said,
20 世纪 60 年代开始，亚伯拉罕·马斯洛和卡尔·罗杰斯等人物试图通过建立“第三势力”心理学（也称为人本主义心理学）来克服心理分析和行为主义的局限性。正如马斯洛所说，

“The science of psychology has been far more successful on the negative than on the positive side; it has revealed to us much about man’s shortcomings, his illnesses, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his full psychological height. It is as if psychology had voluntarily restricted itself to only half its rightful jurisdiction, and that the darker, meaner half.” (Maslow, 1954, p. 354).
心理学在负面方面比在正面方面更成功；它向我们揭示了人类许多缺点、疾病和罪过，但很少涉及他的潜能、美德、可实现的目标或他的完整心理高度。这就像心理学自愿将自己限制在只有其应有管辖权的一半，以及那更黑暗、更卑鄙的一半。（马斯洛，1954，第 354 页）。

Humanistic psychology instead addressed the full range of human functioning and focused on personal fulfillment, valuing feelings over intellect, hedonism, a belief in human perfectibility, emphasis on the present, self-disclosure, self-actualization, positive regard, client centered therapy, and the hierarchy of needs. Again, these topics were in stark contrast to much of the work being done in the field of psychology up to and at this time.
人文心理学则关注人类功能的全面范围，侧重于个人实现，重视情感胜过理智，享乐主义，相信人类可以完善，强调当下，自我披露，自我实现，积极关注，以客户为中心的治疗，以及需求层次。再次，这些主题与当时心理学领域的大部分工作形成了鲜明对比。

In 1996, Martin Seligman became the president of the American Psychological Association (APA) and called for a positive psychology or one that had a more positive conception of human potential and nature. Building on Maslow and Roger’s work, he ushered in the scientific study of such topics as happiness, love, hope, optimism, life satisfaction, goal setting, leisure, and subjective well-being. Though positive and humanistic psychology have similarities, their methodology was much different. While humanistic psychology generally relied on qualitative methods, positive psychology utilizes a quantitative approach and aims to help people make the most out of life’s setbacks, relate well to others, find fulfillment in creativity, and find lasting meaning and satisfaction (https://www.positivepsychologyinstitute.com.au/what-is-positive-psychology).
1996 年，马丁·塞利格曼成为美国心理学会（APA）的主席，并呼吁积极心理学或更积极的人类潜能和自然观。在马斯洛和罗杰的工作基础上，他引领了对幸福、爱情、希望、乐观、生活满意度、目标设定、休闲和主观幸福感等主题的科学研究。尽管积极心理学和人本心理学有相似之处，但它们的方法论大不相同。人本心理学通常依赖定性方法，而积极心理学采用定量方法，旨在帮助人们充分利用生活的挫折，与他人建立良好关系，在创造力中找到满足感，以及找到持久的意义和满足感（https://www.positivepsychologyinstitute.com.au/what-is-positive-psychology）。

So, to understand what normal behavior is, do we look to positive psychology for an indication, or do we first define abnormal behavior and then reverse engineer a definition of what normal is? Our preceding discussion gave suggestions about what normal behavior is, but could the darker elements of our personality also make up what is normal to some extent? Possibly. The one truth is that no matter what behavior we display, if taken to the extreme, it can become disordered – whether trying to control others through social influence or helping people in an altruistic fashion. As such, we can consider **abnormal behavior **to be a combination of personal distress, psychological dysfunction, deviance from social norms, dangerousness to self and others, and costliness to society.
因此，要了解正常行为是什么，我们是寻求积极心理学的指示，还是首先定义异常行为，然后逆向工程出什么是正常的定义？我们之前的讨论提供了关于什么是正常行为的建议，但我们的个性中的阴暗面也可能在一定程度上构成正常。可能如此。一个真理是，无论我们表现出什么行为，如果走向极端，它都可能变得混乱——无论是试图通过社会影响控制他人，还是以利他主义的方式帮助人们。因此，我们可以将异常行为视为个人痛苦、心理功能障碍、偏离社会规范、对自己和他人的危险性以及对社会成本的综合。

1.1.2. How Do We Determine What Abnormal Behavior Is? 1.1.2. 我们如何确定什么是异常行为？

In the previous section we showed that what we might consider normal behavior is difficult to define. Equally challenging is understanding what abnormal behavior is, which may be surprising to you. A publication which you will become intimately familiar with throughout this book, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition, Text Revision (DSM-5-TR; 2022), states that, “Although no definition can capture all aspects of the range of disorders contained in DSM-5″ (pg. 13) certain aspects are required. These include:
在前一节中，我们展示了我们可能认为的正常行为难以定义。同样具有挑战性的是理解异常行为是什么，这可能会让您感到惊讶。您将在本书中深入了解的出版物，美国精神病学协会的精神疾病诊断与统计手册第 5 版，文本修订版（DSM-5-TR；2022 年），指出：“尽管没有定义能够涵盖 DSM-5 中包含的所有疾病范围的所有方面”（第 13 页），但某些方面是必需的。这些包括：

Dysfunction – Includes “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (pg. 14). Abnormal behavior, therefore, has the capacity to make well-being difficult to obtain and can be assessed by looking at an individual’s current performance and comparing it to what is expected in general or how the person has performed in the past. As such, a good employee who suddenly demonstrates poor performance may be experiencing an environmental demand leading to stress and ineffective coping mechanisms. Once the demand resolves itself, the person’s performance should return to normal according to this principle.
功能障碍——包括“个体认知、情绪调节或行为上的临床显著紊乱，反映了心理、生物或发展过程中精神功能失调”（第 14 页）。因此，异常行为有能力使获得幸福变得困难，可以通过观察个体的当前表现并将其与一般期望或个人过去的表现进行比较来评估。因此，一个突然表现出较差表现的优秀员工可能正在经历导致压力和无效应对机制的环境需求。一旦需求自行解决，根据这一原则，该人的表现应该恢复正常。
Distress – When the person experiences a disabling condition “in social, occupational, or other important activities” (pg. 14). Distress can take the form of psychological or physical pain, or both concurrently. Alone though, distress is not sufficient enough to describe behavior as abnormal. Why is that? The loss of a loved one would cause even the most “normally” functioning individual pain. An athlete who experiences a career-ending injury would display distress as well. Suffering is part of life and cannot be avoided. And some people who exhibit abnormal behavior are generally positive while doing so.
痛苦——当个人在“社会、职业或其他重要活动中”经历一种致残状态时（第 14 页）。痛苦可以表现为心理或身体上的痛苦，或者两者同时发生。然而，单独的痛苦不足以描述行为异常。为什么？失去亲人甚至会让最“正常”运作的人感到痛苦。一个经历职业生涯终结性伤害的运动员也会表现出痛苦。痛苦是生活的一部分，无法避免。而且，一些表现出异常行为的人通常在这样做时是积极的。
Deviance – Closer examination of the word abnormal indicates a move away from what is normal, or the mean (i.e., what would be considered average and in this case in relation to behavior), and so is behavior that infrequently occurs (sort of an outlier in our data). Our culture, or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group, determines what is normal. Thus, a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms. Social norms change over time due to shifts in accepted values and expectations. For instance, homosexuality was taboo in the U.S. just a few decades ago, but today, it is generally accepted. Likewise, PDAs, or public displays of affection, do not cause a second look by most people unlike the past when these outward expressions of love were restricted to the privacy of one’s own house or bedroom. In the U.S., crying is generally seen as a weakness for males. However, if the behavior occurs in the context of a tragedy such as the Vegas mass shooting on October 1, 2017, in which 58 people were killed and about 500 were wounded while attending the Route 91 Harvest Festival, then it is appropriate and understandable. Finally, consider that statistically deviant behavior is not necessarily negative. Genius is an example of behavior that is not the norm.
偏差——对“异常”一词的进一步考察表明，它是指远离正常或平均值（即通常被认为的平均值，在这种情况下与行为相关），因此，不常发生的行为（在我们的数据中有点像异常值）。我们的文化，或者说社会传承的行为、习俗、价值观、技术、态度、信仰、艺术和其他特定于某个群体的产品，决定了什么是正常。因此，当一个人未能遵循社会规定的和未明说的规则，即社会规范时，他或她被称为偏差者。社会规范因接受的价值和期望的变化而随时间变化。例如，仅仅几十年前，同性恋在美国还是禁忌，但如今，它通常被接受。同样，公众示爱（PDAs）不会引起大多数人的注意，而过去这些爱的外在表达仅限于个人的房屋或卧室的私密空间。在美国，哭泣通常被视为男性的弱点。然而，如果这种行为发生在悲剧的背景下，例如 2017 年 10 月 1 日的拉斯维加斯大规模枪击事件，在该事件中，58 人死亡，约 500 人受伤，他们在参加 91 号公路丰收节时，那么这是适当且可以理解的。最后，考虑到从统计学的角度来看，异常行为并不一定是负面的。天才就是非典型行为的例子。

Though not part of the DSM conceptualization of what abnormal behavior is, many clinicians add dangerousness to this list when behavior represents a threat to the safety of the person or others. It is important to note that having a mental disorder does not imply a person is automatically dangerous. The depressed or anxious individual is often no more a threat than someone who is not depressed, and as Hiday and Burns (2010) showed, dangerousness is more the exception than the rule. Still, mental health professionals have a duty to report to law enforcement when a mentally disordered individual expresses intent to harm another person or themselves. It is important to point out that people seen as dangerous are also not automatically mentally ill.
尽管这不是 DSM 对异常行为的定义的一部分，许多临床医生在行为代表对个人或他人安全构成威胁时，会将危险性添加到这个列表中。重要的是要注意，患有精神疾病并不意味着一个人自动具有危险性。抑郁或焦虑的个人通常并不比没有抑郁的人更具威胁性，正如 Hiday 和 Burns（2010）所展示的，危险性是例外而非规则。然而，精神健康专业人员有责任在精神疾病个体表达伤害他人或自己的意图时向执法部门报告。重要的是要指出，被视为危险的人也不一定是精神疾病患者。

1.1.3. The Costs of Mental Illness 1.1.3. 精神疾病成本

This leads us to wonder what the cost of mental illness is to society. The National Alliance on Mental Illness (NAMI) states that mental illness affects a person’s life which then ripples out to the family, community, and world. For instance, people with serious mental illness are at increased risk for diabetes, cancer, and cardiometabolic disease while 18% of those with a mental illness also have a substance use disorder. Within the family, an estimated 8.4 million Americans provide care to an adult with an emotional or mental illness with caregivers spending about 32 hours a week providing unpaid care. At the community level 21% of the homeless also have a serious mental illness while 70% of youth in the juvenile justice system have at least one mental health condition. And finally, depression is a leading cause of disability worldwide and depression and anxiety disorders cost the global economy $1 trillion each year in lost productivity (Source: NAMI, The Ripple Effect of Mental Illness infographic; https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers).
这让我们思考精神疾病对社会造成的成本。美国精神疾病联盟（NAMI）表示，精神疾病会影响一个人的生活，进而波及家庭、社区和世界。例如，患有严重精神疾病的人患糖尿病、癌症和心代谢疾病的风险增加，而 18%患有精神疾病的人还患有物质使用障碍。在家庭层面，约有 840 万美国人照顾患有情绪或精神疾病的成年人，照顾者每周大约花费 32 小时提供无偿护理。在社区层面，21%的无家可归者也患有严重的精神疾病，而 70%的青少年司法系统中的青少年至少有一种心理健康状况。最后，抑郁症是全球残疾的主要原因，抑郁症和焦虑症每年给全球经济造成 1 万亿美元的损失（来源：NAMI，《精神疾病涟漪效应》信息图；https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers）。

In terms of worldwide impact, data from 2010 estimates $2.5 trillion in global costs, with $1.7 trillion being indirect costs (i.e., invisible costs “associated with income losses due to mortality, disability, and care seeking, including lost production due to work absence or early retirement”) and the remainder being direct (i.e., visible costs to include “medication, physician visits, psychotherapy sessions, hospitalization,” etc.). It is now projected that mental illness costs will be around $16 trillion by 2030. The authors add, “It should be noted that these calculations did not include costs associated with mental disorders from outside the healthcare system, such as legal costs caused by illicit drug abuse” (Trautmann, Rehm, & Wittchen, 2016). The costs for mental illness have also been found to be greater than the combined costs of somatic diseases such as cancer, diabetes, and respiratory disorders (Whiteford et al., 2013).
在全球范围内的影响方面，2010 年的数据显示全球成本估计为 25 万亿美元，其中 17 万亿美元为间接成本（即无形成本，“与死亡、残疾和寻求护理相关的收入损失相关，包括因工作缺席或提前退休而造成的生产损失”）其余为直接成本（即包括“药物、医生就诊、心理治疗、住院”等在内的可见成本）。现在预计到 2030 年，精神疾病成本将达到约 160 万亿美元。作者补充说，“应该注意的是，这些计算没有包括来自医疗体系之外的精神疾病相关成本，例如非法药物滥用造成的法律成本”（Trautmann，Rehm，& Wittchen，2016）。精神疾病成本也被发现高于癌症、糖尿病和呼吸系统疾病等躯体疾病的总成本（Whiteford 等人，2013）。

Christensen et al. (2020) did a review of 143 cost-of-illness studies that covered 48 countries and several types of mental illness. Their results showed that mental disorders are a substantial economic burden for societies and that certain groups of mental disorders are more costly than others. At the higher cost end were developmental disorders to include autism spectrum disorders followed by schizophrenia and intellectual disabilities. They write, “However, it is important to note that while disorders such as mood, neurotic and substance use disorders were less costly according to societal cost per patient, these disorders are much more prevalent and thus would contribute substantially to the total national cost in a country.” And much like Trautmann, Rehm, & Wittchen (2016) other studies show that indirect costs are higher than direct costs (Jin & Mosweu, 2017; Chong et al., 2016).
克利斯滕森等人（2020 年）对涵盖 48 个国家和多种精神疾病类型的 143 项疾病成本研究进行了综述。他们的结果显示，精神疾病对社会来说是一项重大的经济负担，并且某些精神疾病群体比其他群体成本更高。在成本较高的端点是发育障碍，包括自闭症谱系障碍，其次是精神分裂症和智力障碍。他们写道：“然而，值得注意的是，尽管根据每名患者的社会成本，情绪、神经质和物质使用障碍的成本较低，但这些疾病的发病率更高，因此会在一个国家的总国家成本中贡献很大。” 与特拉特曼、雷姆和维特钦（2016 年）的研究类似，其他研究也表明间接成本高于直接成本（金和莫斯维乌，2017 年；钟等，2016 年）。

1.1.4. Defining Key Terms 1.1.4. 定义关键术语

Our discussion so far has concerned what normal and abnormal behavior is. We saw that the study of normal behavior falls under the providence of positive psychology. Similarly, the scientific study of abnormal behavior, with the intent to be able to predict reliably, explain, diagnose, identify the causes of, and treat maladaptive behavior, is what we refer to as abnormal psychology. Abnormal behavior can become pathological and has led to the scientific study of psychological disorders, or psychopathology. From our previous discussion we can fashion the following definition of a psychological or mental disorder: mental disorders are characterized by psychological dysfunction, which causes physical and/or psychological distress or impaired functioning, and is not an expected behavior according to societal or cultural standards.
我们迄今为止的讨论涉及了正常和异常行为是什么。我们看到了正常行为的研究属于积极心理学的范畴。同样，以能够可靠地预测、解释、诊断、识别异常行为的成因和治疗方法为目的的异常行为的科学研究，就是我们所说的异常心理学。异常行为可能变成病理性，这导致了心理障碍或心理病理学的科学研究。从我们之前的讨论中，我们可以制定以下心理或精神障碍的定义：精神障碍以心理功能障碍为特征，导致身体和/或心理痛苦或功能障碍，根据社会或文化标准，这不是预期的行为。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

Abnormal behavior is a combination of personal distress, psychological dysfunction, deviance from social norms, dangerousness to self and others, and costliness to society.
异常行为是个人痛苦、心理功能障碍、偏离社会规范、对自己和他人的危险性以及对社会成本的综合体现。
Abnormal psychology is the scientific study of abnormal behavior, with the intent to be able to predict reliably, explain, diagnose, identify the causes of, and treat maladaptive behavior.
异常心理学是研究异常行为的科学，旨在能够可靠地预测、解释、诊断、识别不良行为的成因并对其进行治疗。
The study of psychological disorders is called psychopathology.
心理疾病的研究被称为心理病理学。
Mental disorders are characterized by psychological dysfunction, which causes physical and/or psychological distress or impaired functioning, and is not an expected behavior according to societal or cultural standards
精神疾病以心理功能障碍为特征，导致身体和/或心理痛苦或功能障碍，不符合社会或文化标准所预期的行为

Section 1.1 Review Questions
第 1.1 节复习问题

What is the disease model and what problems existed with it? What was to overcome its limitations?
什么是疾病模型？它存在哪些问题？如何克服其局限性？
Can we adequately define normal behavior? What about abnormal behavior?
能否充分定义正常行为？异常行为又该如何定义？
What aspects are part of the American Psychiatric Association’s definition of abnormal behavior?
哪些方面是美國精神病學會對異常行為定義的一部分？
How costly is mental illness?
心理疾病有多昂贵？
What is abnormal psychology?
什么是变态心理学？
What is psychopathology? 什么是心理病理学？
How do we define mental disorders?
我们如何定义精神疾病？

1.2. Classifying Mental Disorders 1.2. 精神疾病分类

Section Learning Objectives 章节学习目标

Define and exemplify classification.
定义并举例说明分类。
Define nomenclature. 定义命名法。
Define epidemiology. 定义流行病学。
Define the presenting problem and clinical description.
定义所呈现的问题和临床描述。
Differentiate prevalence, incidence, and any subtypes.
区分患病率、发病率和任何亚型。
Define comorbidity. 定义共病。
Define etiology. 定义病因。
Define course. 定义课程。
Define prognosis. 定义预后。
Define treatment. 定义治疗。

1.2.1. Classification 1.2.1. 分类

Classification is not a foreign concept and as a student you have likely taken at least one biology class that discussed the taxonomic classification system of Kingdom, Phylum, Class, Order, Family, Genus, and Species revolutionized by Swedish botanist, Carl Linnaeus. You probably even learned a witty mnemonic such as ‘King Phillip, Come Out For Goodness Sake’ to keep the order straight. The Library of Congress uses classification to organize and arrange their book collections and includes such categories as B – Philosophy, Psychology, and Religion; H – Social Sciences; N – Fine Arts; Q – Science; R – Medicine; and T – Technology.
分类不是一个外国概念，作为一名学生，你可能至少上过一门讨论生物分类系统——界、门、纲、目、科、属、种的课程，这是瑞典植物学家卡尔·林奈所革命的。你可能甚至学到了一个巧妙的助记法，比如“菲利普国王，为了上帝的恩典出来吧”，以保持顺序清晰。国会图书馆使用分类来组织和安排他们的藏书，包括以下类别：B - 哲学、心理学和宗教；H - 社会科学；N - 美术；Q - 科学；R - 医学；T - 技术。

Simply, classification is how we organize or categorize things. The second author’s wife has been known to color-code her Blu Ray collection by genre, movie title, and release date. It is useful for us to do the same with abnormal behavior, and classification provides us with a nomenclature, or naming system, to structure our understanding of mental disorders in a meaningful way. Of course, we want to learn as much as we can about a given disorder so we can understand its cause, predict its future occurrence, and develop ways to treat it.
简单来说，分类就是我们对事物进行组织或分类的方式。第二作者的妻子以类型、电影标题和发行日期对她的蓝光收藏进行颜色编码，这是很有用的。对我们来说，对异常行为进行同样的处理也很有用，分类为我们提供了一个命名法，或称谓系统，以有意义的方式构建我们对精神疾病的理解。当然，我们希望尽可能多地了解一种特定的疾病，以便我们能够理解其病因，预测其未来的发生，并开发治疗方法。

1.2.2. Determining Occurrence of a Disorder 1.2.2. 确定疾病的发病情况

**Epidemiology **is the scientific study of the frequency and causes of diseases and other health-related states in specific populations such as a school, neighborhood, a city, country, and the world. **Psychiatric or mental health epidemiology **refers to the occurrence of mental disorders in a population. In mental health facilities, we say that a patient presents with a specific problem, or the presenting problem, and we give a clinical description of it, which includes information about the thoughts, feelings, and behaviors that constitute that mental disorder. We also seek to gain information about the occurrence of the disorder, its cause, course, and treatment possibilities.
流行病学是研究特定人群（如学校、社区、城市、国家乃至全球）中疾病和其他健康相关状态的发生频率和原因的科学。精神病学或心理健康流行病学是指人群中精神障碍的发生。在心理健康机构中，我们说患者表现出特定问题，或称为主诉问题，并对其提供临床描述，这包括构成该精神障碍的思想、情感和行为等信息。我们还寻求获取有关该障碍的发生、原因、病程和治疗可能性的信息。

Occurrence can be investigated in several ways. First, **prevalence **is the percentage of people in a population that has a mental disorder or can be viewed as the number of cases divided by the total number of people in the sample. For instance, if 20 people out of 100 have bipolar disorder, then the prevalence rate is 20%. Prevalence can be measured in several ways:
发生可以通过多种方式进行调查。首先，患病率是指人群中患有精神疾病或可以视为病例数除以样本中总人数的百分比。例如，如果 100 人中有 20 人患有双相情感障碍，那么患病率就是 20%。患病率可以通过多种方式进行测量：

**Point prevalence **indicates the proportion of a population that has the characteristic at a specific point in time. In other words, it is the number of active cases.
点现患率表示在特定时间点具有该特征的人口比例。换句话说，它是指活跃病例的数量。
**Period prevalence **indicates the proportion of a population that has the characteristic at any point during a given period of time, typically the past year.
时期患病率表示在任何给定时间段内（通常是过去一年）具有该特征的人口比例。
**Lifetime prevalence **indicates the proportion of a population that has had the characteristic at any time during their lives.
终身患病率表示在任何时候都有该特征的群体比例。

According to a 2020 infographic by the National Alliance on Mental Illness (NAMI), for U.S. adults, 1 in 5 experienced a mental illness, 1 in 20 had a serious mental illness, 1 in 15 experienced both a substance use disorder and mental disorder, and over 12 million had serious thoughts of suicide (2020 Mental Health By the Numbers: US Adults infographic). In terms of adolescents aged 12-17, in 2020 1 in 6 experienced a major depressive episode, 3 million had serious thoughts of suicide, and there was a 31% increase in mental health-related emergency department visits. Among U.S. young adults aged 18-25, 1 in 3 experienced a mental illness, 1 in 10 had a serious mental illness, and 3.8 had serious thoughts of suicide (2020 Mental Health By the Numbers: Youth and Young Adults infographic). These numbers would represent period prevalence rates during the pandemic, and for the year 2020. In the, You are Not Alone infographic, NAMI reported the following 12-month prevalence rates for U.S. Adults: 19% having an anxiety disorder, 8% having depression, 4% having PTSD, 3% having bipolar disorder, and 1% having schizophrenia.
根据美国精神疾病联盟（NAMI）2020 年的一份信息图表，美国成年人中，五分之一的人经历过精神疾病，二十分之一的人患有严重的精神疾病，十五分之一的人同时患有物质使用障碍和精神疾病，超过 1200 万人有严重的自杀念头（2020 年心理健康数据：美国成年人信息图表）。在 12 至 17 岁的青少年中，2020 年六分之一的人经历过重度抑郁发作，300 万人有严重的自杀念头，心理健康相关急诊室就诊人数增加了 31%。在美国 18 至 25 岁的年轻人中，三分之一的人经历过精神疾病，十分之一的人患有严重的精神疾病，3.8%的人有严重的自杀念头（2020 年心理健康数据：青年和年轻人信息图表）。这些数字代表了疫情期间的时期患病率，以及 2020 年的年度患病率。在“你并不孤单”信息图表中，NAMI 报告了美国成年人过去 12 个月的患病率：19%患有焦虑症，8%患有抑郁症，4%患有创伤后应激障碍，3%患有双相情感障碍，1%患有精神分裂症。

*Source: *https://www.nami.org/mhstats 来源：https://www.nami.org/mhstats

**Incidence **indicates the number of new cases in a population over a specific period. This measure is usually lower since it does not include existing cases as prevalence does. If you wish to know the number of new cases of social phobia during the past year (going from say Aug 21, 2015 to Aug 20, 2016), you would only count cases that began during this time and ignore cases before the start date, even if people are currently afflicted with the mental disorder. Incidence is often studied by medical and public health officials so that causes can be identified, and future cases prevented.
发病率表示在特定时期内人群中新增病例的数量。这个指标通常较低，因为它不包括像患病率那样已有的病例。如果您想了解过去一年（比如从 2015 年 8 月 21 日到 2016 年 8 月 20 日）社交恐惧症的新增病例数，您只需计算在这段时间内开始出现的病例，并忽略开始日期之前的病例，即使这些人目前患有这种精神疾病。发病率通常由医疗和公共卫生官员研究，以便确定原因，并预防未来的病例。

Finally, **comorbidity **describes when two or more mental disorders are occurring at the same time and in the same person. The National Comorbidity Survey Replication (NCS-R) study conducted by the National Institute of Mental Health (NIMH) and published in the June 6, 2005 issue of the Archives of General Psychiatry, sought to discover trends in prevalence, impairment, and service use during the 1990s. The first study, conducted from 1980 to 1985, surveyed 20,000 people from five different geographical regions in the U.S. A second study followed from 1990-1992 and was called the National Comorbidity Survey (NCS). The third study, the NCS-R, used a new nationally representative sample of the U.S. population, and found that 45% of those with one mental disorder met the diagnostic criteria for two or more disorders. The authors also found that the severity of mental illness, in terms of disability, is strongly related to comorbidity, and that substance use disorders often result from disorders such as anxiety and bipolar disorders. The implications of this are significant as services to treat substance abuse and mental disorders are often separate, despite the disorders appearing together.
最终，共病描述的是在同一个个体中同时发生两种或多种精神疾病的情况。国家共病调查复制（NCS-R）研究由美国国立精神卫生研究所（NIMH）进行，并于 2005 年 6 月 6 日发表在《普通精神病学档案》上，旨在发现 20 世纪 90 年代共病在患病率、残疾和服务使用方面的趋势。第一项研究于 1980 年至 1985 年进行，调查了来自美国五个不同地理区域的 20,000 人。第二项研究从 1990 年至 1992 年进行，被称为国家共病调查（NCS）。第三项研究，即 NCS-R，使用了一个新的全国代表性样本的美国人口，发现 45%患有一种精神疾病的人符合两种或更多疾病的诊断标准。作者还发现，精神疾病的严重程度，从残疾的角度来看，与共病密切相关，并且物质使用障碍通常是由焦虑症和双相情感障碍等疾病引起的。这一点的意义重大，因为治疗物质滥用和心理健康疾病的服务通常分开，尽管这些疾病常常同时出现。

The **etiology **is the cause of the disorder. There may be social, biological, or psychological explanations for the disorder which need to be understood to identify the appropriate treatment. Likewise, the effectiveness of a treatment may give some hint at the cause of the mental disorder. More on this in Module 2.
病因是疾病的原因。对于这种疾病，可能有社会、生物或心理的解释，需要理解以确定适当的治疗方法。同样，治疗的有效性可能对精神疾病的原因提供一些线索。更多内容请参阅第 2 模块。

The **course **of the disorder is its particular pattern. A disorder may be acute, meaning that it lasts a short time, or chronic, meaning it persists for a long time. It can also be classified as time-limited, meaning that recovery will occur after some time regardless of whether any treatment occurs.
疾病的病程是其特定的模式。一种疾病可能是急性的，意味着它持续时间短，或者慢性，意味着它持续时间长。它还可以被归类为时间有限的，意味着无论是否进行治疗，恢复将在一段时间后发生。

**Prognosis **is the anticipated course the mental disorder will take. A key factor in determining the course is age, with some disorders presenting differently in childhood than adulthood.
预后是指精神障碍预计将采取的进程。决定进程的一个关键因素是年龄，有些障碍在儿童期和成年期表现不同。

Finally, we will discuss several treatment strategies in this book in relation to specific disorders, and in a general fashion in Module 3. **Treatment **is any procedure intended to modify abnormal behavior into normal behavior. The person suffering from the mental disorder seeks the assistance of a trained professional to provide some degree of relief over a series of therapy sessions. The trained mental health professional may prescribe medication or utilize psychotherapy to bring about this change. Treatment may be sought from the primary care provider, in an outpatient facility, or through inpatient care or hospitalization at a mental hospital or psychiatric unit of a general hospital. According to NAMI, the average delay between symptom onset and treatment is 11 years with 45% of adults with mental illness, 66% of adults with serious mental illness, and 51% of youth with a mental health condition seeking treatment in a given year. They also report that 50% of white, 49% of lesbian/gay and bisexual, 43% of mixed/multiracial, 34% of Hispanic or Latinx, 33% of black, and 23% of Asian adults with a mental health diagnosis received treatment or counseling in the past year (Source: Mental Health Care Matters infographic, https://www.nami.org/mhstats).
最后，我们将在这本书中讨论几种与特定疾病相关的治疗策略，并在第 3 模块以一般方式讨论。治疗是指任何旨在将异常行为转变为正常行为的程序。患有精神疾病的人会寻求受过训练的专业人士的帮助，在一系列治疗过程中提供一定程度的缓解。受过训练的精神健康专业人士可能会开药或利用心理治疗来实现这种转变。治疗可以寻求于初级保健提供者、门诊设施、或在精神医院或综合医院的 psychiatric unit 进行住院治疗。根据 NAMI 的数据，症状出现与治疗之间的平均延迟为 11 年，45%的精神疾病成年人、66%的重度精神疾病成年人和 51%的精神健康状况青少年在给定的一年中寻求治疗。他们还报告说，在过去一年中，50%的白人、49%的男同性恋/女同性恋和双性恋者、43%的混血/多民族、34%的西班牙裔或拉丁裔、33%的黑人和 23%的亚洲成年人接受了心理健康诊断，并接受了治疗或咨询（来源：心理健康护理事项信息图，https://www.nami.org/mhstats）。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

Classification, or how we organize or categorize things, provides us with a nomenclature, or naming system, to structure our understanding of mental disorders in a meaningful way.
分类，或者说我们如何组织或分类事物，为我们提供了一种命名法，或者说命名系统，以有意义的方式构建我们对精神疾病的理解。
Epidemiology is the scientific study of the frequency and causes of diseases and other health-related states in specific populations.
流行病学是研究特定人群中疾病和其他健康相关状态发生频率及其原因的科学。
Prevalence is the percentage of people in a population that has a mental disorder or can be viewed as the number of cases divided by the total number of people in the sample.
患病率是指人群中患有精神疾病或可以视为病例数除以样本中总人数的百分比。
Incidence indicates the number of new cases in a population over a specific period.
发病率表示在特定时期内人群中新增病例的数量。
Comorbidity describes when two or more mental disorders are occurring at the same time and in the same person.
共病描述的是在同一个个体中同时发生两种或多种精神障碍的情况。
The etiology is the cause of a disorder while the course is its particular pattern and can be acute, chronic, or time-limited.
病因是疾病的原因，而病程是其特定的模式，可以是急性、慢性或时间有限的。
Prognosis is the anticipated course the mental disorder will take.
预后是指预计心理障碍将采取的进程。

Section 1.2 Review Questions
第 1.2 节复习题

What is the importance of classification for the study of mental disorders?
什么是精神疾病研究中分类的重要性？
What information does a clinical description include?
临床描述包括哪些信息？
In what ways is occurrence investigated?
以何种方式进行研究发生？
What is the etiology of a mental illness?
什么是精神疾病的病因？
What is the relationship of course and prognosis to one another?
课程与预后之间有什么关系？
What is treatment and who seeks it?
什么是治疗？谁寻求治疗？

1.3. The Stigma of Mental Illness 1.3. 精神疾病的耻辱

Section Learning Objectives 章节学习目标

Clarify the importance of social cognition theory in understanding why people do not seek care.
阐明社会认知理论在理解人们为何不寻求照顾的重要性。
Define categories and schemas.
定义类别和架构。
Define stereotypes and heuristics.
定义刻板印象和启发式方法。
Describe social identity theory and its consequences.
描述社会认同理论及其后果。
Differentiate between prejudice and discrimination.
区分偏见和歧视。
Contrast implicit and explicit attitudes.
对比隐性和显性态度。
Explain the concept of stigma and its three forms.
解释耻辱的概念及其三种形式。
Define courtesy stigma. 定义礼貌的耻辱。
Describe what the literature shows about stigma.
描述文献中关于污名的表现。

In the previous section, we discussed the fact that care can be sought out in a variety of ways. The problem is that many people who need care never seek it out. Why is that? We already know that society dictates what is considered abnormal behavior through culture and social norms, and you can likely think of a few implications of that. But to fully understand society’s role in why people do not seek care, we need to determine the psychological processes underlying this phenomenon in the individual.
在前一节中，我们讨论了可以通过多种方式寻求关怀的事实。问题是许多需要关怀的人从未寻求过。为什么是这样？我们已经知道，社会通过文化和社会规范来规定什么是异常行为，你可能会想到一些由此产生的后果。但要完全理解社会在人们不寻求关怀中的作用，我们需要确定个体中这一现象背后的心理过程。

Social cognition is the process through which we collect information from the world around us and then interpret it. The collection process occurs through what we know as sensation – or detecting physical energy emitted or reflected by physical objects. Detection occurs courtesy of our eyes, ears, nose, skin and mouth; or via vision, hearing, smell, touch, and taste, respectfully. Once collected, the information is relayed to the brain through the neural impulse where it is processed and interpreted, or meaning is added to this raw sensory data which we call perception.
社会认知是我们从周围世界收集信息并对其进行解释的过程。收集过程通过我们称之为感觉的方式发生——即检测物理对象发出的或反射的物理能量。检测是通过我们的眼睛、耳朵、鼻子、皮肤和嘴巴；或者通过视觉、听觉、嗅觉、触觉和味觉来实现的。一旦收集到信息，它就会通过神经冲动传递到大脑，在那里进行处理和解释，或者为这种原始感官数据添加意义，我们称之为感知。

One way meaning is added is by taking the information we just detected and using it to assign people to categories, or groups. For each category, we have a schema, or a set of beliefs and expectations about a group of people, believed to apply to all members of the group, and based on experience. You might think of them as organized ways of making sense of experience. So, it is during our initial interaction with someone that we collect information about them, assign the person to a category for which we have a schema, and then use that to affect how we interact with them. First impressions, called the primacy effect, are important because even if we obtain new information that should override an incorrect initial assessment, the initial impression is unlikely to change. We call this the perseverance effect, or belief perseverance.
一种增加含义的方式是通过获取我们刚刚检测到的信息，并将其用于将人们分配到类别或群体中。对于每个类别，我们都有一个模式，或是一套关于一群人的信念和期望，认为它适用于该群体的所有成员，并基于经验。你可能会把它们看作是有序地理解经验的方式。因此，在我们与某人初次互动时，我们收集有关他们的信息，将他们分配到我们有一个模式的类别中，然后利用这一点来影响我们与他们互动的方式。第一印象，称为首因效应，很重要，因为即使我们获得了应该覆盖错误初始评估的新信息，初始印象也不太可能改变。我们称之为坚持效应或信念坚持。

**Stereotypes **are special types of schemas that are very simplistic, very strongly held, and not based on firsthand experience. They are heuristics, or mental shortcuts, that allow us to assess this collected information very quickly. One piece of information, such as skin color, can be used to assign the person to a schema for which we have a stereotype. This can affect how we think or feel about the person and behave toward them. Again, human beings tend to imply things about an individual solely due to a distinguishing feature and disregard anything inconsistent with the stereotype.
刻板印象是特殊类型的图式，非常简单化，非常强烈，且不是基于第一手经验。它们是启发式方法，或心理捷径，使我们能够快速评估这些收集到的信息。例如，皮肤颜色这样的信息可以用来将个人归入我们对其有刻板印象的图式中。这可能会影响我们对该人的思考或感受，以及我们对待他们的行为。再次强调，人类往往仅根据某个人的显著特征来暗示某些事情，而忽视与刻板印象不一致的任何事物。

**Social identity theory **(Tajfel, 1982; Turner, 1987) states that people categorize their social world into meaningfully simplistic representations of groups of people. These representations are then organized as prototypes, or “fuzzy sets of a relatively limited number of category-defining features that not only define one category but serve to distinguish it from other categories” (Foddy and Hogg, as cited in Foddy et al., 1999). We construct in-groups and out-groups and categorize the self as an in-group member. The self is assimilated into the salient in-group prototype, which indicates what cognitions, affect, and behavior we may exhibit. Stereotyping, out-group homogeneity, in-group/out-group bias, normative behavior, and conformity are all based on self-categorization.
社会认同理论（Tajfel，1982；Turner，1987）认为，人们将他们的社会世界分类为对人群的具有意义的简化表征。这些表征随后被组织为原型，或“相对有限数量的类别定义特征的模糊集合，不仅定义了一个类别，而且有助于将其与其他类别区分开来”（Foddy 和 Hogg，如 Foddy 等人，1999 年所述）。我们构建了内群体和外群体，并将自我归类为内群体成员。自我被同化到显著的群体原型中，这表明我们可能表现出哪些认知、情感和行为。刻板印象、外群体同质性、内群体/外群体偏见、规范行为和从众都是基于自我分类的。

How so? Out-group homogeneity occurs when we see all members of an outside group as the same. This leads to a tendency to show favoritism to, and exclude or hold a negative view of, members outside of, one’s immediate group, called the in-group/out-group bias. The negative view or set of beliefs about a group of people is what we call prejudice, and this can result in acting in a way that is negative against a group of people, called discrimination. It should be noted that a person can be prejudicial without being discriminatory since most people do not act on their attitudes toward others due to social norms against such behavior. Likewise, a person or institution can be discriminatory without being prejudicial. For example, when a company requires that an applicant have a certain education level or be able to lift 80 pounds as part of typical job responsibilities. Individuals without a degree or ability to lift will be removed from consideration for the job, but this discriminatory act does not mean that the company has negative views of people without degrees or the inability to lift heavy weight. You might even hold a negative view of a specific group of people and not be aware of it. An attitude we are unaware of is called an implicit attitude**,** which stands in contrast to explicit attitudes, which are the views within our conscious awareness.
如何呢？当我们将一个外部群体的所有成员视为相同的时候，就会发生群体同质性。这导致了一种偏好于自己群体成员并排斥或对群体外成员持有负面看法的倾向，这被称为内群体/外群体偏见。对一群人的负面看法或信念集合就是我们所说的偏见，这可能导致对一群人采取负面行为的歧视。需要注意的是，一个人可能存在偏见但不一定是歧视者，因为大多数人不会因为社会规范反对这种行为而根据他们对别人的态度行事。同样，一个人或机构可能是歧视者但不一定是偏见者。例如，当一家公司要求应聘者必须达到一定的教育水平或能够承担典型工作职责中的 80 磅举重时。没有学位或举重能力的人将被排除在考虑工作之外，但这种歧视行为并不意味着公司对没有学位或举重能力的人有负面看法。你可能甚至对某个特定群体持有负面看法，却浑然不觉。我们未意识到的态度被称为隐含态度，与我们的意识中存在的显性态度形成对比。

We have spent quite a lot of space and time understanding how people gather information about the world and people around them, process this information, use it to make snap judgements about others, form groups for which stereotypes may exist, and then potentially hold negative views of this group and behave negatively toward them as a result. Just one piece of information can be used to set this series of mental events into motion. Outside of skin color, the label associated with having a mental disorder can be used. Stereotypes about people with a mental disorder can quickly and easily transform into prejudice when people in a society determine the schema to be correct and form negative emotions and evaluations of this group (Eagly & Chaiken, 1993). This, in turn, can lead to discriminatory practices such as an employer refusing to hire, a landlord refusing to rent an apartment, or avoiding a romantic relationship, all due to the person having a mental illness.
我们花费了大量的空间和时间来理解人们如何了解世界和周围的人，如何处理这些信息，如何用它来对他人做出快速判断，形成可能存在刻板印象的群体，然后可能对这个群体持有负面观点并因此对他们产生负面行为。仅仅一条信息就可以引发这一系列心理事件。除了肤色之外，与患有精神疾病相关的标签也可以被使用。关于患有精神疾病的人的刻板印象可以迅速而轻易地转化为偏见，当社会中的个人确定这种模式是正确的，并形成对这个群体的负面情绪和评价时（Eagly & Chaiken，1993）。这反过来可能导致歧视行为，例如雇主拒绝雇佣、房东拒绝出租公寓或避免浪漫关系，所有这些都是因为这个人患有精神疾病。

Overlapping with prejudice and discrimination in terms of how people with mental disorders are treated is stigma, or when negative stereotyping, labeling, rejection, and loss of status occur. Stigma takes on three forms as described below:
与对精神障碍者如何对待的偏见和歧视重叠的是污名，即当出现负面刻板印象、标签化、排斥和地位丧失时。污名以下列三种形式出现：

Public stigma – When members of a society endorse negative stereotypes of people with a mental disorder and discriminate against them. They might avoid them altogether, resulting in social isolation. An example is when an employer intentionally does not hire a person because their mental illness is discovered.
公共耻辱 - 当社会成员支持对精神疾病患者的负面刻板印象并歧视他们时。他们可能会完全避开他们，导致社会孤立。一个例子是当雇主故意不雇佣一个人，因为他们的精神疾病被发现。
Label avoidance –To avoid being labeled as “crazy” or “nuts” people needing care may avoid seeking it altogether or stop care once started. Due to these labels, funding for mental health services could be restricted and instead, physical health services funded.
标签规避 - 为了避免被贴上“疯狂”或“神经病”的标签，需要照顾的人可能会完全避免寻求帮助，或者在开始照顾后停止。由于这些标签，心理健康服务的资金可能会受到限制，而相反，则会资助身体健康服务。
Self-stigma – When people with mental illnesses internalize the negative stereotypes and prejudice, and in turn, discriminate against themselves. They may experience shame, reduced self-esteem, hopelessness, low self-efficacy, and a reduction in coping mechanisms. An obvious consequence of these potential outcomes is the why try effect, or the person saying ‘Why should I try and get that job? I am not worthy of it’ (Corrigan, Larson, & Rusch, 2009; Corrigan, et al., 2016).
自我污名化 - 当患有精神疾病的人内化了负面刻板印象和偏见，反过来又歧视自己。他们可能会经历羞耻、自尊心降低、绝望、自我效能感低和应对机制减少。这些潜在结果的一个明显后果是“为什么尝试”效应，即人们说“我为什么要尝试得到那份工作？我不配”（Corrigan, Larson, & Rusch, 2009；Corrigan, et al., 2016）。

Another form of stigma that is worth noting is that of **courtesy stigma **or when stigma affects people associated with a person who has a mental disorder. Karnieli-Miller et al. (2013) found that families of the afflicted were often blamed, rejected, or devalued when others learned that a family member had a serious mental illness (SMI). Due to this, they felt hurt and betrayed, and an important source of social support during a difficult time had disappeared, resulting in greater levels of stress. To cope, some families concealed their relative’s illness, and some parents struggled to decide whether it was their place to disclose their child’s condition. Others fought with the issue of confronting the stigma through attempts at education versus just ignoring it due to not having enough energy or desiring to maintain personal boundaries. There was also a need to understand the responses of others and to attribute it to a lack of knowledge, experience, and/or media coverage. In some cases, the reappraisal allowed family members to feel compassion for others rather than feeling put down or blamed. The authors concluded that each family “develops its own coping strategies which vary according to its personal experiences, values, and extent of other commitments” and that “coping strategies families employ change over-time.”
另一种值得注意的耻辱形式是礼貌耻辱或当耻辱影响到与患有精神疾病的人有关联的人时。Karnieli-Miller 等人（2013 年）发现，当其他人得知家庭成员患有严重精神疾病（SMI）时，受影响的家庭往往会被责备、排斥或贬值。因此，他们感到受伤和背叛，一个在困难时期的重要社会支持来源消失了，导致压力水平更高。为了应对，一些家庭隐藏了他们亲属的疾病，一些父母在决定是否应该透露孩子的状况时感到挣扎。其他人则在与教育问题作斗争，试图面对耻辱，而不是因为缺乏精力或希望维持个人界限而忽视它。还需要理解他人的反应，并将其归因于缺乏知识、经验以及/或媒体报道。在某些情况下，重新评估使家庭成员能够对他人产生同情，而不是感到被贬低或责备。作者得出结论，每个家庭“都会根据其个人经历、价值观和其他承诺的范围发展出自己独特的应对策略”，并且“家庭所采用的应对策略会随着时间的推移而变化。””

Other effects of stigma include experiencing work-related discrimination resulting in higher levels of self-stigma and stress (Rusch et al., 2014), higher rates of suicide especially when treatment is not available (Rusch, Zlati, Black, and Thornicroft, 2014; Rihmer & Kiss, 2002), and a decreased likelihood of future help-seeking intention (Lally et al., 2013). The results of the latter study also showed that personal contact with someone with a history of mental illness led to a decreased likelihood of seeking help. This is important because 48% of the university sample stated that they needed help for an emotional or mental health issue during the past year but did not seek help. Similar results have been reported in other studies (Eisenberg, Downs, Golberstein, & Zivin, 2009). It is also important to point out that social distance, a result of stigma, has also been shown to increase throughout the life span, suggesting that anti-stigma campaigns should focus on older people primarily (Schomerus, et al., 2015).
其他污名效应包括经历与工作相关的歧视，导致自我污名和压力水平更高（Rusch 等人，2014 年），自杀率更高，尤其是在治疗不可用的情况下（Rusch，Zlati，Black 和 Thornicroft，2014 年；Rihmer 和 Kiss，2002 年），以及未来寻求帮助意愿降低的可能性（Lally 等人，2013 年）。后一项研究的结果还显示，与有精神病史的人的个人接触导致寻求帮助的可能性降低。这很重要，因为 48%的大学生样本表示，在过去一年中他们需要帮助处理情绪或心理健康问题，但并未寻求帮助。其他研究也报告了类似的结果（Eisenberg，Downs，Golberstein 和 Zivin，2009 年）。还值得注意的是，由于污名而产生的社会距离在整个生命周期中也已被证明在增加，这表明反污名运动应主要针对老年人（Schomerus 等人，2015 年）。

One potentially disturbing trend is that mental health professionals have been shown to hold negative attitudes toward the people they serve. Hansson et al. (2011) found that staff members at an outpatient clinic in the southern part of Sweden held the most negative attitudes about whether an employer would accept an applicant for work, willingness to date a person who had been hospitalized, and hiring a patient to care for children. Attitudes were stronger when staff treated patients with a psychosis or in inpatient settings. In a similar study,
一种可能令人不安的趋势是，心理健康专业人士对他们所服务的人持有负面态度。Hansson 等人（2011 年）发现，瑞典南部一家门诊诊所的工作人员对雇主是否会接受求职者、是否愿意与曾住院的人约会以及雇佣患者照顾孩子等问题持有最负面的态度。当工作人员对待患有精神分裂症的患者或在住院环境中工作时，态度更为强烈。在类似的研究中，

Martensson, Jacobsson, and Engstrom (2014) found that staff had more positive attitudes towards persons with mental illness if their knowledge of such disorders was less stigmatized; their workplaces were in the county council where they were more likely to encounter patients who recover and return to normal life in society, rather than in municipalities where patients have long-term and recurrent mental illness; and they have or had one close friend with mental health issues.
马滕松、雅各布森和恩斯特罗姆（2014）发现，如果他们对这些疾病的了解不那么具有污名化，工作人员对精神疾病患者的态度更积极；他们的工作场所位于县议会，在那里他们更有可能遇到康复并回归社会正常生活的患者，而不是在患者长期反复患有精神疾病的城市；他们有一个或曾经有一个精神健康问题的亲密朋友。

To help deal with stigma in the mental health community, Papish et al. (2013) investigated the effect of a one-time contact-based educational intervention compared to a four-week mandatory psychiatry course on the stigma of mental illness among medical students at the University of Calgary. The curriculum included two methods requiring contact with people diagnosed with a mental disorder: patient presentations, or two one-hour oral presentations in which patients shared their story of having a mental illness, and “clinical correlations” in which a psychiatrist mentored students while they interacted with patients in either inpatient or outpatient settings. Results showed that medical students held a stigma towards mental illness and that comprehensive medical education reduced this stigma. As the authors stated, “These results suggest that it is possible to create an environment in which medical student attitudes towards mental illness can be shifted in a positive direction.” That said, the level of stigma was still higher for mental illness than it was for the stigmatized physical illness, type 2 diabetes mellitus.
为了帮助处理心理健康领域的污名，Papish 等人（2013 年）调查了一次性基于接触的教育干预措施与为期四周的强制精神病学课程对卡尔加里大学医学生中精神疾病污名的影响。课程包括两种需要与被诊断为精神疾病的人接触的方法：患者展示，即两个一小时的口头展示，其中患者分享他们患有精神疾病的故事，以及“临床相关性”，其中精神科医生在学生与住院或门诊患者互动时指导学生。结果显示，医学生持有对精神疾病的污名，而全面的医学教育减少了这种污名。正如作者所说：“这些结果表明，有可能创造一个环境，使医学生对精神疾病的态度可以朝着积极的方向转变。”尽管如此，精神疾病的污名程度仍然高于受污名化的物理疾病，即 2 型糖尿病。

What might happen if mental illness is presented as a treatable condition? McGinty, Goldman, Pescosolido, and Barry (2015) found that portraying schizophrenia, depression, and heroin addiction as untreated and symptomatic increased negative public attitudes towards people with these conditions. Conversely, when the same people were portrayed as successfully treated, the desire for social distance was reduced, there was less willingness to discriminate against them, and belief in treatment effectiveness increased among the public.
如果将精神疾病呈现为可治疗的状况，可能会发生什么？McGinty、Goldman、Pescosolido 和 Barry（2015）发现，将精神分裂症、抑郁症和海洛因成瘾描绘为未治疗和有症状的，会增加公众对这些疾病患者的负面态度。相反，当同样的人被描绘为成功接受治疗时，减少了对他们的社会距离感，减少了歧视他们的意愿，公众对治疗有效性的信念也增加了。

Self-stigma has also been shown to affect self-esteem, which then affects hope, which then affects the quality of life among people with severe mental illness. As such, hope should play a central role in recovery (Mashiach-Eizenberg et al., 2013). Narrative Enhancement and Cognitive Therapy (NECT) is an intervention designed to reduce internalized stigma and targets both hope and self-esteem (Yanos et al., 2011). The intervention replaces stigmatizing myths with facts about illness and recovery, which leads to hopefulness and higher levels of self-esteem in clients. This may then reduce susceptibility to internalized stigma.
自我污名也已被证明会影响自尊，进而影响希望，这又进而影响严重精神疾病患者的生命质量。因此，希望应在康复中发挥核心作用（Mashiach-Eizenberg 等，2013）。叙事增强与认知疗法（NECT）是一种旨在减少内化污名的干预措施，针对希望和自尊（Yanos 等，2011）。该干预措施用关于疾病和康复的事实取代污名化的神话，从而使客户充满希望并提高自尊水平。这可能会减少对内化污名的易感性。

Stigma leads to health inequities (Hatzenbuehler, Phelan, & Link, 2013), prompting calls for stigma change. Targeting stigma involves two different agendas: The services agenda attempts to remove stigma so people can seek mental health services, and the rights agenda tries to replace discrimination that “robs people of rightful opportunities with affirming attitudes and behavior” (Corrigan, 2016). The former is successful when there is evidence that people with mental illness are seeking services more or becoming better engaged. The latter is successful when there is an increase in the number of people with mental illnesses in the workforce who are receiving reasonable accommodations. The federal government has tackled this issue with landmark legislation such as the Patient Protection and Affordable Care Act of 2010, Mental Health Parity and Addiction Equity Act of 2008, and the Americans with Disabilities Act of 1990. However, protections are not uniform across all subgroups due to “1) explicit language about inclusion and exclusion criteria in the statute or implementation rule, 2) vague statutory language that yields variation in the interpretation about which groups qualify for protection, and 3) incentives created by the legislation that affect specific groups differently” (Cummings, Lucas, and Druss, 2013). More on this in Module 15.
耻辱导致健康不平等（Hatzenbuehler、Phelan 和 Link，2013），促使人们呼吁改变耻辱。针对耻辱的措施涉及两个不同的议程：服务议程试图消除耻辱，以便人们可以寻求心理健康服务；权利议程试图用肯定的态度和行为取代“剥夺人们合法机会的歧视”（Corrigan，2016）。当有证据表明患有精神疾病的人寻求服务更多或参与度更高时，前者是成功的。当有精神疾病的人在劳动力中接受合理便利的人数增加时，后者是成功的。联邦政府通过具有里程碑意义的立法来解决这一问题，例如 2010 年的《患者保护和平价医疗法案》、2008 年的《心理健康平等和成瘾公平法案》以及 1990 年的《美国残疾人法案》。然而，由于“1）法律或实施规则中关于纳入和排除标准的明确语言，2）模糊的法律语言导致对哪些群体有资格获得保护的解释存在差异，以及 3）立法产生的对不同群体产生不同影响的激励措施”，因此保护措施并非在所有子群体中都是统一的”（Cummings，Lucas，和 Druss，2013）。关于这一点，在模块 15 中将有更多介绍。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

Stigma is when negative stereotyping, labeling, rejection, and loss of status occur and take the form of public or self-stigma, and label avoidance.
耻辱是指当出现负面刻板印象、标签化、排斥和地位丧失，并采取公众或自我耻辱的形式，以及标签回避行为时。

Section 1.3 Review Questions
第 1.3 节复习题

How does social cognition help us to understand why stigmatization occurs?
社会认知如何帮助我们理解污名化现象发生的原因？
Define stigma and describe its three forms. What is courtesy stigma?
定义耻辱，并描述其三种形式。什么是礼貌耻辱？
What are the effects of stigma on the afflicted?
什么是耻辱对受影响者的影响？
Is stigmatization prevalent in the mental health community? If so, what can be done about it?
心理健康社区中是否存在污名化现象？如果是的话，可以采取什么措施来应对？
How can we reduce stigmatization?
我们如何减少污名化？

1.4. The History of Mental Illness 1.4. 精神疾病的历史

Section Learning Objectives 章节学习目标

Describe prehistoric and ancient beliefs about mental illness.
描述史前和古代对精神病的信仰。
Describe Greco-Roman thought on mental illness.
描述希腊罗马对精神病的看法。
Describe thoughts on mental illness during the Middle Ages.
描述中世纪对精神病的看法。
Describe thoughts on mental illness during the Renaissance.
描述文艺复兴时期对精神病的看法。
Describe thoughts on mental illness during the 18th and 19th centuries.
描述 18 世纪和 19 世纪对精神病的看法。
Describe thoughts on mental illness during the 20th and 21st centuries.
描述 20 世纪和 21 世纪对精神疾病的看法。
Describe the status of mental illness today.
描述当今精神疾病的状态。
Outline the use of psychoactive drugs throughout time and their impact.
概述心理活性药物在历史上的使用及其影响。
Clarify the importance of managed health care for the treatment of mental illness.
明确管理型医疗在治疗精神疾病中的重要性。
Define and clarify the importance of multicultural psychology.
定义并阐明多元文化心理学的重要性。
State the issue surrounding prescription rights for psychologists.
阐述围绕心理学家处方权的争议问题。
Explain the importance of prevention science.
解释预防科学的重要性。

As we have seen so far, what is considered abnormal behavior is often dictated by the culture/society a person lives in, and unfortunately, the past has not treated the afflicted very well. In this section, we will examine how past societies viewed and dealt with mental illness.
如我们所见，被认为异常的行为通常是由个人所在的文化/社会所决定的，不幸的是，过去并没有很好地对待受苦的人。在本节中，我们将探讨过去的社会如何看待和处理精神疾病。

1.4.1. Prehistoric and Ancient Beliefs 1.4.1. 史前和古代信仰

Prehistoric cultures often held a supernatural view of abnormal behavior and saw it as the work of evil spirits, demons, gods, or witches who took control of the person. This form of demonic possession often occurred when the person engaged in behavior contrary to the religious teachings of the time. Treatment by cave dwellers included a technique called trephination, in which a stone instrument known as a trephine was used to remove part of the skull, creating an opening. Through it, the evil spirits could escape, thereby ending the person’s mental affliction and returning them to normal behavior. Early Greek, Hebrew, Egyptian, and Chinese cultures used a treatment method called exorcism in which evil spirts were cast out through prayer, magic, flogging, starvation, having the person ingest horrible tasting drinks, or noisemaking.
史前文化通常对异常行为持有超自然观点，将其视为邪恶精灵、恶魔、神或女巫控制人的行为。这种恶魔附身通常发生在个人行为违反当时宗教教义时。洞穴居民的治疗方法包括一种称为钻孔的技术，使用一种称为钻孔器的石制工具移除部分头骨，从而创造一个开口。通过这个开口，邪恶的精灵可以逃逸，从而结束个人的精神痛苦，并使他们恢复正常行为。早期希腊、希伯来、埃及和中国文化使用了一种称为驱魔的治疗方法，通过祈祷、魔法、鞭打、饥饿、让人吞下难吃的饮料或制造噪音来驱逐邪恶精灵。

1.4.2. Greco-Roman Thought 1.4.2. 希腊罗马思想

Rejecting the idea of demonic possession, Greek physician Hippocrates (460-377 B.C.) said that mental disorders were akin to physical ailments and had natural causes. Specifically, they arose from brain pathology, or head trauma/brain dysfunction or disease, and were also affected by heredity. Hippocrates classified mental disorders into three main categories – melancholia, mania, and phrenitis (brain fever) – and gave detailed clinical descriptions of each. He also described four main fluids or humors that directed normal brain functioning and personality – blood which arose in the heart, black bile arising in the spleen, yellow bile or *choler *from the liver, and phlegm from the brain. Mental disorders occurred when the humors were in a state of imbalance such as an excess of yellow bile causing frenzy and too much black bile causing melancholia or depression. Hippocrates believed mental illnesses could be treated as any other disorder and focused on the underlying pathology.
拒绝恶魔附身这一观点，古希腊医生希波克拉底（公元前 460-377 年）认为精神疾病类似于身体疾病，有自然原因。具体来说，它们源于脑部病理、头部创伤/脑功能障碍或疾病，并受遗传影响。希波克拉底将精神疾病分为三大类——忧郁症、狂躁症和脑热（phrenitis）——并对每种疾病进行了详细的临床描述。他还描述了四种主要体液或体液，它们指导着正常的脑功能和性格——心脏产生的血液、脾脏产生的黑胆汁、肝脏产生的黄胆汁或胆汁，以及来自大脑的痰液。当体液处于不平衡状态时，如黄胆汁过多导致狂热，或黑胆汁过多导致忧郁或抑郁时，就会发生精神疾病。希波克拉底认为精神疾病可以像其他疾病一样治疗，并专注于潜在的病理。

Also noteworthy was the Greek philosopher Plato (429-347 B.C.), who said that the mentally ill were not responsible for their actions and should not be punished. It was the responsibility of the community and their families to care for them. The Greek physician Galen (A.D. 129-199) said mental disorders had either physical or psychological causes, including fear, shock, alcoholism, head injuries, adolescence, and changes in menstruation.
值得注意的是古希腊哲学家柏拉图（公元前 429-347 年），他认为精神疾病患者对其行为不负责任，不应受到惩罚。照顾他们的责任在于社区和他们的家庭。古希腊医生盖伦（公元 129-199 年）表示，精神疾病要么有生理原因，要么有心理原因，包括恐惧、震惊、酗酒、头部受伤、青春期和月经变化。

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 or warm baths, the hope being that their patients would be as comfortable as they could be. 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.
在罗马，医生阿斯克勒庇阿德（公元前 124-40 年）和哲学家西塞罗（公元前 106-43 年）否定了希波克拉底的四种体液理论，而是认为忧郁源于悲伤、恐惧和愤怒；而不是过多的黑胆汁。罗马医生用按摩或热水浴来治疗精神疾病，希望他们的病人尽可能舒适。他们实践了“相反相成”的概念，即通过相反的方法来达到平衡，并在身体和精神领域引入对比刺激。一个例子就是在热水浴中喝冷饮。

1.4.3. The Middle Ages – 500 AD to 1500 AD 1.4.3. 中世纪 - 公元 500 年至 1500 年

The progress made during the time of the Greeks and Romans was quickly reversed during the Middle Ages with the increase in power of the Church and the fall of the Roman Empire. Mental illness was yet again explained as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of demonic influence. In extreme cases, the afflicted were exposed to confinement, beatings, and even execution. Scientific and medical explanations, such as those proposed by Hippocrates, were discarded.
古希腊和罗马时期取得的进步在中世纪随着教会权力的增强和罗马帝国的衰落而迅速逆转。精神疾病再次被解释为恶魔附身，使用诸如驱魔、鞭打、祈祷、触摸圣物、吟唱、参观圣地和圣水等方法来消除恶魔的影响。在极端情况下，受影响的人被暴露于监禁、殴打甚至处决。希波克拉底等提出的科学和医学解释被摒弃。

Group hysteria, or mass madness, was also seen when large numbers of people displayed similar symptoms and false beliefs. This included the belief that one was possessed by wolves or other animals and imitated their behavior, called lycanthropy, and a mania in which large numbers of people had an uncontrollable desire to dance and jump, called tarantism. The latter was believed to have been caused by the bite of the wolf spider, now called the tarantula, and spread quickly from Italy to Germany and other parts of Europe where it was called Saint Vitus’s dance.
群体癔病，或称大众疯狂，也出现在大量人群表现出相似症状和错误信念时。这包括相信一个人被狼或其他动物附身并模仿它们的行为，称为狼人症，以及大量人群无法控制的跳舞和跳跃狂热，称为塔兰图拉症。后者被认为是由狼蛛（现称为塔兰图拉）的咬伤引起的，并迅速从意大利传播到德国和其他欧洲部分地区，在那里被称为圣维图斯之舞。

Perhaps the return to supernatural explanations during the Middle Ages makes sense given events of the time. The black death (bubonic plague) killed up to a third, or according to other estimates almost half, of the population. Famine, war, social oppression, and pestilence were also factors. The constant presence of death led to an epidemic of depression and fear. Near the end of the Middle Ages, mystical explanations for mental illness began to lose favor, and government officials regained some of their lost power over nonreligious activities. Science and medicine were again called upon to explain psychopathology.
中世纪回归超自然解释似乎合乎当时的事件。黑死病（淋巴腺鼠疫）导致人口三分之一或根据其他估计近一半死亡。饥荒、战争、社会压迫和瘟疫也是因素。死亡的持续存在导致抑郁症和恐惧的流行。在中世纪末期，对精神疾病的神秘解释开始失去青睐，政府官员在非宗教活动中恢复了一些失去的权力。科学和医学再次被召唤来解释精神病理学。

1.4.4. The Renaissance – 14th to 16th centuries 1.4.4. 文艺复兴 - 14 世纪至 16 世纪

The most noteworthy development in the realm of philosophy during the Renaissance was the rise of humanism, or the worldview that emphasizes human welfare and the uniqueness of the individual. This perspective helped continue the decline of supernatural views of mental illness. In the mid to late 1500s, German physician Johann Weyer (1515-1588) published his book, *On the Deceits of the Demons, *that rebutted the Church’s witch-hunting handbook, the Malleus Maleficarum, and argued that many accused of being witches and subsequently imprisoned, tortured, and/or burned at the stake, were mentally disturbed and not possessed by demons or the Devil himself. He believed that like the body, the mind was susceptible to illness. Not surprisingly, the book was vehemently protested and banned by the Church. It should be noted that these types of acts occurred not only in Europe, but also in the United States. The most famous example, the Salem Witch Trials of 1692, resulted in more than 200 people accused of practicing witchcraft and 20 deaths.
在文艺复兴时期哲学领域最引人注目的发展是人类主义的兴起，即强调人类福祉和个人独特性的世界观。这种观点有助于继续衰落对精神疾病的超自然观点。在 16 世纪中叶到晚期，德国医生约翰·威耶（1515-1588）出版了其著作《论恶魔的诡计》，反驳了教会猎巫手册《女巫之锤》，并认为许多被指控为女巫并被监禁、折磨和/或被烧死的人实际上是精神错乱的，而不是被恶魔或魔鬼本身附身。他认为，像身体一样，心灵也容易生病。毫不奇怪，这本书遭到了教会的强烈抗议并被禁止。应该指出的是，这类行为不仅发生在欧洲，也发生在美国。最著名的例子是 1692 年的塞勒姆女巫审判，导致 200 多人被指控施行巫术，20 人死亡。

The number of asylums, or places of refuge for the mentally ill where they could receive care, began to rise during the 16th century as the government realized there were far too many people afflicted with mental illness to be left in private homes. Hospitals and monasteries were converted into asylums. Though the intent was benign in the beginning, as the facilities overcrowded, the patients came to be treated more like animals than people. In 1547, the Bethlem Hospital opened in London with the sole purpose of confining those with mental disorders. Patients were chained up, placed on public display, and often heard crying out in pain. The asylum became a tourist attraction, with sightseers paying a penny to view the more violent patients, and soon was called “Bedlam” by local people; a term that today means “a state of uproar and confusion” (https://www.merriam-webster.com/dictionary/bedlam).
收容所或精神病患者的庇护所数量开始增加，这些地方可以为他们提供护理，16 世纪时，政府意识到有太多患有精神疾病的人无法留在私人住所。医院和修道院被改造成收容所。虽然最初意图是良善的，但随着设施拥挤，患者被当作动物而不是人对待。1547 年，伦敦的贝斯勒姆医院开业，唯一目的是关押患有精神疾病的人。患者被锁链束缚，公开展示，常常听到他们痛苦地呼喊。收容所成为了一个旅游景点，游客支付一便士观看更暴力的患者，很快当地人称其为“Bedlam”，这个词今天意味着“一片混乱和喧嚣”（https://www.merriam-webster.com/dictionary/bedlam）。

1.4.5. Reform Movement – 18th to 19th centuries 1.4.5. 改革运动 - 18 世纪至 19 世纪

The rise of the moral treatment movement occurred in Europe in the late 18th century and then in the United States in the early 19th century. The earliest proponent was Francis Pinel (1745-1826), the superintendent of la Bicetre, a hospital for mentally ill men in Paris. Pinel stressed respectful treatment and moral guidance for the mentally ill while considering their individual, social, and occupational needs. Arguing that the mentally ill were sick people, Pinel ordered that chains be removed, outside exercise be allowed, sunny and well-ventilated rooms replace dungeons, and patients be extended kindness and support. This approach led to considerable improvement for many of the patients, so much so, that several were released.
道德治疗运动的兴起发生在 18 世纪末的欧洲，然后在 19 世纪初的美国。最早的倡导者是弗朗西斯·皮内尔（1745-1826），他是巴黎一家精神病男子医院的院长。皮内尔强调对精神病人的尊重治疗和道德指导，同时考虑他们的个人、社会和职业需求。他认为精神病人是生病的人，因此下令解除锁链，允许户外运动，用阳光充足、通风良好的房间取代地牢，并给予病人善意和支持。这种方法使许多病人的状况得到了显著改善，以至于有几个人被释放。

Following Pinel’s lead, William Tuke (1732-1822), a Quaker tea merchant, established a pleasant rural estate called the York Retreat. The Quakers believed that all people should be accepted for who they are and treated kindly. At the retreat, patients could work, rest, talk out their problems, and pray (Raad & Makari, 2010). The work of Tuke and others led to the passage of the Country Asylums Act of 1845, which required that every county provide asylum to the mentally ill. This sentiment extended to English colonies such as Canada, India, Australia, and the West Indies as word of the maltreatment of patients at a facility in Kingston, Jamaica spread, leading to an audit of colonial facilities and their policies.
跟随平尔的榜样，威廉·塔克（1732-1822），一位贵格会茶叶商人，建立了一个名为约克隐修院的宜人乡村庄园。贵格会认为所有人都应该被接受为他们的本来面目，并受到友善的对待。在隐修院，病人可以工作、休息、谈论他们的问题，并祈祷（Raad & Makari，2010）。塔克和其他人的工作导致了 1845 年《乡村精神病院法案》的通过，该法案要求每个县为精神病患者提供庇护。这种情绪扩展到了加拿大、印度、澳大利亚和西印度群岛等英国殖民地，因为金斯敦一家设施中患者虐待的消息传播开来，导致对殖民地设施及其政策的审计。

Reform in the United States started with the figure largely considered to be the father of American psychiatry, Benjamin Rush (1745-1813). Rush advocated for the humane treatment of the mentally ill, showing them respect, and even giving them small gifts from time to time. Despite this, his practice included treatments such as bloodletting and purgatives, the invention of the “tranquilizing chair,” and reliance on astrology, showing that even he could not escape from the beliefs of the time.
美国改革始于被广泛认为是美国精神病学之父的本杰明·拉什（1745-1813）。拉什提倡对精神疾病患者的仁爱治疗，向他们表示尊重，甚至不时地给他们一些小礼物。尽管如此，他的治疗方法包括放血和泻药，发明了“镇静椅”，并依赖占星术，这表明即使是他也无法摆脱时代的信仰。

Due to the rise of the moral treatment movement in both Europe and the United States, asylums became habitable places where those afflicted with mental illness could recover. Regrettably, its success was responsible for its decline. The number of mental hospitals greatly increased, leading to staffing shortages and a lack of funds to support them. Though treating patients humanely was a noble endeavor, it did not work for some patients and other treatments were needed, though they had not been developed yet. Staff recognized that the approach worked best when the facility had 200 or fewer patients, but waves of immigrants arriving in the U.S. after the Civil War overwhelmed the facilities, and patient counts soared to 1,000 or more. Prejudice against the new arrivals led to discriminatory practices in which immigrants were not afforded the same moral treatments as native citizens, even when the resources were available to treat them.
由于欧洲和美国道德治疗运动的兴起，精神病院变成了可以居住的地方，那些患有精神疾病的人可以在那里康复。遗憾的是，它的成功导致了它的衰落。精神病院的数量大幅增加，导致人员短缺和资金不足。尽管人道地治疗病人是一项高尚的事业，但它对一些病人不起作用，需要其他治疗方法，尽管那时这些方法尚未开发。工作人员认识到，当设施有 200 名或更少的病人时，这种方法效果最好，但内战后在美移民潮涌入，设施被压垮，病人数量激增至 1000 人或更多。对新来者的偏见导致了歧视性做法，即移民无法获得与本土公民相同的道德治疗，即使有资源治疗他们。

The moral treatment movement also fell due to the rise of the mental hygiene movement, which focused on the physical well-being of patients. Its leading proponent in the United States was Dorothea Dix (1802-1887), a New Englander who observed the deplorable conditions suffered by the mentally ill while teaching Sunday school to female prisoners. Over the next 40 years, from 1841 to 1881, she motivated people and state legislators to do something about this injustice and raised millions of dollars to build over 30 more appropriate mental hospitals and improve others. Her efforts even extended beyond the U.S. to Canada and Scotland.
道德治疗运动也因心理健康运动的兴起而衰落，后者专注于患者的身体健康。在美国，其主要的倡导者是多罗西亚·狄克斯（1802-1887），一位新英格兰人，她在教女性囚犯主日学校时观察到精神病患者所遭受的悲惨状况。在接下来的 40 年里，从 1841 年到 1881 年，她激励人们和州立法者对此不公采取行动，并筹集了数百万美元来建造 30 多所更合适的精神病院并改善其他设施。她的努力甚至扩展到了加拿大和苏格兰。

Finally, in 1908 Clifford Beers (1876-1943) published his book, A Mind that Found Itself, in which he described his struggle with bipolar disorder and the “cruel and inhumane treatment people with mental illnesses received. He witnessed and experienced horrific abuse at the hands of his caretakers. At one point during his institutionalization, he was placed in a straitjacket for 21 consecutive nights” (https://www.mhanational.org/our-history). His story aroused sympathy from the public and led him to found the National Committee for Mental Hygiene, known today as Mental Health America, which provides education about mental illness and the need to treat these people with dignity. Today, MHA has over 200 affiliates in 41 states and employs 6,500 affiliate staff and over 10,000 volunteers.
最终，在 1908 年，克利福德·比尔斯（1876-1943）出版了其著作《自我发现的头脑》，在其中他描述了自己与双相情感障碍的斗争以及精神疾病患者所遭受的“残酷和不人道”的治疗。他目睹并经历了看护者对他的可怕虐待。在他被机构化的某个时刻，他被连续 21 个晚上关在紧身衣里”（https://www.mhanational.org/our-history）。他的故事引起了公众的同情，并促使他创立了国家精神卫生委员会，即今天的心理健康美国，该组织提供有关精神疾病及其需要以尊严对待这些人的教育。如今，MHA 在 41 个州拥有超过 200 个分支机构，雇佣了 6,500 名分支机构工作人员和超过 10,000 名志愿者。

“In the early 1950s, Mental Health America issued a call to asylums across the country for their discarded chains and shackles. On April 13, 1953, at the McShane Bell Foundry in Baltimore, Md., Mental Health America melted down these inhumane bindings and recast them into a sign of hope: the Mental Health Bell.
在 20 世纪 50 年代初，美国心理健康协会向全国的精神病院发出呼吁，要求他们捐赠被丢弃的锁链和镣铐。1953 年 4 月 13 日，在马里兰州巴尔的摩的 McShane Bell 铸造厂，美国心理健康协会将这些不人道的束缚熔化，重新铸造成希望的象征：心理健康钟。

Now the symbol of Mental Health America, the 300-pound Bell serves as a powerful reminder that the invisible chains of misunderstanding and discrimination continue to bind people with mental illnesses. Today, the Mental Health Bell rings out hope for improving mental health and achieving victory over mental illnesses.”
现在，美国心理健康协会的象征，300 磅重的钟铃，作为一个强有力的提醒，表明误解和歧视的无形锁链仍在束缚着患有精神疾病的人们。今天，心理健康钟铃鸣响，为改善心理健康和战胜精神疾病带来希望。”

For more information on MHA, please visit: https://www.mhanational.org/
有关 MHA 的更多信息，请访问：https://www.mhanational.org/

1.4.6. 20th – 21st Centuries 1.4.6. 20 世纪 - 21 世纪

The decline of the moral treatment approach in the late 19th century led to the rise of two competing perspectives – the biological or somatogenic perspective and the psychological or psychogenic perspective.
19 世纪末道德治疗方法的衰落导致了两种竞争性观点的兴起——生物或躯体发生观点和心理或心理发生观点。

1.4.6.1. Biological or Somatogenic Perspective.1.4.6.1. 生物或躯体发生视角。

Recall that Greek physicians Hippocrates and Galen said that mental disorders were akin to physical disorders and had natural causes. Though the idea fell into oblivion for several centuries, it re-emerged in the late 19th century for two reasons. First, German psychiatrist Emil Kraepelin (1856-1926) discovered that symptoms occurred regularly in clusters, which he called syndromes. These syndromes represented a unique mental disorder with a distinct cause, course, and prognosis. In 1883 he published his textbook, *Compendium der Psychiatrie *(Textbook of Psychiatry), and described a system for classifying mental disorders that became the basis of the American Psychiatric Association’s *Diagnostic and Statistical Manual of Mental Disorders (DSM) *that is currently in its 5th edition Text Revision (published in 2022).
回忆一下，希腊医生希波克拉底和盖伦认为精神疾病类似于身体疾病，有自然原因。尽管这个观点在几个世纪里被遗忘，但它在 19 世纪末因两个原因重新出现。首先，德国精神病学家埃米尔·克雷佩林（1856-1926 年）发现症状经常以簇状出现，他将这些症状称为综合征。这些综合征代表了一种独特的心理疾病，具有明确的病因、病程和预后。1883 年，他出版了其教科书《精神病学概要》（精神病学教科书），并描述了一种用于分类精神疾病的方法，这成为美国精神病学协会的精神疾病诊断与统计手册（DSM）的基础，目前该手册已修订至第 5 版（2022 年出版）。

Secondly, in 1825, the behavioral and cognitive symptoms of advanced syphilis were identified to include a belief that everyone is plotting against you or that you are God (a delusion of grandeur), and were termed general paresis by French physician A.L.J. Bayle. In 1897, Viennese psychiatrist Richard von Krafft-Ebbing injected patients suffering from general paresis with matter from syphilis spores and noted that none of the patients developed symptoms of syphilis, indicating they must have been previously exposed and were now immune. This led to the conclusion that syphilis was the cause of the general paresis. In 1906, August von Wassermann developed a blood test for syphilis, and in 1917 a cure was found. Julius von Wagner-Jauregg noticed that patients with general paresis who contracted malaria recovered from their symptoms. To test this hypothesis, he injected nine patients with blood from a soldier afflicted with malaria. Three of the patients fully recovered while three others showed great improvement in their paretic symptoms. The high fever caused by malaria burned out the syphilis bacteria. Hospitals in the United States began incorporating this new cure for paresis into their treatment approach by 1925.
其次，在 1825 年，法国医生 A.L.J. Bayle 确定了晚期梅毒的行为和认知症状，包括认为每个人都正在密谋反对你或认为你是上帝（一种妄自尊大的错觉），并将其称为一般性麻痹。在 1897 年，维也纳精神病学家理查德·冯·克拉夫特-埃宾向患有一般性麻痹的患者注射了梅毒芽孢的物质，并注意到没有患者出现梅毒症状，这表明他们之前已经接触过并且现在具有免疫力。这导致了梅毒是一般性麻痹原因的结论。在 1906 年，奥古斯特·冯·瓦瑟曼发明了梅毒血液检测，在 1917 年找到了治疗方法。朱利叶斯·冯·瓦格纳-约尔吉格注意到患有一般性麻痹并感染疟疾的患者症状有所恢复。为了测试这个假设，他向九名患者注射了患有疟疾的士兵的血液。三名患者完全康复，另外三名患者在麻痹症状上有了显著改善。疟疾引起的高烧烧毁了梅毒细菌。美国医院从 1925 年开始将这种新的治疗麻痹症的方法纳入其治疗方案中。

Also noteworthy was the work of American psychiatrist John P. Grey. Appointed as superintendent of the Utica State Hospital in New York, Grey asserted that insanity always had a physical cause. As such, the mentally ill should be seen as physically ill and treated with rest, proper room temperature and ventilation, and a nutritive diet.
美国精神病学家约翰·P·格雷的工作也值得关注。他被任命为纽约尤蒂卡州立医院的院长，格雷坚称疯狂总是有生理原因。因此，精神疾病患者应被视为身体疾病患者，并应通过休息、适当的室内温度和通风以及营养饮食来治疗。

The 1930s also saw the use of electric shock as a treatment method, which was stumbled upon accidentally by Benjamin Franklin while experimenting with electricity in the early 18th century. He noticed that after suffering a severe shock his memories had changed, and in published work, he suggested physicians study electric shock as a treatment for melancholia.
20 世纪 30 年代还出现了电击作为一种治疗方法，这是本杰明·富兰克林在 18 世纪初实验电时意外发现的。他注意到，在遭受严重电击后，他的记忆发生了变化，并在他的出版物中建议医生研究电击作为治疗忧郁症的方法。

1.4.6.2. Psychological or Psychogenic Perspective.1.4.6.2. 心理或心理原性视角。

The **psychological or psychogenic perspective **states that emotional or psychological factors are the cause of mental disorders and represented a challenge to the biological perspective. This perspective had a long history but did not gain favor until the work of Viennese physician Franz Anton Mesmer (1734-1815). Influenced heavily by Newton’s theory of gravity, he believed that the planets also affected the human body through the force of animal magnetism and that all people had a universal magnetic fluid that determined how healthy they were. He demonstrated the usefulness of his approach when he cured Franzl Oesterline, a 27-year-old woman suffering from what he described as a convulsive malady. Mesmer used a magnet to disrupt the gravitational tides that were affecting his patient and produced a sensation of the magnetic fluid draining from her body. This procedure removed the illness from her body and provided a near-instantaneous recovery. In reality, the patient was placed in a trancelike state which made her highly suggestible. With other patients, Mesmer would have them sit in a darkened room filled with soothing music, into which he would enter dressed in a colorful robe and pass from person to person touching the afflicted area of their body with his hand or a rod/wand. He successfully cured deafness, paralysis, loss of bodily feeling, convulsions, menstrual difficulties, and blindness.
心理或心理原性视角认为情绪或心理因素是精神障碍的原因，这向生物视角提出了挑战。这种视角有着悠久的历史，但直到维也纳医生弗朗茨·安东·梅斯梅尔（1734-1815）的工作才受到青睐。受到牛顿引力理论的强烈影响，他相信行星也通过动物磁力的力量影响人体，并且所有人都有一种普遍的磁性流体，这种流体决定了他们的健康状况。当他治愈了 27 岁的女性弗朗茨尔·奥斯特林，她患有他描述为痉挛性疾病时，他展示了他的方法的有效性。梅斯梅尔使用磁铁来干扰影响他的病人的引力潮汐，并产生磁性流体从她体内排出的感觉。这种程序从她体内移除了疾病，并提供了近乎瞬间的恢复。实际上，病人被置于一种类似催眠的状态，这使得她非常容易受暗示。与其他病人不同，梅斯梅尔会让他们坐在一个充满舒缓音乐的昏暗房间里，他会穿着五彩斑斓的长袍进入，从一个人走到另一个人，用手或魔杖触摸他们身体上的不适部位。他成功地治愈了聋哑、瘫痪、身体感觉丧失、抽搐、月经困难以及失明。

His approach gained him celebrity status as he demonstrated it at the courts of English nobility. However, the medical community was hardly impressed. A royal commission was formed to investigate his technique but could not find any proof for his theory of animal magnetism. Though he was able to cure patients when they touched his “magnetized” tree, the result was the same when “non-magnetized” trees were touched. As such, Mesmer was deemed a charlatan and forced to leave Paris. His technique was called mesmerism, better known today as hypnosis.
他的方法使他获得了名人的地位，因为他曾在英国贵族的法庭上展示它。然而，医学界几乎没有留下印象。成立了一个皇家委员会来调查他的技术，但无法找到任何证明他动物磁气理论的证据。尽管他在病人触摸他的“磁化”树时能够治愈他们，但当触摸“非磁化”的树时，结果是一样的。因此，梅斯梅尔被认为是一个江湖骗子，被迫离开巴黎。他的技术被称为梅斯梅尔术，今天更广为人知的是催眠术。

The psychological perspective gained popularity after two physicians practicing in the city of Nancy in France discovered that they could induce the symptoms of hysteria in perfectly healthy patients through hypnosis and then remove the symptoms in the same way. The work of Hippolyte-Marie Bernheim (1840-1919) and Ambroise-Auguste Liebault (1823-1904) came to be part of what was called the Nancy School and showed that hysteria was nothing more than a form of self-hypnosis. In Paris, this view was challenged by Jean Charcot (1825-1893), who stated that hysteria was caused by degenerative brain changes, reflecting the biological perspective. He was proven wrong and eventually turned to their way of thinking.
法国南希市的两位医生发现，他们可以通过催眠诱导完全健康的患者出现歇斯底里的症状，并以同样的方式消除这些症状，这种心理视角因此获得了普及。希波利特-玛丽·贝尔海姆（1840-1919）和安布罗斯-奥古斯特·利巴乌（1823-1904）的工作成为了所谓的南希学派的一部分，并表明歇斯底里不过是一种自我催眠的形式。在巴黎，这种观点受到了让·夏尔科（1825-1893）的挑战，他认为歇斯底里是由大脑退行性变化引起的，反映了生物学的视角。他最终被证明是错误的，并最终转向了他们的思维方式。

The use of hypnosis to treat hysteria was also carried out by fellow Frenchman Pierre Janet (1859-1947), and student of Charcot, who believed that hysteria had psychological, not biological causes. Namely, these included unconscious forces, fixed ideas, and memory impairments. In Vienna, Josef Breuer (1842-1925) induced hypnosis and had patients speak freely about past events that upset them. Upon waking, he discovered that patients sometimes were free of their symptoms of hysteria. Success was even greater when patients not only recalled forgotten memories but also relived them emotionally. He called this the cathartic method, and our use of the word catharsis today indicates a purging or release, in this case, of pent-up emotion.
催眠治疗歇斯底里的方法也被法国同行皮埃尔·让内（1859-1947）所采用，他是沙可的学生，认为歇斯底里是由心理而非生物原因引起的。具体来说，这包括无意识的力量、固定的观念和记忆障碍。在维也纳，约瑟夫·布吕尔（1842-1925）诱导催眠，让患者自由地谈论令他们不安的过去事件。醒来后，他发现患者有时会摆脱歇斯底里的症状。当患者不仅回忆起遗忘的记忆，而且情感上重新体验它们时，成功更大。他称之为净化法，而我们今天使用“净化”一词，意味着一种净化或释放，在这种情况下，是压抑情感的释放。

By the end of the 19th century, it had become evident that mental disorders were caused by a combination of biological and psychological factors, and the investigation of how they develop began. Sigmund Freud’s development of psychoanalysis followed on the heels of the work of Bruner, and others who came before him.
19 世纪末，精神疾病是由生物和心理因素共同作用的结果变得明显，对其发展机制的探究也随之开始。弗洛伊德对精神分析的发展紧随布鲁纳以及其他在他之前的研究者的工作之后。

1.4.7. Current Views/Trends 1.4.7. 当前观点/趋势

1.4.7.1. Mental illness today.1.4.7.1. 当今精神疾病。

An article published by the Harvard Medical School in March 2014 called “The Prevalence and Treatment of Mental Illness Today” presented the results of the National Comorbidity Study Replication of 2001-2003, which included a sample of more than 9,000 adults. The results showed that nearly 46% of the participants had a psychiatric disorder at some time in their lives. The most commonly reported disorders were:
2014 年 3 月哈佛医学院发表的一篇文章《当今精神疾病的流行与治疗》介绍了 2001-2003 年国家共病研究复制的成果，该研究包括了一个超过 9000 名成年人的样本。结果显示，近 46%的参与者在其一生中的某个时期有过精神疾病。最常见的疾病包括：

Major depression – 17%
重度抑郁症 - 17%
Alcohol abuse – 13%
酒精滥用 - 13%
Social anxiety disorder – 12%
社交焦虑症 - 12%
Conduct disorder – 9.5%
品行障碍 - 9.5%

Also of interest was that women were more likely to have had anxiety and mood disorders while men showed higher rates of impulse control disorders. Comorbid anxiety and mood disorders were common, and 28% reported having more than one co-occurring disorder (Kessler, Berglund, et al., 2005; Kessler, Chiu, et al., 2005; Kessler, Demler, et al., 2005).
女性更容易患有焦虑和情绪障碍，而男性则表现出更高的冲动控制障碍发生率。共病焦虑和情绪障碍很常见，28%的人报告说他们同时患有多种疾病（Kessler, Berglund, 等人，2005；Kessler, Chiu, 等人，2005；Kessler, Demler, 等人，2005）。

About 80% of the sample reported seeking treatment for their disorder, but with as much as a 10-year gap after symptoms first appeared. Women were more likely than men to seek help while whites were more likely than African and Hispanic Americans (Wang, Berglund, et al., 2005; Wang, Lane, et al., 2005). Care was sought primarily from family doctors, nurses, and other general practitioners (23%), followed by social workers and psychologists (16%), psychiatrists (12%), counselors or spiritual advisers (8%), and complementary and alternative medicine providers (CAMs; 7%).
关于 80%的样本报告称他们寻求治疗自己的疾病，但症状首次出现后可能有长达 10 年的间隔。女性比男性更有可能寻求帮助，而白人比非洲裔和西班牙裔美国人更有可能寻求帮助（王、伯格伦德等，2005；王、莱恩等，2005）。主要从家庭医生、护士和其他全科医生（23%）寻求护理，其次是社会工作者和心理学家（16%）、精神科医生（12%）、顾问或精神顾问（8%），以及补充和替代医学提供者（CAMs；7%）。

In terms of the quality of the care, the article states:
关于护理质量，文章指出：

Most of this treatment was inadequate, at least by the standards applied in the survey. The researchers defined minimum adequacy as a suitable medication at a suitable dose for two months, along with at least four visits to a physician; or else eight visits to any licensed mental health professional. By that definition, only 33% of people with a psychiatric disorder were treated adequately, and only 13% of those who saw general medical practitioners.
大多数这种治疗都不充分，至少按照调查中应用的标准来看是这样。研究人员将最低充分性定义为适合的药物和适合的剂量连续两个月，以及至少四次看医生；否则为任何有执照的心理健康专业人士看八次病。按照这个定义，只有 33%的精神疾病患者得到了充分治疗，而只有 13%看过普通医疗医生的人得到了治疗。

In comparison to the original study conducted from 1991-1992, the use of mental health services has increased over 50% during this decade. This may be attributed to treatment becoming more widespread and increased attempts to educate the public about mental illness. Stigma, discussed in Section 1.3, has reduced over time, diagnosis is more effective, community outreach programs have increased, and most importantly, general practitioners have been more willing to prescribe psychoactive medications which themselves are more readily available now. The article concludes, “Survey researchers also suggest that we need more outreach and voluntary screening, more education about mental illness for the public and physicians, and more effort to treat substance abuse and impulse control disorders.” We will explore several of these issues in the remainder of this section, including the use of psychiatric drugs and deinstitutionalization, managed health care, private psychotherapy, positive psychology and prevention science, multicultural psychology, and prescription rights for psychologists.
与 1991-1992 年进行的原始研究相比，在这十年中，心理健康服务的使用增加了 50%以上。这可能是由于治疗变得更加普遍，以及公众对精神疾病的教育尝试增加。在第 1.3 节中讨论的耻辱感随着时间的推移而减少，诊断更加有效，社区外展项目增加，最重要的是，普通医生更愿意开具精神活性药物，这些药物现在也更容易获得。文章总结道：“调查研究人员还建议，我们需要更多的外展和自愿筛查，公众和医生对精神疾病的教育更多，以及更多努力治疗物质滥用和冲动控制障碍。”在本节的剩余部分，我们将探讨这些问题中的几个，包括精神药物的使用和去机构化，管理型医疗保健，私人心理治疗，积极心理学和预防科学，跨文化心理学，以及心理学家的处方权。

1.4.7.2. Use of psychiatric drugs and deinstitutionalization. 1.4.7.2. 精神药物的使用和去机构化。

Beginning in the 1950s, psychiatric or psychotropic drugs were used for the treatment of mental illness and made an immediate impact. Though drugs alone cannot cure mental illness, they can improve symptoms and increase the effectiveness of treatments such as psychotherapy. Classes of psychiatric drugs include anti-depressants used to treat depression and anxiety, mood-stabilizing medications to treat bipolar disorder, anti-psychotic drugs to treat schizophrenia, and anti-anxiety drugs to treat generalized anxiety disorder or panic disorder
从 20 世纪 50 年代开始，精神药物或精神活性药物被用于治疗精神疾病，并立即产生了影响。尽管药物本身不能治愈精神疾病，但它们可以改善症状并提高心理治疗等治疗方法的有效性。精神药物类别包括用于治疗抑郁症和焦虑的抗抑郁药、用于治疗双相情感障碍的情绪稳定剂、用于治疗精神分裂症的抗精神病药以及用于治疗广泛性焦虑症或恐慌症的抗焦虑药。

Frank (2006) found that by 1996, psychotropic drugs were used in 77% of mental health cases and spending on these drugs grew from $2.8 billion in 1987 to about $18 billion in 2001 (Coffey et al., 2000; Mark et al., 2005), representing over a sixfold increase. The largest classes of psychotropic drugs are anti-psychotics and anti-depressants, followed closely by anti-anxiety medications. Frank, Conti, and Goldman (2005) point out, “The expansion of insurance coverage for prescription drugs, the introduction and diffusion of managed behavioral health care techniques, and the conduct of the pharmaceutical industry in promoting their products all have influenced how psychotropic drugs are used and how much is spent on them.” Is it possible then that we are overprescribing these mediations? Davey (2014) provides ten reasons why this may be so, including leading suffers from believing that recovery is in their hands but instead in the hands of their doctors; increased risk of relapse; drug companies causing the “medicalization of perfectly normal emotional processes, such as bereavement” to ensure their survival; side effects; and a failure to change the way the person thinks or the socioeconomic environments that may be the cause of the disorder. For more on this article, please see: https://www.psychologytoday.com/blog/why-we-worry/201401/overprescribing-drugs-treat-mental-health-problems. Smith (2012) echoed similar sentiments in an article on inappropriate prescribing. He cites the approval of Prozac by the Food and Drug Administration (FDA) in 1987 as when the issue began and the overmedication/overdiagnosis of children with ADHD as a more recent example.
弗兰克（2006）发现，到 1996 年，77%的精神健康病例使用了精神药物，这些药物的开支从 1987 年的 28 亿美元增长到 2001 年约 180 亿美元（Coffey 等人，2000 年；Mark 等人，2005 年），增长了六倍以上。最大的精神药物类别是抗精神病药和抗抑郁药，其次是抗焦虑药物。Frank、Conti 和 Goldman（2005）指出：“处方药保险范围的扩大、管理式行为健康护理技术的引入和推广以及制药行业在推广其产品方面的行为，都影响了精神药物的使用方式和支出。”那么，我们是否过度开具这些药物呢？戴维（2014）提供了十个可能的原因，包括主要患者相信康复掌握在自己手中，但实际上在医生手中；复发的风险增加；制药公司导致“医疗化”完美正常的情绪过程，如丧亲之痛，以确保其生存；副作用；以及未能改变个人的思维方式或可能引起该疾病的社经环境。有关本文的更多信息，请参阅：https://www.psychologytoday.com/blog/why-we-worry/201401/overprescribing-drugs-treat-mental-health-problems。史密斯（2012）在一篇关于不适当处方的文章中表达了类似的观点。他引用了美国食品药品监督管理局（FDA）在 1987 年批准百忧解作为问题开始的时候，以及将儿童多动症过度用药/过度诊断作为更近期的例子。

A result of the use of psychiatric drugs was deinstitutionalization, or the release of patients from mental health facilities. This shifted resources from inpatient to outpatient care and placed the spotlight back on the biological or somatogenic perspective. When people with severe mental illness do need inpatient care, it is typically in the form of short-term hospitalization.
精神药物的使用导致去机构化，即患者从心理健康设施中释放出来。这导致资源从住院护理转向门诊护理，并将焦点重新放在生物学或躯体发生学观点上。当严重精神疾病患者确实需要住院护理时，通常是短期住院的形式。

1.4.7.3. Managed health care.1.4.7.3. 管理型医疗保健。

Managed health care is a term used to describe a type of health insurance in which the insurance company determines the cost of services, possible providers, and the number of visits a subscriber can have within a year. This is regulated through contracts with providers and medical facilities. The plans pay the providers directly, so subscribers do not have to pay out-of-pocket or complete claim forms, though most require co-pays paid directly to the provider at the time of service. Exactly how much the plan costs depends on how flexible the subscriber wants it to be; the more flexibility, the higher the cost. Managed health care takes three forms:
管理型医疗保健是指一种医疗保险类型，保险公司决定服务费用、可能的提供者和投保人在一年内可以访问的次数。这是通过与提供者和医疗机构签订合同来监管的。计划直接向提供者付款，因此投保人无需自付现金或填写索赔表格，尽管大多数计划要求在服务时直接向提供者支付共付费用。计划的具体费用取决于投保人希望其有多大的灵活性；灵活性越高，费用越高。管理型医疗保健有三种形式：

Health Maintenance Organizations (HMO) – Typically only pay for care within the network. The subscriber chooses a primary care physician (PCP) who coordinates most of their care. The PCP refers the subscriber to specialists or other health care providers as is necessary. This is the most restrictive option.
健康维护组织（HMO）- 通常只支付网络内的护理费用。订阅者选择一位初级保健医师（PCP），该医师协调大部分护理。PCP 根据需要将订阅者推荐给专科医生或其他医疗服务提供者。这是最限制性的选择。
Preferred Provider Organizations (PPO) – Usually pay more if the subscriber obtains care within the network, but if care outside the network is sought, they cover part of the cost.
优选提供者组织（PPO）- 如果参保人在网络内获得护理，通常支付更多，但如果在网络上寻求护理，则部分承担费用。
Point of Service (POS) – These plans provide the most flexibility and allow the subscriber to choose between an HMO or a PPO each time care is needed.
服务点（POS）- 这些计划提供最大的灵活性，允许订阅者在每次需要护理时选择 HMO 或 PPO。

Regarding the treatment needed for mental illness, managed care programs regulate the pre-approval of treatment via referrals from the PCP, determine which mental health providers can be seen, and oversee which conditions can be treated and what type of treatment can be delivered. This system was developed in the 1980s to combat the rising cost of mental health care and took responsibility away from single practitioners or small groups who could charge what they felt was appropriate. The actual impact of managed care on mental health services is still questionable at best.
关于治疗精神疾病所需的治疗，管理护理计划通过 PCP 的转诊来规范治疗的预先批准，确定可以看哪些心理健康提供者，并监督哪些条件可以治疗以及可以提供什么类型的治疗。该系统于 20 世纪 80 年代开发，旨在应对精神健康护理成本的上升，并将责任从单个人或小团体中移除，他们可以收取他们认为合适的服务费用。管理护理对精神健康服务实际影响的最大疑问。

1.4.7.4. Multicultural psychology.1.4.7.4. 多元文化心理学。

As our society becomes increasingly diverse, medical practitioners and psychologists alike must take into account the patient’s gender, age, race, ethnicity, socioeconomic (SES) status, and culture and how these factors shape the individual’s thoughts, feelings, and behaviors. Additionally, we need to understand how the various groups, whether defined by race, culture, or gender, differ from one another. This approach is called multicultural psychology.
随着我们的社会日益多元化，医疗从业者和精神病学家都必须考虑患者的性别、年龄、种族、民族、社会经济（SES）状况以及文化，以及这些因素如何塑造个人的思想、情感和行为。此外，我们还需要了解各种群体，无论是由种族、文化还是性别定义的，彼此之间有何不同。这种做法被称为多元文化心理学。

In August 2002, the American Psychological Association’s (APA) Council of Representatives put forth six guidelines based on the understanding that “race and ethnicity can impact psychological practice and interventions at all levels” and the need for respect and inclusiveness. They further state, “psychologists are in a position to provide leadership as agents of prosocial change, advocacy, and social justice, thereby promoting societal understanding, affirmation, and appreciation of multiculturalism against the damaging effects of individual, institutional, and societal racism, prejudice, and all forms of oppression based on stereotyping and discrimination.” The guidelines from the 2002 document are as follows:
2002 年 8 月，美国心理学会（APA）的理事会提出六项指导方针，基于对“种族和民族可以影响所有层面的心理实践和干预”以及尊重和包容性的认识。他们进一步声明：“心理学家作为促进社会变革、倡导和社会正义的代理人，处于提供领导力的位置，从而促进社会对多元文化的理解、肯定和欣赏，对抗个人、制度和基于刻板印象和歧视的社会压迫的破坏性影响。”2002 年文件中的指导方针如下：

“Guideline #1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves.
指南#1：鼓励心理学家认识到，作为文化存在者，他们可能持有可能有害影响他们对与自己种族和民族不同的人的感知和互动的态度和信念。
Guideline #2: Psychologists are encouraged to recognize the importance of multicultural sensitivity/responsiveness, knowledge, and understanding about ethnically and racially different individuals.
指南#2：鼓励心理学家认识到对来自不同种族和民族个体在文化上敏感/反应性、知识和理解的重要性。
Guideline #3: As educators, psychologists are encouraged to employ the constructs of multiculturalism and diversity in psychological education.
指南#3：作为教育工作者，心理学家被鼓励在心理学教育中运用多元文化和多样性的结构。
Guideline #4: Culturally sensitive psychological researchers are encouraged to recognize the importance of conducting culture–centered and ethical psychological research among persons from ethnic, linguistic, and racial minority backgrounds.
指南#4：鼓励具有文化敏感性的心理学研究人员认识到，在来自民族、语言和种族少数群体的人员中开展以文化为中心和道德的心理学研究的重要性。
Guideline #5: Psychologists strive to apply culturally-appropriate skills in clinical and other applied psychological practices.
指南 #5：心理学家努力在临床和其他应用心理学实践中运用文化适宜的技能。
Guideline #6: Psychologists are encouraged to use organizational change processes to support culturally informed organizational (policy) development and practices.”
指南#6：鼓励心理学家使用组织变革流程来支持文化知情型组织（政策）发展和实践。”

*Source: *https://apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx
来源：https://apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx

This type of sensitivity training is vital because bias based on ethnicity, race, and culture has been found in the diagnosis and treatment of autism (Harrison et al., 2017; Burkett, 2015), borderline personality disorder (Jani et al., 2016), and schizophrenia (Neighbors et al., 2003; Minsky et al., 2003). Despite these findings, Schwartz and Blankenship (2014) state, “It should also be noted that although clear evidence supports a longstanding trend in differential diagnoses according to consumer race, this trend does not imply that one race (e.g., African Americans) actually demonstrate more severe symptoms or higher prevalence rates of psychosis compared with other races (e.g., Euro-Americans). Because clinicians are the diagnosticians and misinterpretation, bias or other factors may play a role in this trend caution should be used when making inferences about actual rates of psychosis among ethnic minority persons.” Additionally, white middle-class help seekers were offered appointments with psychotherapists almost three times as often as their black working-class counterparts. Women were offered an appointment time in their preferred time range more than men were, though average appointment offer rates were similar between genders (Kugelmass, 2016). These findings collectively show that though we are becoming more culturally sensitive, we have a lot more work to do.
这种敏感性培训至关重要，因为研究发现，在自闭症（Harrison 等人，2017；Burkett，2015）、边缘型人格障碍（Jani 等人，2016）和精神分裂症（Neighbors 等人，2003；Minsky 等人，2003）的诊断和治疗中存在基于种族、民族和文化差异的偏见。尽管有这些发现，Schwartz 和 Blankenship（2014）表示，“还应指出，尽管有明确的证据支持根据消费者种族进行差异诊断的长期趋势，但这种趋势并不意味着某一种族（例如，非裔美国人）实际上表现出更严重的症状或精神分裂症的更高发病率，与其他种族（例如，欧洲裔美国人）相比。因为临床医生是诊断者，误解、偏见或其他因素可能在这种趋势中发挥作用，因此在推断少数民族人群实际精神分裂症发病率时应该谨慎。”此外，白人中产阶级寻求帮助的人几乎有三次预约心理治疗师的机会，比他们的黑人工人阶级同行多。女性比男性更有可能被安排在她们偏好的时间段内，尽管男女之间的平均预约提供率相似（Kugelmass，2016）。这些发现共同表明，尽管我们越来越具有文化敏感性，但我们还有更多的工作要做。

1.4.7.5. Prescription rights for psychologists. 1.4.7.5. 心理学家处方权。

To reduce inappropriate prescribing as described in 1.4.7.2, it has been proposed to allow appropriately trained psychologists the right to prescribe. Psychologists are more likely to utilize both therapy and medication, and so can make the best choice for their patient. The right has already been granted in New Mexico, Louisiana, Guam, the military, the Indian Health Services, and the U.S. Public Health Services. Measures in other states “have been opposed by the American Medical Association and American Psychiatric Association over concerns that inadequate training of psychologists could jeopardize patient safety. Supporters of prescriptive authority for psychologists are quick to point out that there is no evidence to support these concerns” (Smith, 2012).
为了减少 1.4.7.2 中描述的不当处方，建议允许适当培训的心理学家拥有处方权。心理学家更有可能同时使用治疗和药物，因此可以为他们的患者做出最佳选择。新墨西哥州、路易斯安那州、关岛、军队、美国印第安人卫生服务和美国公共卫生服务已经授予了这一权利。其他州的措施“因担心心理学家培训不足可能危及患者安全，遭到美国医学协会和美国精神病学协会的反对。支持心理学家处方权的支持者迅速指出，没有证据支持这些担忧”（史密斯，2012）。

1.4.7.6. Prevention science.1.4.7.6. 预防科学。

As a society, we used to wait for a mental or physical health issue to emerge, then scramble to treat it. More recently, medicine and science has taken a **prevention **stance, identifying the factors that cause specific mental health issues and implementing interventions to stop them from happening, or at least minimize their deleterious effects. Our focus has shifted from individuals to the population. Mental health promotion programs have been instituted with success in schools (Shoshani & Steinmetz, 2014; Weare & Nind, 2011; Berkowitz & Beer, 2007), in the workplace (Czabała, Charzyńska, & Mroziak, B., 2011), with undergraduate and graduate students (Conley et al., 2017; Bettis et al., 2016), in relation to bullying (Bradshaw, 2015), and with the elderly (Forsman et al., 2011). Many researchers believe it is the ideal time to move from knowledge to action and to expand public mental health initiatives (Wahlbeck, 2015). The growth of positive psychology in the late 1990s has further propelled this movement forward. For more on positive psychology, please see Section 1.1.1.
作为一个社会，我们过去常常等待心理或身体健康问题出现，然后匆忙治疗。最近，医学和科学采取了预防立场，确定了导致特定心理健康问题的因素，并实施干预措施以阻止它们发生，或者至少最小化其有害影响。我们的关注点已从个体转向人群。在学校（Shoshani & Steinmetz，2014；Weare & Nind，2011；Berkowitz & Beer，2007）、工作场所（Czabała，Charzyńska，& Mroziak B.，2011）、本科生和研究生（Conley 等，2017；Bettis 等，2016）、欺凌（Bradshaw，2015）以及老年人（Forsman 等，2011）中已经成功实施了心理健康促进计划。许多研究人员认为，现在是把知识转化为行动并扩大公众心理健康倡议的理想的时机（Wahlbeck，2015）。20 世纪 90 年代末积极心理学的兴起进一步推动了这一运动。有关积极心理学的更多信息，请参阅第 1.1.1 节。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

Some of the earliest views of mental illness saw it as the work of evil spirts, demons, gods, or witches who took control of the person, and in the Middle Ages it was seen as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of demonic influence.
一些最早的关于精神病的看法认为它是邪恶精灵、恶魔、神或女巫控制人的行为，在中世纪，它被视为魔鬼附身，使用诸如驱魔、鞭打、祈祷、触摸圣物、吟唱、参观圣地和圣水等方法来消除人的恶魔影响。
During the Renaissance, humanism was on the rise which emphasized human welfare and the uniqueness of the individual and led to an increase in the number of asylums as places of refuge for the mentally ill.
在文艺复兴时期，人文主义兴起，强调人类福祉和个体的独特性，导致精神病院作为精神疾病患者的庇护所数量增加。
The 18th to 19th centuries saw the rise of the moral treatment movement followed by the mental hygiene movement.
18 世纪至 19 世纪见证了道德治疗运动的兴起，随后是心理健康运动。
The psychological or psychogenic perspective states that emotional or psychological factors are the cause of mental disorders and represented a challenge to the biological perspective which said that mental disorders were akin to physical disorders and had natural causes.
心理或心理原发视角认为，情绪或心理因素是精神障碍的原因，这向生物视角提出了挑战，后者认为精神障碍类似于身体疾病，有自然原因。
Psychiatric or psychotropic drugs used to treat mental illness became popular beginning in the 1950s and led to deinstitutionalization or a shift from inpatient to outpatient care.
精神病或精神药物用于治疗精神疾病，从 20 世纪 50 年代开始流行，导致了去机构化或从住院到门诊护理的转变。

Section 1.4 Review Questions
第 1.4 节复习题

How has mental illness been viewed across time?
如何看待历史上的精神疾病？
Contrast the moral treatment and mental hygiene movements.
对比道德治疗和精神卫生运动。
Contrast the biological or somatogenic perspective with that of the psychological or psychogenic perspective.
对比生物学或躯体发生视角与心理学或心理发生视角。
Discuss contemporary trends in relation to the use of drugs to treat mental illness, deinstitutionalization, managed health care, multicultural psychology, prescription rights for psychologists, and prevention science.
讨论与药物治疗精神疾病、去机构化、管理型医疗保健、跨文化心理学、心理学家的处方权以及预防科学相关的当代趋势。

1.5. Research Methods in Psychopathology 1.5. 精神病学的研究方法

Section Learning Objectives 章节学习目标

Define the scientific method.
定义科学方法。
Outline and describe the steps of the scientific method, defining all key terms.
概述并描述科学方法的步骤，定义所有关键术语。
Identify and clarify the importance of the three cardinal features of science.
确定并阐明科学三大基本特征的重要性。
List the five main research methods used in psychology.
列出心理学中使用的五种主要研究方法。
Describe observational research, listing its advantages and disadvantages.
描述观察性研究，列举其优缺点。
Describe case study research, listing its advantages and disadvantages.
描述案例研究，列出其优缺点。
Describe survey research, listing its advantages and disadvantages.
描述调查研究的优缺点。
Describe correlational research, listing its advantages and disadvantages.
描述相关性研究，列举其优缺点。
Describe experimental research, listing its advantages and disadvantages.
描述实验研究，列出其优缺点。
State the utility and need for multimethod research.
阐述多方法研究的效用和必要性。

1.5.1. The Scientific Method 1.5.1. 科学方法

Psychology is the “scientific study of behavior and mental processes.” We will spend quite a lot of time on the behavior and mental processes part throughout this book and in relation to mental disorders. Still, before we proceed, it is prudent to further elaborate on what makes psychology scientific. It is safe to say that most people outside of our discipline or a sister science would be surprised to learn that psychology utilizes the scientific method at all. That may be even truer of clinical psychology, especially in light of the plethora of self-help books found at any bookstore. But yes, the treatment methods used by mental health professionals are based on empirical research and the scientific method.
心理学是“对行为和心理过程的科学研究。”在这本书中，我们将花费大量时间讨论行为和心理过程部分，以及与精神疾病相关的内容。然而，在继续之前，进一步阐述使心理学成为科学的原因是明智的。可以说，大多数非我们学科或姐妹学科的人都会惊讶地发现心理学竟然使用了科学方法。这一点在临床心理学中可能更为明显，尤其是在考虑到书店里充斥着各种自助书籍的情况下。但确实，心理健康专业人士使用的治疗方法是基于实证研究和科学方法的。

As a starting point, we should expand on what the scientific method is.
作为一个起点，我们应该扩展科学方法是什么。

The scientific method is a systematic method for gathering knowledge about the world around us.
科学方法是获取我们周围世界知识的一种系统方法。

The keyword here is systematic, meaning there is a set way to use it. What is that way? Well, depending on what source you look at, it can include a varying number of steps. I like to use the following:
这里的重点是系统性的，意味着有固定的使用方式。那是什么方式呢？嗯，根据你参考的来源不同，可能包括不同数量的步骤。我喜欢使用以下方法：

Table 1.1: The Steps of the Scientific Method
表 1.1：科学方法步骤

Step 步骤	Name 命名	Description 描述
0	Ask questions and be willing to wonder. 提出问题，并愿意去思考。	To study the world around us, you have to wonder about it. This inquisitive nature is the hallmark of critical thinking —our ability to assess claims made by others and make objective judgments that are independent of emotion and anecdote and based on hard evidence —and a requirement to be a scientist. 为了研究我们周围的世界，你必须对其感到好奇。这种好奇心是批判性思维的标志——我们评估他人提出的论断并做出不受情感和轶事影响、基于坚实证据的客观判断的能力——以及成为一名科学家的必备条件。
1	Generate a research question or identify a problem to investigate. 生成一个研究问题或确定一个要调查的问题。	Through our wonderment about the world around us and why events occur as they do, we begin to ask questions that require further investigation to arrive at an answer. This investigation usually starts with a literature review, or when we conduct a literature search through our university library or a search engine such as Google Scholar to see what questions have been investigated already and what answers have been found, so that we can identify gaps or holes in this body of work. 通过我们对周围世界及其发生原因的惊奇，我们开始提出需要进一步调查以得出答案的问题。这种调查通常从文献综述开始，或者当我们通过大学图书馆或谷歌学术等搜索引擎进行文献搜索，看看已经研究了哪些问题以及找到了什么答案，以便我们能够确定这一研究领域中的空白或不足。
2	Attempt to explain the phenomena we wish to study. 尝试解释我们希望研究的现象。	We now attempt to formulate an explanation of why the event occurs as it does. This systematic explanation of a phenomenon is a theory and our specific, testable prediction is the hypothesis. We will know if our theory is correct because we have formulated a hypothesis that we can now test. 我们现在试图解释为什么事件会以这种方式发生。这种现象的系统解释是一种理论，我们具体的、可测试的预测是假设。我们将知道我们的理论是否正确，因为我们已经制定了一个可以现在测试的假设。
3	Test the hypothesis. 测试假设。	It goes without saying that if we cannot test our hypothesis, then we cannot show whether our prediction is correct or not. Our plan of action of how we will go about testing the hypothesis is called our research design. In the planning stage, we will select the appropriate research method to answer our question/test our hypothesis. 不言而喻，如果我们不能测试我们的假设，那么我们无法证明我们的预测是正确还是错误。我们如何测试假设的行动计划被称为我们的研究设计。在规划阶段，我们将选择适当的研究方法来回答我们的问题/测试我们的假设。
4	Interpret the results. 解释结果。	With our research study done, we now examine the data to see if the pattern we predicted exists. We need to see if a cause and effect statement can be made, assuming our method allows for this inference. More on this in Section 2.3. For now, it is essential to know that statistics have two forms. First, there are descriptive statistics which provide a means of summarizing or describing data and presenting the data in a usable form. You likely have heard of mean or average, median, and mode. Along with standard deviation and variance, these are ways to describe our data. Second, there are inferential statistics that allow for the analysis of two or more sets of numerical data to determine the statistical significance of the results. Significance is an indication of how confident we are that our results are due to our manipulation or design and not chance. 我们的研究完成后，我们现在检查数据以查看我们预测的模式是否存在。我们需要看看是否可以做出因果关系陈述，假设我们的方法允许这种推理。关于这一点，请参阅第 2.3 节。目前，了解统计学有两种形式是至关重要的。首先，有描述性统计，它提供了一种总结或描述数据以及以可使用形式呈现数据的方法。你很可能听说过平均值或平均数、中位数和众数。与标准差和方差一样，这些都是描述我们数据的方式。其次，有推断性统计，它允许分析两个或多个数值数据集，以确定结果的统计显著性。显著性是我们对我们结果是由于我们的操作或设计而不是偶然性的信心程度的指示。
5	Draw conclusions carefully. 谨慎得出结论。	We need to interpret our results accurately and not overstate our findings. To do this, we need to be aware of our biases and avoid emotional reasoning so that they do not cloud our judgment. How so? In our effort to stop a child from engaging in self-injurious behavior that could cause substantial harm or even death, we might overstate the success of our treatment method. 我们需要准确解读我们的结果，不要夸大我们的发现。为此，我们需要意识到我们的偏见，避免情绪化推理，以免它们影响我们的判断。如何做到这一点？在我们努力阻止孩子从事可能造成严重伤害甚至死亡的自残行为时，我们可能会夸大我们治疗方法的成功率。
6	Communicate our findings to the broader scientific community. 与更广泛的科学界沟通我们的发现。	Once we have decided on whether our hypothesis was correct or not, we need to share this information with others so that they might comment critically on our methodology, statistical analyses, and conclusions. Sharing also allows for replication or repeating the study to confirm its results. Communication occurs via scientific journals, conferences, or newsletters released by many of the organizations mentioned in Module 1.6. 一旦我们决定我们的假设是否正确，我们就需要与他人分享这一信息，以便他们可以对我们进行研究方法、统计分析以及结论进行批判性评论。分享还允许重复研究以确认其结果。沟通通过科学期刊、会议或许多在 1.6 模块中提到的组织发布的通讯进行。

Science has at its root three cardinal features that we will see play out time and time again throughout this book. They are:
科学在其根源处有三个基本特征，我们将在整本书中反复看到它们发挥作用。它们是：

Observation – To know about the world around us, we have to be able to see it firsthand. When a mental disorder afflicts an individual, we can see it through their overt behavior. An individual with depression may withdraw from activities he/she enjoys, those with social anxiety disorder will avoid social situations, people with schizophrenia may express concern over being watched by the government, and individuals with dependent personality disorder may leave major decisions to trusted companions. In these examples and numerous others, the behaviors that lead us to a diagnosis of a specific disorder can easily be observed by the clinician, the patient, and/or family and friends.
观察——要了解我们周围的世界，我们必须能够亲自看到它。当一种精神疾病困扰着一个人时，我们可以通过他们的明显行为来看到它。患有抑郁症的人可能会退出他/她喜欢的活动，患有社交焦虑症的人会避免社交场合，患有精神分裂症的人可能会表达对被政府监视的担忧，而患有依赖性人格障碍的人可能会将重大决定留给信任的伴侣。在这些例子和无数其他例子中，导致我们诊断出特定疾病的那些行为可以很容易地被临床医生、患者以及/或家人和朋友观察到。
Experimentation – To be able to make causal or cause and effect statements, we must isolate variables. We must manipulate one variable and see the effect of doing so on another variable. Let’s say we want to know if a new treatment for bipolar disorder is as effective as existing treatments, or more importantly, better. We could design a study with three groups of bipolar patients. One group would receive no treatment and serve as a control group. A second group would receive an existing and proven treatment and would also be considered a control group. Finally, the third group would receive the new treatment and be the experimental group. What we are manipulating is what treatment the groups get – no treatment, the older treatment, and the newer treatment. The first two groups serve as controls since we already know what to expect from their results. There should be no change in bipolar disorder symptoms in the no-treatment group, a general reduction in symptoms for the older treatment group, and the same or better performance for the newer treatment group. As long as patients in the newer treatment group do not perform worse than their older treatment counterparts, we can say the new drug is a success. You might wonder why we would get excited about the performance of the new drug being the same as the old drug. Does it really offer any added benefit? In terms of a reduction of symptoms, maybe not, but it could cost less money than the older drug and that would be of value to patients.
实验 – 要能够做出因果或原因和结果陈述，我们必须隔离变量。我们必须操纵一个变量，并观察这样做对另一个变量的影响。比如说，我们想知道针对双相情感障碍的新治疗方法是否与现有治疗方法一样有效，或者更重要的是，更有效。我们可以设计一项针对三组双相情感障碍患者的研究。一组将不接受治疗，作为对照组。第二组将接受现有的和经过验证的治疗，也将被视为对照组。最后，第三组将接受新的治疗方法，作为实验组。我们正在操纵的是各组接受的治疗 – 无治疗、较老的治疗和较新的治疗。前两组作为对照组，因为我们已经知道他们的结果会有什么。无治疗组的双相情感障碍症状应该没有变化，较老的治疗组症状应该有所减轻，较新的治疗组的性能应该相同或更好。只要新治疗方案组的患者表现不比他们的老治疗方案组更差，我们就可以说新药是成功的。你可能会想知道为什么我们会因为新药的表现与旧药相同而感到兴奋。它真的提供了任何额外的益处吗？在减少症状方面，可能没有，但它可能比旧药便宜，这对患者来说是有价值的。
Measurement – How do we know that the new drug has worked? Simply, we can measure the person’s bipolar disorder symptoms before any treatment was implemented, and then again once the treatment has run its course. This pre-post test design is typical in drug studies.
测量 - 我们如何知道新药有效？简单来说，我们可以在实施任何治疗之前测量该人的双相情感障碍症状，然后在治疗结束后再次测量。这种前后测试设计在药物研究中很典型。

1.5.2. Research Methods 1.5.2. 研究方法

Step 3 called on the scientist to test his or her hypothesis. Psychology as a discipline uses five main research designs. They are:
第三步要求科学家测试他的或她的假设。心理学作为一门学科，使用五种主要的研究设计。它们是：

1.5.2.1. Naturalistic and laboratory observation. 1.5.2.1. 自然观察和实验室观察。

In terms of naturalistic observation, the scientist studies human or animal behavior in its natural environment, which could include the home, school, or a forest. The researcher counts, measures, and rates behavior in a systematic way and, at times, uses multiple judges to ensure accuracy in how the behavior is being measured. The advantage of this method is that you see behavior as it happens, and the experimenter does not taint the data. The disadvantage is that it could take a long time for the behavior to occur, and if the researcher is detected, then this may influence the behavior of those being observed.
在自然观察方面，科学家在其自然环境中研究人类或动物的行为，这可能包括家庭、学校或森林。研究人员以系统的方式计数、测量和评估行为，有时使用多个评判者以确保测量行为的准确性。这种方法的优点是您可以看到行为的发生过程，实验者不会污染数据。缺点是行为可能需要很长时间才会发生，如果研究人员被发现，那么这可能会影响被观察者的行为。

**Laboratory observation **involves observing people or animals in a laboratory setting. The researcher might want to know more about parent-child interactions, and so, brings a mother and her child into the lab to engage in preplanned tasks such as playing with toys, eating a meal, or the mother leaving the room for a short time. The advantage of this method over the naturalistic method is that the experimenter can use sophisticated equipment to record the session and examine it later. The problem is that since the subjects know the experimenter is watching them, their behavior could become artificial. Clinical observation is a commonly employed research method to study psychopathology; we will talk about it more throughout this book.
实验室观察涉及在实验室环境中观察人或动物。研究人员可能想了解更多关于亲子互动的信息，因此将一位母亲和她的孩子带到实验室，让他们参与预先计划的活动，如玩玩具、吃饭或母亲短暂离开房间。与自然主义方法相比，这种方法的优势在于实验者可以使用复杂的设备记录会话并在以后进行检查。问题是，由于受试者知道实验者在观察他们，他们的行为可能会变得不自然。临床观察是研究心理病理学的常用研究方法；本书中我们将对此进行更多讨论。

1.5.2.2. Case studies.1.5.2.2. 案例研究。

Psychology can also utilize a detailed description of one person or a small group based on careful observation. This was the approach the founder of psychoanalysis, Sigmund Freud, took to develop his theories. The advantage of this method is that you arrive at a detailed description of the investigated behavior, but the disadvantage is that the findings may be unrepresentative of the larger population, and thus, lacking generalizability. Again, bear in mind that you are studying one person or a tiny group. Can you possibly make conclusions about all people from just one person, or even five or ten? The other issue is that the case study is subject to researcher bias in terms of what is included in the final narrative and what is left out. Despite these limitations, case studies can lead us to novel ideas about the cause of abnormal behavior and help us to study unusual conditions that occur too infrequently to analyze with large sample sizes and in a systematic way.
心理学还可以利用对一个人或一个小群体的细致观察来详细描述。这就是精神分析学创始人弗洛伊德发展其理论所采取的方法。这种方法的优点是您可以获得对所研究行为的详细描述，但缺点是研究结果可能无法代表更大的人群，因此缺乏普遍性。再次提醒，您正在研究一个人或一个非常小的群体。您能否仅从一个人，甚至五个人或十个人那里得出关于所有人的结论？另一个问题是，案例研究在最终叙述中包含什么以及省略什么方面容易受到研究者偏见的影响。尽管存在这些局限性，案例研究可以引导我们关于异常行为原因的新想法，并帮助我们研究那些太罕见以至于无法用大样本量和系统方式分析的异常情况。

1.5.2.3. Surveys/Self-Report data.1.5.2.3. 问卷调查/自我报告数据。

This is a questionnaire consisting of at least one scale with some questions used to assess a psychological construct of interest such as parenting style, depression, locus of control, or sensation-seeking behavior. It may be administered by paper and pencil or computer. Surveys allow for the collection of large amounts of data quickly, but the actual survey could be tedious for the participant and social desirability, when a participant answers questions dishonestly so that they are seen in a more favorable light, could be an issue. For instance, if you are asking high school students about their sexual activity, they may not give genuine answers for fear that their parents will find out. You could alternatively gather this information via an interview in a structured or unstructured fashion.
这是一份至少包含一个量表的问卷，其中一些问题用于评估感兴趣的心理学结构，例如教养方式、抑郁、控制点或寻求刺激的行为。它可以由纸笔或计算机进行。问卷调查可以快速收集大量数据，但实际的调查可能对参与者来说很繁琐，而且当参与者不诚实地回答问题以获得更好的评价时，社会期望可能成为问题。例如，如果你在询问高中生他们的性行为，他们可能因为害怕父母发现而不给出真实答案。你可以通过结构化或非结构化的访谈来收集这些信息。

1.5.2.4. Correlational research.1.5.2.4. 相关性研究。

This research method examines the relationship between two variables or two groups of variables. A numerical measure of the strength of this relationship is derived, called the correlation coefficient. It can range from -1.00, a perfect inverse relationship in which one variable goes up as the other goes down, to 0 indicating no relationship at all, to +1.00 or a perfect relationship in which as one variable goes up or down so does the other. In terms of a negative correlation, we might say that as a parent becomes more rigid, controlling, and cold, the attachment of the child to parent goes down. In contrast, as a parent becomes warmer, more loving, and provides structure, the child becomes more attached. The advantage of correlational research is that you can correlate anything. The disadvantage is that you can correlate anything, including variables that do not have any relationship with one another. Yes, this is both an advantage and a disadvantage. For instance, we might correlate instances of making peanut butter and jelly sandwiches with someone we are attracted to sitting near us at lunch. Are the two related? Not likely, unless you make a really good PB&J, but then the person is probably only interested in you for food and not companionship. The main issue here is that correlation does not allow you to make a causal statement.
这种方法研究两个变量或两组变量之间的关系。从这个关系强度中得出一个数值度量，称为相关系数。它可以从-1.00（一个完美的反向关系，其中一个变量上升，另一个变量下降）到 0（表示没有任何关系），再到+1.00 或一个完美的关系，其中一个变量上升或下降，另一个变量也相应上升或下降。就负相关而言，我们可能会说，当父母变得更加僵化、控制欲强和冷漠时，孩子对父母的依恋就会下降。相反，当父母变得更加温暖、充满爱心并提供结构时，孩子就会更加依恋。相关性研究的优点是你可以关联任何事物。缺点是你可以关联任何事物，包括彼此之间没有任何关系的变量。是的，这既是优点也是缺点。例如，我们可能会将制作花生酱果酱三明治的实例与我们午餐时坐在附近的人吸引联系起来。这两者有关系吗？不太可能，除非你做得非常棒的 PB&J 三明治，但那样的话，这个人可能只是对你感兴趣食物而不是陪伴。这里的主要问题是相关性并不允许你做出因果陈述。

A special form of correlational research is the **epidemiological study **in which the prevalence and incidence of a disorder in a specific population are measured (See Section 1.2 for definitions).
一种特殊的相关性研究形式是流行病学研究，其中测量特定人群中某种疾病的流行率和发病率（定义请参见第 1.2 节）。

1.5.2.5. Experiments.1.5.2.5. 实验。

This is a controlled test of a hypothesis in which a researcher manipulates one variable and measures its effect on another variable. The manipulated variable is called the independent variable (IV), and the one that is measured is called the dependent variable (DV). In the example under Experimentation in Section 1.5.1, the treatment for bipolar disorder was the IV, while the actual intensity or number of symptoms serve as the DV. A common feature of experiments is a **control group **that does not receive the treatment or is not manipulated and an **experimental group **that does receive the treatment or manipulation. If the experiment includes random assignment, participants have an equal chance of being placed in the control or experimental group. The control group allows the researcher (or teacher) to make a comparison to the experimental group and make a causal statement possible, and stronger. In our experiment, the new treatment should show a marked reduction in the intensity of bipolar symptoms compared to the group receiving no treatment, and perform either at the same level as, or better than, the older treatment. This would be the initial hypothesis made before starting the experiment.
这是对假设进行控制测试，其中研究人员操纵一个变量并测量其对另一个变量的影响。被操纵的变量称为自变量（IV），而被测量的变量称为因变量（DV）。在 1.5.1 节实验中的例子中，治疗双相情感障碍是 IV，而实际症状的强度或数量作为 DV。实验的常见特征是控制组不接受治疗或未进行操纵，而实验组则接受治疗或操纵。如果实验包括随机分配，参与者被分配到控制组或实验组的概率是相等的。控制组允许研究人员（或教师）将实验组进行比较，并使因果陈述成为可能，并更加强大。在我们的实验中，新的治疗方法应该与未接受治疗组相比，显著降低双相症状的强度，并且表现要么与旧的治疗方法相同，要么更好。这将是开始实验之前提出的初步假设。

In a drug study, to ensure the participants’ expectations do not affect the final results by giving the researcher what he/she is looking for (in our example, symptoms improve whether the participant is receiving treatment or not), we might use what is called a placebo, or a sugar pill made to look exactly like the pill given to the experimental group. This way, participants all are given something, but cannot figure out what exactly it is. You might say this keeps them honest and allows the results to speak for themselves.
在一项药物研究中，为确保参与者的期望不会通过给予研究者他/她所寻找的东西（在我们的例子中，无论参与者是否接受治疗，症状都会改善）影响最终结果，我们可能会使用所谓的安慰剂，即制作得与实验组所给的药片完全一样的糖片。这样，所有参与者都会得到一些东西，但无法确定具体是什么。你可能会说这让他们保持诚实，并让结果自己说话。

Finally, the study of mental illness does not always afford us a large sample of participants to study, so we have to focus on one individual using a single-subject experimental design. This differs from a case study in the sheer number of strategies available to reduce potential confounding variables, or variables not originally part of the research design but contribute to the results in a meaningful way. One type of single-subject experimental design is the reversal or ABAB design. Kuttler, Myles, and Carson (1998) used social stories to reduce tantrum behavior in two social environments in a 12-year old student diagnosed with autism, Fragile-X syndrome, and intermittent explosive disorder. Using an ABAB design, they found that precursors to tantrum behavior decreased when the social stories were available (B) and increased when the intervention was withdrawn (A). A more recent study (Balakrishnan & Alias, 2017) also established the utility of social stories as a social learning tool for children with autism spectrum disorder (ASD) using an ABAB design. During the baseline phase (A), the four student participants were observed, and data recorded on an observation form. During the treatment phase (B), they listened to the social story and data was recorded in the same manner. Upon completion of the first B, the students returned to A, which was followed one more time by B and the reading of the social story. Once the second treatment phase ended, the participation was monitored again to obtain the outcome. All students showed improvement during the treatment phases in terms of the number of positive peer interactions, but the number of interactions reduced in the absence of social stories. From this, the researchers concluded that the social story led to the increase in positive peer interactions of children with ASD.
最后，精神疾病的研究并不总是能为我们提供足够大的参与者样本进行研究，因此我们必须专注于使用单一受试者实验设计来研究一个个体。这与案例研究不同，因为单一受试者实验设计在减少潜在混杂变量或非研究设计原始部分的变量方面提供了大量策略，这些变量以有意义的方式对结果产生影响。单一受试者实验设计的一种类型是逆转或 ABAB 设计。Kuttler、Myles 和 Carson（1998）使用社交故事来减少一名被诊断为自闭症、脆性 X 综合症和间歇性爆炸性障碍的 12 岁学生的两种社交环境中的暴怒行为。使用 ABAB 设计，他们发现当社交故事可用时（B），暴怒行为的先兆减少，而当干预措施被撤回时（A），先兆增加。一项更近的研究（Balakrishnan & Alias，2017）也证实了社交故事作为自闭症谱系障碍（ASD）儿童的社会学习工具的实用性，使用 ABAB 设计。在基线阶段（A），观察了四名学生参与者，并在观察表上记录了数据。在治疗阶段（B）中，他们听了社交故事，并以相同的方式记录了数据。完成第一个 B 后，学生回到 A，然后再次进行 B 和阅读社交故事。一旦第二个治疗阶段结束，再次监测参与情况以获得结果。所有学生在治疗阶段在积极同伴互动的数量方面都有所改善，但在没有社交故事的情况下，互动次数减少了。据此，研究人员得出结论，社交故事导致了自闭症儿童积极同伴互动的增加。

1.5.2.6. Multi-method research.1.5.2.6. 多方法研究。

As you have seen above, no single method alone is perfect. All have strengths and limitations. As such, for the psychologist to provide the most precise picture of what is affecting behavior or mental processes, several of these approaches are typically employed at different stages of the research study. This is called **multi-method research. **
如您所见，上述任何单一方法都不是完美的。它们都有优点和局限性。因此，为了心理学家能提供最精确的行为或心理过程影响图景，通常在研究的不同阶段采用这些方法中的几个。这被称为多方法研究。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

The scientific method is a systematic method for gathering knowledge about the world around us.
科学方法是获取我们周围世界知识的一种系统方法。
A systematic explanation of a phenomenon is a theory and our specific, testable prediction is the hypothesis**.**
现象的系统解释是理论，我们具体的、可测试的预测是假设。
Replication is when we repeat the study to confirm its results.
复制是指我们重复进行这项研究以确认其结果。
Psychology’s five main research designs are observation, case studies, surveys, correlation, and experimentation.
心理学五大主要研究设计是观察、案例研究、调查、相关性和实验。
No single research method alone is perfect – all have strengths and limitations.
没有单一的研究方法本身是完美的——所有方法都有优点和局限性。

Section 1.5 Review Questions
第 1.5 节复习题

What is the scientific method and what steps make it up?
什么是科学方法，它由哪些步骤组成？
Differentiate theory and hypothesis.
区分理论与假设。
What are the three cardinal features of science and how do they relate to the study of mental disorders?
科学的三项基本特征是什么？它们如何与精神疾病的研究相关联？
What are the five main research designs used by psychologists? Define each and then state its strengths and limitations.
心理学家使用的五种主要研究设计是什么？定义每种，然后说明其优势和局限性。
What is the advantage of multi-method research?
什么是多方法研究的优势？

1.6. Mental Health Professionals, Societies, and Journals 1.6. 精神健康专业人士、学会和期刊

Section Learning Objectives 章节学习目标

Identify and describe the various types of mental health professionals.
识别并描述各种心理健康专业人士的类型。
Clarify what it means to communicate findings.
明确沟通发现的意义。
Identify professional societies in clinical psychology.
识别临床心理学中的专业协会。
Identify publications in clinical psychology.
识别临床心理学出版物。

1.6.1. Types of Professionals 1.6.1. 专业人士类型

There are many types of mental health professionals that people may seek out for assistance. They include:
有许多心理健康专业人士，人们可能会寻求他们的帮助。包括：

Table 1.2: Types of Mental Health Professionals
表 1.2：心理健康专业人士类型

Name 姓名	Degree Required 学位要求	Function/Training 功能/训练	Can they prescribe medications? 他们可以开药吗？
Clinical Psychologist 临床心理学家	Ph.D./PsyD 博士/心理学博士	Trained to make diagnoses and can provide individual and group therapy 经过训练以进行诊断，并能提供个体和团体治疗	Yes – In 6 states 是的 - 在 6 个州
School Psychologist 学校心理学家	Masters or Ph.D. 硕士或博士	Trained to make diagnoses and can provide individual and group therapy but also works with school staff 训练有素，能够进行诊断，并提供个人和团体治疗，同时与学校工作人员合作	No 没有
Counseling Psychologist 心理咨询师	Ph.D. 博士学位	Trained to make diagnoses and can provide individual and group therapy 经过训练以进行诊断，并能提供个体和团体治疗	Yes – In 6 states 是的 - 在 6 个州
Clinical Social Worker	M.S.W. or Ph.D.	Trained to make diagnoses and can provide individual and group therapy and is involved in advocacy and case management. Usually in hospital settings.	No
Psychiatrist	M.D.	Has specialized training in the diagnosis and treatment of mental disorders	Yes
Psychiatric Nurse Practitioner	M.S.N.	Has specialized treatment in the care and treatment of psychiatric patients	Yes
Occupational Therapist	B.S.	Trained to assist individuals suffering from physical or psychological handicaps and help them acquire needed resources	No
Pastoral Counselor	Clergy	Trained in pastoral education and can make diagnoses and can provide individual and group therapy	No
Drug Abuse and/or Alcohol Counselor	B.S. or higher	Trained in alcohol and drug abuse and can make diagnoses and can provide individual and group therapy	No
Child/Adolescent Psychiatrist	M.D. or Ph.D.	Specialized training in the diagnosis and treatment of mental illness in children	Yes
Marital and Family Therapist	Masters	Specialized training in marital and family therapy; Can make diagnoses and can provide individual and group therapy	No

For more information on types of mental health professionals, please visit:
有关心理健康专业人员的类型更多信息，请访问：

https://www.mhanational.org/types-mental-health-professionals

1.6.2. Professional Societies and Journals 1.6.2. 专业社团和期刊

One of the functions of science is to communicate findings. Testing hypotheses, developing sound methodology, accurately analyzing data, and drawing sound conclusions are important, but you must tell others what you have done too. This is accomplished by joining professional societies and submitting articles to peer-reviewed journals. Below are some of the organizations and journals relevant to applied behavior analysis.
科学的一个功能是传达发现。检验假设、发展健全的方法论、准确分析数据和得出合理的结论很重要，但你必须告诉别人你做了什么。这可以通过加入专业协会和向同行评审期刊投稿来实现。以下是与应用行为分析相关的一些组织和期刊。

1.6.2.1. Professional Societies 1.6.2.1. 专业协会

Society of Clinical Psychology – Division 12 of the American Psychological Association
美国心理学会临床心理学分会 - 第 12 分会
- Website – https://div12.org/ 网站 – https://div12.org/
- Mission Statement – “The mission of the Society of Clinical Psychology is to represent the field of Clinical Psychology through encouragement and support of the integration of clinical psychological science and practice in education, research, application, advocacy and public policy, attending to the importance of diversity.”
  使命宣言——“临床心理学协会的使命是通过鼓励和支持临床心理学科学与实践在教育、研究、应用、倡导和公共政策中的整合，关注多样性的重要性。”
- Publications – Clinical Psychology: Science and Practice and the newsletter Clinical Psychology: Science and Practice(quarterly)
  出版物 - 临床心理学：科学与实践及《临床心理学：科学与实践》（季刊）通讯
- Other Information – Members and student affiliates may join one of eight sections such as clinical emergencies and crises, clinical psychology of women, assessment psychology, and clinical geropsychology
  其他信息 - 会员和学生附属人员可以加入八个部门之一，例如临床紧急情况和危机、女性临床心理学、评估心理学和临床老年心理学
Society of Clinical Child and Adolescent Psychology – Division 53 of the American Psychological Association
美国心理学会临床儿童和青少年心理学分会——美国心理学会第 53 分会
- Website – https://www.clinicalchildpsychology.org/
  网站 – https://www.clinicalchildpsychology.org/
- Mission Statement – “Our mission is to serve children, adolescents and families with the best possible clinical care based on psychological science. SCCAP strives to integrate scientific and professional aspects of clinical child and adolescent psychology, in that it promotes scientific inquiry, training, and clinical practice related to serving children and their families.”
  使命宣言——“我们的使命是利用心理学科学提供最佳的医疗服务，服务于儿童、青少年及其家庭。SCCAP 致力于整合临床儿童和青少年心理学的科学和专业方面，因为它促进了与服务于儿童及其家庭相关的科学探究、培训和临床实践。”
- Publication – Journal of Clinical Child and Adolescent Psychology
  出版物 - 临床儿童青少年心理学杂志
American Academy of Clinical Psychology
美国临床心理学学会
- Website – https://www.aacpsy.org/ 网站 – https://www.aacpsy.org/
- Mission Statement – The American Academy of Clinical Psychology seeks to “recognize and promote advanced competence within Professional Psychology,” “provide a professional community that encourages communication between and among Members and Fellows of the Academy,” “provide opportunities for advanced education in Professional Psychology,” and “expand awareness and availability of AACP Members and Fellows to the public through promotion and education.”
  使命宣言 - 美国临床心理学学会致力于“认可和促进专业心理学中的高级能力”，“提供一个鼓励学会成员和院士之间交流的专业社区”，“提供专业心理学高级教育的机会”，以及“通过推广和教育扩大 AACP 成员和院士对公众的认知和可用性”。
- Publication – Bulletin of the American Academy of Clinical Psychology (newsletter)
  出版物 - 美国临床心理学学会公报（通讯）
The Society for a Science of Clinical Psychology (SSCP)
美国临床心理学科学学会（SSCP）
- Website – http://www.sscpweb.org/ 网站 – http://www.sscpweb.org/
- Mission Statement – “The Society for a Science of Clinical Psychology (SSCP) was established in 1966. Its purpose is to affirm and continue to promote the integration of the scientist and the practitioner in training, research, and applied endeavors. Its members represent a diversity of interests and theoretical orientations across clinical psychology. The common bond of the membership is a commitment to empirical research and the ideal that scientific principles should play a role in training, practice, and establishing public policy for health and mental health concerns. SSCP has organizational affiliations with both the American Psychological Association (Section III of Division 12) and the Association for Psychological Science.”
  使命宣言——“临床心理学科学学会（SSCP）成立于 1966 年。其目的是确认并继续促进科学家和实践者在培训、研究和应用努力中的整合。其成员代表了临床心理学中多样化的兴趣和理论取向。成员之间的共同纽带是对实证研究的承诺以及科学原则应在培训、实践和制定公共卫生和心理健康问题的公共政策中发挥作用的理念。SSCP 与美国心理学会（第 12 分部第 III 节）和心理科学协会都有组织联系。”
- Other Information – Offers ten awards ranging from early career award, outstanding mentor award, outstanding student teacher award, and outstanding student clinician award.
  其他信息 - 提供十个奖项，包括早期职业奖、杰出导师奖、杰出学生教师奖和杰出学生临床医生奖。
American Society of Clinical Hypnosis
美国临床催眠学会
- Website – http://www.asch.net/ 网站 – http://www.asch.net/
- Mission Statement – “To provide and encourage education programs to further, in every ethical way, the knowledge, understanding, and application of hypnosis in health care; to encourage research and scientific publication in the field of hypnosis; to promote the further recognition and acceptance of hypnosis as an important tool in clinical health care and focus for scientific research; to cooperate with other professional societies that share mutual goals, ethics and interests; and to provide a professional community for those clinicians and researchers who use hypnosis in their work.”
  使命宣言——“提供并鼓励教育项目，以各种道德方式进一步推动医疗保健中催眠的知识、理解和应用；鼓励催眠领域的科研和科学出版物；促进催眠作为临床医疗和科学研究重要工具的进一步认可和接受；与其他具有共同目标、道德和兴趣的专业协会合作；并为那些在工作中使用催眠的临床医生和研究人员提供一个专业社区。”
- Publication – American Journal of Clinical Hypnosis
  发表 - 美国临床催眠杂志
- Other Information – Offers certification in clinical hypnosis
  其他信息 - 提供临床催眠认证

1.6.2.2. Professional Journals 1.6.2.2. 专业技术期刊

Clinical Psychology: Science and Practice
临床心理学：科学与实践
- Website – http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-2850
  网站 – http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-2850
- Published by – American Psychological Association, Division 12
  由美国心理学会，第 12 分会出版
- Description – “Clinical Psychology: Science and Practice presents cutting-edge developments in the science and practice of clinical psychology and related mental health fields by publishing scholarly articles, primarily involving narrative and systematic reviews as well as meta-analyses related to assessment, intervention, and service delivery.”
  描述 - “《临床心理学：科学与实践》通过发表学术论文，主要涉及叙事和系统综述以及与评估、干预和服务提供相关的元分析，展示了临床心理学及其相关心理健康领域的最新发展。”
Journal of Clinical Child and Adolescent Psychology
《临床儿童与青少年心理学杂志》
- Website – https://www.clinicalchildpsychology.org/JCCAP
  网站 – https://www.clinicalchildpsychology.org/JCCAP
- Published by – American Psychological Association, Division 53
  由美国心理学会，第 53 分会出版
- Description – “It publishes original contributions on the following topics: (a) the development and evaluation of assessment and intervention techniques for use with clinical child and adolescent populations; (b) the development and maintenance of clinical child and adolescent problems; (c) cross-cultural and socio-demographic issues that have a clear bearing on clinical child and adolescent psychology in terms of theory, research, or practice; and (d) training and professional practice in clinical child and adolescent psychology, as well as child advocacy.”
  描述 - “它发表以下主题的原创新贡献：（a）用于临床儿童和青少年人群的评估和干预技术的开发和评估；（b）临床儿童和青少年问题的开发和维护；（c）对临床儿童和青少年心理学在理论、研究或实践方面有明确影响的文化和社会人口问题；（d）临床儿童和青少年心理学的培训和职业实践，以及儿童倡导。”
American Journal of Clinical Hypnosis
美国临床催眠杂志
- Website – http://www.asch.net/Public/AmericanJournalofClinicalHypnosis.aspx
  网站 – http://www.asch.net/Public/AmericanJournalofClinicalHypnosis.aspx
- Published by – American Society of Clinical Hypnosis
  由美国临床催眠学会出版
- Description – “The Journal publishes original scientific articles and clinical case reports on hypnosis, as well as reviews of related books and abstracts of the current hypnosis literature.”
  描述 - “该杂志发表关于催眠的原创科学文章和临床病例报告，以及相关书籍的评论和当前催眠文献的摘要。”

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

Mental health professionals take on many different forms with different degree requirements, training, and the ability to prescribe mediations.
心理健康专业人士以多种形式存在，对学位要求、培训和处方药物的能力各不相同。
Telling others what we have done is achieved by joining professional societies and submitting articles to peer-reviewed journals.
告诉他人我们所做的事情，是通过加入专业协会并向同行评审的期刊投稿来实现的。

Section 1.6 Review Questions
第 1.6 节复习题

Provide a general overview of the types of mental professionals and the degree, training, and ability to prescribe medications that they have.
提供对心理专业人士类型的一般概述，以及他们所拥有的学位、培训和处方药物的能力。
Briefly outline professional societies and journals related to clinical psychology and related disciplines.
简要概述与临床心理学及相关学科相关的专业协会和期刊。

Module Recap 模块总结

In Module 1, we undertook a relatively lengthy discussion of what abnormal behavior is by first looking at what normal behavior is. What emerged was a general set of guidelines focused on mental illness as causing dysfunction, distress, deviance, and at times, being dangerous for the afflicted and others around him/her. Then we classified mental disorders in terms of their occurrence, cause, course, prognosis, and treatment. We acknowledged that mental illness is stigmatized in our society and provided a basis for why this occurs and what to do about it. This involved a discussion of the history of mental illness and current views and trends.
在模块 1 中，我们首先通过观察正常行为来对异常行为进行了相对详细的讨论。结果是形成了一套以精神疾病导致功能障碍、痛苦、偏差，有时甚至对患病者和周围人构成危险为焦点的指导方针。然后，我们根据精神疾病的发病率、病因、病程、预后和治疗将其分类。我们承认精神疾病在我们的社会中受到歧视，并提供了为什么会出现这种情况以及如何应对的基础。这包括对精神疾病历史、当前观点和趋势的讨论。

Psychology is the scientific study of behavior and mental processes. The word scientific is key as psychology adheres to the strictest aspects of the scientific method and uses five main research designs in its investigation of mental disorders – observation, case study, surveys, correlational research, and experiments. Various mental health professionals use these designs, and societies and journals provide additional means to communicate findings or to be good consumers of psychological inquiry.
心理学是行为和心理过程科学研究的学科。科学这个词是关键，因为心理学遵循最严格的科学方法，并在其调查精神疾病时使用五种主要的研究设计——观察、案例研究、调查、相关研究和实验。各种心理健康专业人士使用这些设计，而社会和期刊提供额外的手段来传达发现或成为良好的心理学研究消费者。

It is with this foundation in mind that we move to examine models of abnormality in Module 2.
考虑到这个基础，我们在第 2 模块中转向检查异常模型。

3rd edition 第三版

Source: https://opentext.wsu.edu/abnormal-psych/chapter/module-1-what-is-abnormal-psychology/

Module 1: What is Abnormal Psychology?模块 1：异常心理学概述

Module Overview 模块概述

Module Outline 模块大纲

Module Learning Outcomes 模块学习成果

1.1. Understanding Abnormal Behavior 1.1. 理解异常行为

Section Learning Objectives 章节学习目标

1.1.1. Understanding Abnormal Behavior 1.1.1. 理解异常行为

1.1.2. How Do We Determine What Abnormal Behavior Is? 1.1.2. 我们如何确定什么是异常行为？

1.1.3. The Costs of Mental Illness 1.1.3. 精神疾病成本

1.1.4. Defining Key Terms 1.1.4. 定义关键术语

Key Takeaways 关键要点

1.2. Classifying Mental Disorders 1.2. 精神疾病分类

Section Learning Objectives 章节学习目标

1.2.1. Classification 1.2.1. 分类

1.2.2. Determining Occurrence of a Disorder 1.2.2. 确定疾病的发病情况

1.2.3. Other Key Factors Related to Mental Disorders 1.2.3. 与精神疾病相关的其他关键因素

Key Takeaways 关键要点

1.3. The Stigma of Mental Illness 1.3. 精神疾病的耻辱

Section Learning Objectives 章节学习目标

Key Takeaways 关键要点

1.4. The History of Mental Illness 1.4. 精神疾病的历史

Section Learning Objectives 章节学习目标

1.4.1. Prehistoric and Ancient Beliefs 1.4.1. 史前和古代信仰

1.4.2. Greco-Roman Thought 1.4.2. 希腊罗马思想

1.4.3. The Middle Ages – 500 AD to 1500 AD 1.4.3. 中世纪 - 公元 500 年至 1500 年

1.4.4. The Renaissance – 14th to 16th centuries 1.4.4. 文艺复兴 - 14 世纪至 16 世纪

1.4.5. Reform Movement – 18th to 19th centuries 1.4.5. 改革运动 - 18 世纪至 19 世纪

1.4.6. 20th – 21st Centuries 1.4.6. 20 世纪 - 21 世纪

1.4.6.1. Biological or Somatogenic Perspective.1.4.6.1. 生物或躯体发生视角。

1.4.6.2. Psychological or Psychogenic Perspective.1.4.6.2. 心理或心理原性视角。

1.4.7. Current Views/Trends 1.4.7. 当前观点/趋势

1.4.7.1. Mental illness today.1.4.7.1. 当今精神疾病。

1.4.7.2. Use of psychiatric drugs and deinstitutionalization. 1.4.7.2. 精神药物的使用和去机构化。

1.4.7.3. Managed health care.1.4.7.3. 管理型医疗保健。

1.4.7.4. Multicultural psychology.1.4.7.4. 多元文化心理学。

1.4.7.5. Prescription rights for psychologists. 1.4.7.5. 心理学家处方权。

1.4.7.6. Prevention science.1.4.7.6. 预防科学。

Key Takeaways 关键要点

1.5. Research Methods in Psychopathology 1.5. 精神病学的研究方法

1.5.1. The Scientific Method 1.5.1. 科学方法

1.5.2. Research Methods 1.5.2. 研究方法

1.5.2.1. Naturalistic and laboratory observation. 1.5.2.1. 自然观察和实验室观察。

1.5.2.2. Case studies.1.5.2.2. 案例研究。

1.5.2.3. Surveys/Self-Report data.1.5.2.3. 问卷调查/自我报告数据。

1.5.2.4. Correlational research.1.5.2.4. 相关性研究。

1.5.2.5. Experiments.1.5.2.5. 实验。

1.5.2.6. Multi-method research.1.5.2.6. 多方法研究。

Key Takeaways 关键要点

1.6. Mental Health Professionals, Societies, and Journals 1.6. 精神健康专业人士、学会和期刊

1.6.1. Types of Professionals 1.6.1. 专业人士类型

1.6.2. Professional Societies and Journals 1.6.2. 专业社团和期刊

1.6.2.1. Professional Societies 1.6.2.1. 专业协会

1.6.2.2. Professional Journals 1.6.2.2. 专业技术期刊

Key Takeaways 关键要点

Module Recap 模块总结