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Abnormal Psychology

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Grace Sundarathiti

on 18 March 2011

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Transcript of Abnormal Psychology

Abnormal Psychology Factors Influencing Abnormal Behavior Biological factors:
1. Genetic Predisposition: Females with a family member suffering from an eating disorder are more likely to develop that disorder compared to average women. However, this view may be too reductionist, as bulimia and anorexia are most common among middle and upper class women; therefore socio-cultural factors must be involved.
2. Neurotransmitters: Anorexic patients have overactive serotonin response centers, which cause them to become nervous and jittery. On the other hand, patients suffering from depression have low serotonin levels.
3. Hormones: Anorexic patients have high levels of the brain hormone cortisol, which is released in response to stress.

Cognitive factors: Cognitive psychologists believe that unrealistic, distorted, or irrational perceptions and thoughts of oneself, others, or the environment cause abnormality. It is caused by the difficulty to control thought processes, and in turn using those thought processes to control actions.

Sociocultural factors: Members of society who break social and cultural norms are labeled as abnormal in order to establish clear norms of reality and appropriate behavior, emphasizing on conformity. Criticisms claim that abnormality is based on the fundamental attribution error, where psychologists disregard situational causes of this deviant behavior. Also, different cultures define abnormality in different ways. Psychological research relevant to the study of abnormal behavior includes, but is not limited to: Biopsychosocial Model: This model is a non-reductionist approach to research, recognizing biological, psychological, and social factors in abnormality. It considers the functions of individual body, searches for potential psychological causes to health problems, and takes into account social standings such as economic status, culture, and religion. All three are inter-related. However, this model is difficult to test empirically. Nevertheless, it has provided a framework for treatment.

Diathesis-stress Model: This model explains mental disorders through the interaction of two factors- genetics (nature) and life experience (nurture). If an individual has a certain diathesis, he or she is more vulnerable to develop a disorder when under high levels of stress. Family history, individual character and biology all play a role in determining diathesis.

Examples of studies under abnormal psychology include the Caspi et al (2003) study and the classic Rosenhan study, which will be explained later.
Concepts and Diagnosis Examine the concepts of normality and abnormality • Abnormality defined by the APA as behavior that causes distress, loss of freedom, physical or emotional pain, increased risk of death or injury to self or causes a disability of some sort
• 7 Criteria for Abnormal Behavior - Rosenhan & Seligman, 1984, came up with a list of characteristics on the behaviors that are majorly present in people regarded as abnormal people and also preformed a study.
o Suffering
o Maladaptiveness
o Irrationality
o Unpredictability
o Vividness and unconventionality
o Observer discomfort
o Violation of moral or ideal standards
• 6 Characteristics of Mental Health - Marie Jahoda, in 1958, devised a list of characteristics which are present in the majority of people who are regarded as normal:
o Efficient self-perception
o Realistic self-esteem and acceptance
o Voluntary control of behavior
o Accurate perception of the world
o Sustaining relationships and providing affection
o Self-direction and productivity
o Evaluation
• Actually applying these criteria means most people would be considered abnormal
• Normalness is culturally determined Discuss validity and
Reliability of diagnosis • Problems with classification
o No physical signs of disorders making it difficult to diagnose
o Lack of agreement using same classification system
• DSM-IV - 64% agreed that it is valid
• ICD-10 - 36% agreed that it was valid
• Great Ormond Street System - 88% agreed that is was valid Cultural and Ethical
Considerations In Diagnosis Culture-bound Syndrome
• Shenjing shuairuo accounts for over 50% of outpatient cases in China
o Not included in DSM-IV but many symptoms are similar to the crtieria for a combo of mood and anxiety disorder in DSM-IV Ethical Considerations in Diagnosis
• Self-fulfilling prophecy
o People who believe they are 'abnormal' may begin to act abnormal thus fulfilling the prophecy they have a psychological illness (Scheff, 1966, not proved with study)
• Racial and ethnic (Jenkins-Hall & Sacco, 1991)
o African American women rated more negatively and less socially competent than European women by therapists watching them on videos of a clinical interview
• Only women were used, possible gender difference
• Confirmation bias
o Cognitive bias that leads practioners to assume that patients seeking help are sick and thus look for signs/symptoms that can lead to a diagnosis even if patient is 'normal' (Rosenhan, 1973)
• Powerlessness and depersonalization (no study found)
o Makes assessing patients properly difficult
o Effect of institutionalization where patient has little choice, few rights, not much privacy and a lack of constructive activities affects their 'normal' behavior Studies Conspiration model:
o In order to keep their definition of reality, the family, general practitioners and psychiatrists conspire against the “insane” by imprisoning and degrading them as human beings. Rosenhan (1973) Laing’s (1967)
Aim: To investigate relationship between 5-HTT gene and depression
Participants: 847 Caucasian New Zealanders
Experiment: Had participants give self-reports on depression (cross-check with their friends)
Results: People with short allele for this gene correlated with more vulnerability to depression
Conclusion: Certain diseases based on behavior are caused by genes. In this case, depression is found to be related to the length of the 5-HTT gene. The shorter the 5-HTT gene is; the tendency of getting depression rises. This experiment is one of the few experiments that have supported the theory that the biological function of the body is interrelated with the cognitive aspect of human beings.

Challenging studies:
Murphy’s (1976) – research on Inuit tribes has indicated that there are linguistic distinctions between “shaman” and “crazy people” in a society. Caspi et. al. (2003) Psychological disorders
o Behavioral: Passive, lack of any initiative or spontaneity
o Affective: feeling of guilt and hopelessness. Unable to enjoy company
o Cognitive: frequent negative and irrational thoughts. Faulty attribution of blame resulting in low self-esteem. Difficulty in concentration and unable to make decisions and sometimes thoughts can be suicidal
o Somatic: loss of energy, can have insomnia or hypersomnia, drastic weight gain/loss, diminished sex drive
o Seen more in individualistic cultures (western societies)
• Contradicted by finding in the Caspi study which shows that eastern cultures are more biologically prone to depression
o Affects around 15% of people at some time in their life
o 2-3 times more common in women than in men
o Occurs more frequently in lower socio-economic groups and young adults
o Prevalence rate is above average among Jewish groups
o Caspi et. al; (2003)
• Aim: To investigate the relationship between the 5-HTT gene (serotonin transporter gene) and depression
• Findings: The presence of the short allele correlated with a higher risk for depression between the ages of 21-26
• Conclusion: more prevalent in individuals with the short allele in the 5-HTT gene (Eastern cultures) Affective disorders Anorexia
o Behavioral: will not maintain normal BMI (normal weight for their age and height
o Emotional: Extremely fearful of gaining weight even if the person is underweight
o Cognitive: Person holds a distorted view of body shape and size
o Somatic: amenorrhea (misses three menstrual cycles in a row)
o 95% affected by anorexia are female (10 times more likely in females)
o Lifetime prevalence in females: 0.5%
o Onset age usually is around 14-18 years of age
o More prevalent in Caucasians
o Western societies have higher numbers of anorexia nervosa
• Increasing in eastern societies due to globalization
o Career with potential higher risk: models, actors/actresses, dancers
o Mazzeo & Bulik (2009)
• Aim: goal was to explore the relation between perfectionism and psychopathology including eating disorders such as anorexia nervosa
• Findings: Heightened concern over mistakes was associated with anorexia and bulimia but not with other psychiatric disorders. (Doubt about own actions associated with anxiety disorders)
• Conclusion: more prevalent in people with a perfectionist personality Eating disorders Analyzing Etiologies Etiology is defined as the cause or set of causes of a disease as a subject of investigation. Affective Disorder: Major Depression Eating Disorder: Anorexia Nervosa Major depression can be triggered by various factors, but most of the time, the etiology involves a complex interaction between biological, cognitive and sociocultural factors. Different people have different vulnerability to depression, depending on their genetic predisposition, personality, experience, ways of thinking and dealing with life in general, and the environmental interaction. A combination of these factors triggers the occurrence of depression in individuals, and since each person is unique, the diagnosis of this disorder is also specific to each individual. Sociocultural Factors
- Stress of poverty
o Cutrona et al. (2006)
- Loneliness
- Troubled personal relationships
o Brown and Harris: vulnerability model; examines relationship between social factors and depression in women. Findings revealed that most depressive women recently encountered traumatic event. Working women were more vulnerable to depression, and so are women with children. Troubled personal relationships (with husband) also show tendency to become a factor in the prevalence of depression.
o Cutrona et al. (2006): Demonstrates how environmental and life stressors may contribute to the prevalence of depression in African-American women. Biological Factors
- Genetic factors: Caspi 2003 study, concordance rates
o Caspi (2003): The aim of this investigation was to see the relationship between the 5-HTT gene and the prevalence of depression. The findings from this study showed a correlation between people with short 5-HTT alleles with a higher vulnerability to depression. Therefore, Caspi’s study supports the claim that certain behavior-oriented diseases such as depression are influenced by genetics.
o Concordance Rates: According to the correlation study by Nurnberger and Gershon, the concordance rate for depression is 65% in monozygotic twins and 14% in dizygotic twins.
- Biochemical factors: Lack of Serotonin, physostigmine
o Caspi (2003): Demonstrates how lower levels of serotonin can cause a higher vulnerability for depression.
o Janowsky: Demonstrates how physostigmine induces depression, patients given the drug experience feelings of self-hate, moments after consumption. Cognitive Factors
- Thoughts of hopelessness, Information processing bias
o Beck: suggests that depression can stem from cognitive distortions and biases in information processing. Schemas interfere with thinking, and influences the way people make sense of experiences. It may lead to the person attributing situations on internal, stable, and global factors. Three cognitive distortions include:
• Overgeneralization – of negative events
• Non-logical inference – about themselves
• Dichotomous thinking – selective recall of negative events (black and white thinking)
- Pessimistic thinking patterns
o Goldapple (2004): Study shows that cognitive therapies had the same brain changes as people who took antidepressants. Findings were measured using PET scans.
o Sweeney: 15,000 participants; findings showed that depressive participants tend to attribute negative events to internal, stable, and global causes.
- Feelings of low self-esteem Biological Factors
- Genetic factors:
o Mazzeo and Bulik (2009): The study investigated the interaction between genes and environment in the prevalence of eating disorders. Situational and dispositional factors such as social environment and perfectionism may contribute to the cause of the disorder.
- Appetite and weight regulation imbalance (Hypothalamus)
- Neurotransmission:
o Serotonin
o Norepinephrine
o Dopamine
- Neuropeptides:
o Neuropeptide Y (works to increase appetite)
o Cholecystokinin (works to decrease appetite)
o Leptin (works to decrease appetite) [most important] Cognitive Factors
- Cognitive factors:
o Attentional biases toward food and body-related cues
• Southgate (2008): Measured cognitive styles (reflection and impulsivity) in healthy people and patients with eating disorders, and also cognitive efficiency. Anorexia patients scored higher on cognitive efficiency (weak central coherence, bias toward local detail processing), no difference in cognitive styles.
o Cognitive distortions (Dichotomous thinking)
- Perfectionism:
o Mazzeo and Bulik (2009): Perfectionism may contribute to eating disorders.
- Reward sensitivity: Patients with Anorexia nervosa had higher reward dependence; they have a higher need for reward, and have the urge to continue the rewarded behavior even if it tires them. Sociocultural Factors
- Media portrayal of cultural attitudes toward thinness:
o Becker (1993-1995): this study aimed to investigate the effect of the introduction of Western television to Fiji island on the incidence of anorexia nervosa in teenage girls. 63 girls completed a questionnaire on attitudes towards eating, and a couple of uears later, a sample of 65 girls were questioned to assess the impact of television on eating attitudes. Girls who vomit to control their weights increased from 3%-15% from 1993-1995. Girls that scored high on the quizzes (high tendency to have eating disorder) also increased from 13% to 29%. Findings showed a correlation between the introduction of Western television to eating attitudes, which may lead to the development of eating disorders.
- Family interaction
- Social Learning:
o Modeling from parents
o Low self-efficacy Cultural & Gender Variations
In Prevalence Of Disorders
o Seattle, Washington: 6.3 %
c China: 4 %
o Verona, Italy: 4.7 %
o Groningen, Germany: 15.9 %
o Manchester, United Kingdom: 16.9 %
o Ankara, Turkey: 11.6 %
o Nagasaki, Japan: 2.6 %

Collectivistic cultures believe in advancement of the groups interests, therefore assisting others with their personal issues, such as disorders. A lower rate of depression in collectivistic cultures may also be due to the somatization, i.e reporting bodily symptoms in place of the feeling of depression.

More common in western societies than eastern societies (is increasing in eastern societies however due to westernization).
- Western societies promote an image where individuals must be thin in order to be beautiful. Cultural Variations: Depression:
Women = 10-25%, Men = 5-12%
• Gender bias in diagnosis of depression – more women are diagnosed correctly. Violence and abuse/discrimination against women.

Women = .5%, tens times more likely in women than men
• Women are more sensitive about their body weight compared to men. Gender Variations: ultural ender The National Comorbidity Study:
- A survey was conducted on adults in the United States, Canada, Brazil, Germany and Japan.
o 1.7 women for every man had at one point in time experienced depression.
Study by Dr Zubenko:
- Study conducted on individuals from 81 different families who were experiencing major depression
o Participants had their genomes scanned – in particular 19 regions which were common and therefore likely to contain genes that are related to depression.
o Four regions were found in women but only one in men
• Therefore: Differences in rates of depression between the sexes is highest when women are in their reproductive years – Genetic differences between men and women.
Becker Study (1995)
- TV’s were introduced to the inhabitants of the island of Fiji. Native Fijian girls were given a questionnaire about their eating habits.
o Percentage of girls who used vomiting to control weight increased from 3% to 15% in two years. Girls with a high risk of an eating disorder increased from 13% to 29% in two years.
o Therefore: Social pressures and differences can lead to higher prevalence of disorders
Cooper et al (1972)
- Found New York psychiatrists were twice as likely to diagnose schizophrenia when shown videos of clinical interviews when compared to their London counterparts. The London psychiatrists were twice as likely to give a diagnoses of mania or depression.
o Therefore: Different cultures have different concepts of what is abnormal behavior/ a disorder

Biomedical, Cognitive & Group Approaches to Treatment. · Based on the belief that psychological disorders are caused by abnormal biochemistry in the body
o e.g., the imbalance of neurotransmitters such as the serotonin
· Goal restore harmony of chemicals in the body of the client
· Uses various types of medication
o anti-depressants for cases of anxiety disorders and depression, prescribed by the psychiatrist
o for severe cases: ECT (electroconvulsive therapy) or Shock Therapy
Weaknesses / Strengths
· (-) very reductionistic approach
o based on the belief that psychological disorders can only be solely attributed to chemical imbalances
o ignore all other time-tested factors such as the cognitive and sociocultural factors
· (-) consequences of putting the patient on medications
o no medication is truly free of side effects.
o medications and ECT (which is known for causing memory loss) are the only solution.
· (-) only treat symptoms of the disorder rather than the causes.
· (-) ethical concerns
o 80% of the doctors in the UK admitted that they have prescribed their patients with placebos.
· (+) highly scientific
· (+) proven to be the most effective approach for severe cases of psychological disorders.
· Study: See Caspi (2003), for a study on the underlying etiology of abnormal behavior from the biomedical perspective. Depressed people have acquired a negative schema of the world through negative events
· People with emotional difficulties tend to commit characteristic "logical errors" which slant objective reality to the path of self-deprecation.
· Aaron Beck challenged the notion that depression resulted from anger which is then turned inward. Beck's approach to the treatment of depression consists of placing a heavy emphasis on schema: core beliefs.
· A key factor of this therapeutic process involves restructuring distorted beliefs - schema - which have a pivotal impact on changing dysfunctional behaviors.
· The therapist helps the client make a list of his/her responsibilities, set priorities, and develop a realistic plan of action. The therapist must form a team between the client and themselves while assisting in the clients' plan of action. Therapists also use cognitive rehearsal techniques to identify and change negative thoughts. This was called cognitive restructuring. The patient is encouraged to replace faulty thinking with more accurate and beneficial thought by gaining awareness of their bad thought habits, learn to challenge said habits, and accepting life enhancing thoughts and beliefs.
· When the person encounters a situation that resembles the original conditions of the learned schema, the negative schema is activated. People have negative thoughts of themselves, the world/environment, and the future. If the client can learn to combat self-doubts in the therapy session, he/she may be able to apply their newly acquired cognitive and behavioral skills in real-life settings.
· Beck also asserts that there are three main dysfunctional belief themes (or "schemas") that dominate depressed people's thinking: 1) I am defective or inadequate, 2) All of my experiences result in defeats or failures, and 3) The future is hopeless. Together, these three themes are described as the Negative Cognitive Triad. When these beliefs are present in someone's cognition, depression is very likely to occur. Negative thoughts, generated by dysfunctional beliefs are typically the primary cause of depressive symptoms. The more negative thoughts you experience, the more depressed you will become.
Weaknesses / Strengths
· (-) simply being told that a view doesn’t accurately reflect reality doesn’t actually make them feel any better
· (-) therapist initially may fulfil something of an authority role, in the sense that they provide problem solving experience or expertise in cognitive psychology. Some people may also feel that the therapist can be ‘leading’ in their questioning and somewhat directive in terms of their recommendations.
· (+) Cognitive therapy has empirical support for its effectiveness.
· (-) It is time consuming, and expensive.
· (+)It is mostly effective for drug therapy and mild depression. Several patients, along with a therapist, participate in group-based activity to recover from the disorders
o focuses on primarily on talking.
· Some of the principles of group therapy as suggested by Irvin Yalom
o Universality; the recognition of shared experiences and feelings among the group members that can help alleviate the sense of isolation
o Altruism; the group is a place that the members will help each other, also giving them a chance to develop interpersonal skills.
o Installation of hope; members who have succeeded in overcoming their problems can help the others who are struggling be inspiring and encouraging them.
o Cohesiveness; group therapy’s effectiveness depends on how well the members work together, in order for the group to succeed, the members should feel a sense of belonging and acceptance within the group.
o Catharsis; catharsis is the experience of relief from emotional distress through expression of emotion, when members tell the group of their stories, they can obtain relief from negative feelings
Weaknesses / Strengths
· (-) depends largely on the members of the group
o disruptive member can easily lead to failure of the treatment
o It is likely that the therapy is going to be effective on only milder cases of disorders where the individuals are capable of functioning and thinking rationally.
· (+) members get to form new relationship with others
o reduces the chance of a relapse since the patients know who they can talk to when they have a problem, simulating the therapy in a smaller scale
o group therapy treats the cause of the disorder rather than the symptom.
· (+) allows therapists who are experienced in different fields to work together, thus, improving the effectiveness of the therapy.
· (+) does not involve the use of any medication, there are no side effects on the patients.
· (+) more effective than individualistic approaches for higher functioning adults.
· (-) Obtaining scientific data to assess the effectiveness of group therapy is highly problematic since a group dynamic presents so many more variables than individual therapy. Study:
Goldapple (2004).
o Cognitive therapy is a type of psychotherapy in which negative patterns of thought (schemas) about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression. The Goldapple study investigated how cognitive therapy affects brain changes. PET scans were used to document brain activity before and after 15 to 20 sessions of cognitive therapy over seven weeks. PET scans from a previous study on participants taking antidepressants were used as a control group. Participants were screened to ensure that they had no substance problems or antidepressant treatment one month prior to the study.
o Findings: There were significant changes in glucose metabolism in prefrontal-hippocampal pathways. The changes on the brain were the same as with antidepressants. The generalizability is low, because the sample size is quite small with little racial variation.
· Study: Lyon & Woods (1991)
o Lyon and Woods compared the effectiveness of 70 REBT results with the outcomes of behavior therapy and other psychotherapies. REBT demonstrated better improvement than other groups.
• Though there was a problem with attribution rates (some participants dropped out) and lack of follow-up data, the study illustrated that cognitive therapy showed the greatest improvement of the patient’s conditions. This effectiveness depended largely on the therapists’ experience as well as the duration of the therapy.Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder. Relationship Between Etiology & Therapeutic Approach In Relation To One Disorder. DISORDER : DEPRESSION

Etiology : Biological Level of Analysis

1. Caspi Et. Al
• this study found that people with the short allele of the 5-HTT gene are more prone to depression
• This study links the disorder depression to a biological, rather than a cognitive, cause.

1. Twin studies: Nurnberger and Gershon (1982)
- this study review the results of 7 twin studies
- it was found that major depressive disorder was consistently higher in monozygotic twins that for dizygotic twins
- this study links major depressive disorder with genetics, which is a part of the biological level of analysis


• medication aims to increase the amount of serotonin available
• E.g. SSRIs - selective serotonin reuptake inhibitors
Aim: To test whether psychologists can determine whether a person is normal or abnormal.
Research Method: Field experiment & Participant Observation
Procedure: The experiment was divided into two parts:
1. 8 psychologically normal people (“pseudo-patients”) showed up in different US hospitals and lied that they had been hearing a voice. They gave out false contact names and information; however, they gave true accounts of their experiences.
2. A hospital was notified that they would be receiving more “pseudo-patients” within the next three months, and they need to identify them. None of the pseudo-patients were sent however.
1. 7 of 8 patients were admitted after being falsely diagnosed with schizophrenia. They behaved as they would normally and said that they were feeling alright when asked. They had to prove to the staff that they were fine to be allowed to leave, and all of them came out labeled as ‘schizophrenia in remission’. They stayed for an average of 19 days.
2. 10% of patients admitting were judged to be pseudo-patients by at least two hospital staff members.
Conclusion: In the first case, psychiatrists failed to detect people who were normal and labeled them falsely; in the second case, they couldn’t detect people who were not normal. According to the social and cultural norms criterion, people who break the norm of society are defined as abnormal. This is very subjective, for different societies have different views on what they consider “normal”. This experiment shows how abnormality is not a concrete concept, and a fine line cannot be drawn between normal and abnormal people under this criteria.
Methodological Evaluation:
o High ecological validity: it was conducted as a field experiment. However, they still managed some controls, such as how the patient would react.
o High generalizability: used many hospitals which varied in location, research facilities, etc.
o -Even though the staff didn’t realize that the pseudo-patients were normal, 35 out of 118 patients were suspicious.
o The patients could’ve been dismissed after such a long time because the hospital had to make sure if it was completely safe for them to leave.
- Low replicability: Because it is a field experiment, it cannot be easily replicated without clear controls and variables.
- Ethical Considerations:
o Use of deception: The hospital was deceived twice, although the experiment wouldn’t work if the hospitals knew.
- Privacy: The identities of the hospitals were disclosed. DSM-IV (Inventing Illnesses) Commercial on Anorexia Eating Disorder Treatment Group Therapy (Austin Powers) The Joker (insane or a realist?) Laing’s theory on Psychiatry
with David Rosenhan NEW
MAC ·Studies: Toseland & Siporin (1986)
o Aim: To compare the effectiveness of group and individual therapies.
o Reviewed 74 studies comparing individual and group treatments. Group treatment was found to be as effective as individual treatment in 75% of these studies. More effective in the 25%. No case was found that individual treatment was more effective than group treatment. Group treatment was more cost-effective than individual therapy in 31% of the studies.· McDermott et al. (2001)o
Aim: To determine the effectiveness of group psychotherapy in the treatment of depression.
o Meta-analytic review of studies. Of the 48 studies examined, 43 showed statistically significant reductions in depressive symptoms following group psychotherapy. 9 showed no difference in effectivenes between group and individual therapy. 8 showed CBT to be more effective than psychodynamic group therapy. Discuss The Use of Eclectic
Approaches To Treatment. Definition: a method of treatment that combines two or more techniques or procedures.
Types of Combinations:
Simultaneous use: use of the therapies at the same time
Sequential use: use the one therapy at a time
Stage Oriented use: using a therapy for the patient’s critical stage and other therapies in the maintenance stage
Studies Liu Jing-feng and Zhang Hong-xue (2002) Aim: testing the effectiveness of the combination of 1. Antidepressants, 2. Chinese Herbal Medicine in treating depression
Procedure: one hundred twenty participants were assigned to receive either a Chinese herbal formula/ antidepressant combination treatment or antidepressants alone.
Experimental Group
41 participants in the combination treatment group were said to be cured and return to work and live a normal live.
12 participants had showed improvement and tried to regain their normal lives.
7 had symptoms ended but couldn’t return to their normal lives.
All the participants in the combination group showed improvement.
Control Group
36 participants were cured
8 had shown great improvement
14 of the participants had improved a little
2 didn’t change at all. Only a small percentage of participants had shown improvement
- opens researcher to more than one perspective, hence providing a more comprehensive base of information
- Allows a wider range of patients to be treated
- Broadens the view of both the doctor and the patient

- requires more skill and knowledge to applied
- More than one treatment can cause confusion in determining the effect of each treatment on the patient
- Ma be unsystematic and unfocused
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