Behaviour and personality traits can be inserted into a normal distribution pattern, which predicts how frequent or uncommon a characteristic is. But using this statistical approach to define abnormality provides us with little guidance, for instance being very intelligent or being highly talented in a particular field is infrequent but such behaviour would not be considered as abnormal, “also, there are many kinds of behaviour which are sometimes judged as representing signs of ‘disturbance’, but which are nonetheless quite common” (Hayes, 1993, P. 315).
A second component which abnormal behaviour often disregards, is the violation of social norms. Society establishes social norms and moral standards, which are implicit rules for acceptable behaviour, such behaviour that does not conform to these accepted patterns are considered abnormal. These unwritten social rules are culturally relative and era dependant. They are subjectively defined by a society that varies with current and widespread social attitudes that need constant updating, to exemplify homosexuality was once illegal and regarded as a mental disorder, as it deviated from the social norm.
At a practical level deviation from the expected could be a useful way to identify mental illnesses. It could be beneficial to those suffering from clinical depression as most often than not that are unmotivated to seek help. But a major limitation of this approach is that even within societies there are sub cultural differences in relation to different religious groups, which conform to alternative norms, which makes it very difficult to define abnormality. Also violating social norms is not necessary a bad thing, as some people choose to live a non- conformist lifestyle to exemplify, those who spoke out against the abominable actions of Nazi Germany were regarded as social deviants.
Third, the notion of personal suffering is another important component which is used to define abnormality, thus behaviour is perceived to be abnormal if it creates distress for those experiencing it. Clearly personal distress applies to many forms of mental illness but distress alone does not define abnormality because how does this definition account for the fact that most ‘normal’ individuals endure suffering for instance, losing a loved one or child birth, and that many mentally ill individuals do not appear to suffer any personal distress, “The psychopath treats others coldheartedly and may continually violate the law without experiencing any guilt or remorse” (Davison + Neale, 2001, P. 5).
The forth component relates to disability or dysfunction, thus an individual may be perceived to be abnormal if they are unable to pursue a desired goal. A person with clinical anxiety may experience considerable dysfunction in their everyday activities but how does this constitute as a definition of abnormality as there are no guidelines or rules that tells us which disabilities belong and which do not in society. One individual’s definition of functioning adequately maybe very different compared to another. The most commonly accepted approach to understanding abnormal behaviour is known as the medical model, existing within the biological paradigm.
It proposes the view that individuals who demonstrate disturbing behaviour are mentally ill, resembling causes of physical illness. An assumption embedded within this model is that mental illness can be described in terms of clusters of symptoms, once the symptoms are identified a diagnosis can be made and classified, with treatments of a physical nature, such as drugs, Electro convulsive Shock Treatment (ECT) and psychosurgery. This symptom syndrome approach to abnormality stems from the work of Emil Kraepelin
(1913), who developed one of the first classifications systems. At present there are two classification systems, the Diagnosis and Statistical Manual (DSM) and the International Classification of Diseases and Health Related Problems (ICD). The former is a widely accepted system in the United States and around the world for classifying psychological problems and disorders and is currently in it’s forth revised edition DSM IV, produced by the American Psychological Association. The latter is produced by the World Health Organisation and is mainly used in Europe, with its current version in use being ICD-10.
This essay will centrally focus its evaluation on the DSM IV. The DSM IV comprises of over 200 mental disorders, which are arranged into various categories. A distinguishing feature of the DSM is its multi axial system, with DSM IV representing five classification axes: Axis I: Clinical disorders Axis II: Personality disorders and mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global assessment of functioning. (Davison + Neale, 2001, P. 596).
The classification of diagnosis within the Diagnostic Statistical Manual has within itself its own criticisms, one being that the DSM represents a categorical classification approach, which is argued, “proposes discrete diagnostic entities, which does not allow continuity between normal and abnormal to be taken into consideration” (Davison + Neale, 2001, P. 69).
Thus the validity of DSM represents imperfection, because the system under which the diagnosis of a disorder is made is constructed, as the aetiology of most mental disorders is not known, providing inconclusive answers regarding the mechanisms that may produce symptoms. A study initiated by Rosenhan (1973), very much-raised questions about the validity of the classification system used to diagnose the mentally ill.
Rosenhan postulated that the whole classification system is based on value judgements of psychiatrists, of what they perceive is ‘normal’ and what isn’t, defending the belief that the insane cannot be distinguished from the sane. To test his views Rosenhan admitted eight ‘normal’ people to twelve different psychiatric hospitals of which all of the pseudo-patients complained of hearing voices. The pseudo-patients began to act normal but seven were diagnosed with schizophrenia, concluding, ” it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals” (Rosenhan, 1973 cited in Eysenck + Flanagan, 2001, P.601).
The Diagnostic Statistics Manual can be described as a construction derived from western culture, embedded with western cultural beliefs. The problem this classificatory system reflects is that the DSM has a tendency to perceive mental illness on a founded western medical thought. Such a system might not be applicable in other cultures, and how does it account for the range of culture bound syndromes, which exhibit profoundly striking differences to those of western origin. Such an example of a culturally specific disorder is known as Koro. “An acute anxiety state with partial depersonalisation leading to the conviction of penile shrinkage and to the fears of dissolution” (Yap, 1965 cited in Gallagher, 1980, P. 22), which occurs amongst Chinese males.
Many western psychiatrists argue that these culture bound disorders are culturally relative, in that they are universal disorders labelled differently because of the social milieu in which they are considered. This “confusion arises, of course, from subsuming different types of abnormalities under one heading, ‘abnormality’ and speaking of them as if they were homogeneous entities” (Wegrock, 1939 cited in Southwell + Feldham, 1969, P. 35).
Amongst the most famous proponents of the anti-psychiatry movement were Scheff, (1966) and Szasz, (1972) who proposed critiques of the ontology of mental illness, disputing that the occurrence of mental illness is not something that exists within an individual, but alternatively a social judgement or label imposed upon a behaviour that breaks the expected norms and rules of social behaviour. A powerful argument put forward by Scheff, was his labelling theory, which he argues, through the confirmation of a diagnosis, an individual, through the pressure of society will live up to that label of being ‘mentally ill’.
Thus “his or her behaviour may change in directions that make that label more appropriate than it was in the first place. These expectations may lead to behaviours that confirm the original diagnosis” (Eysenck + Flanagan, 2001, P. 602). Szasz’s belief of mental illness was that it is as convenient as a myth as it plays heir to myths in general and that mental illness is merely a metaphorical expression. Illness is a literal form of a psychosocial disorder whereas the word mental, mind is an organic, conceptual term, which bears no distinction to illness. “Strictly speaking… disease or illness can affect only the body.
There can be no such thing as mental illness” (Szasz, 1974 cited in Eysenck + Flanagan, 2001, P. 602). Szasz illustrates that the concept of mental illness acts as a false explanation, used to conceal the social problems of society and label those who do not conform to the expected norms. Within our culture it is argued that the implications for classifying an individual as mentally ill has adverse consequences, carrying with it negative connotations, that of stigma.
The individual is often rejected for their failure to fulfil societal expectations which “for some interpreters these negative social attitudes towards the mentally ill influence the course and outcome of their disorders” (Bowers 1998, P. 3). To recapitulate on the process of diagnosis, such process can be depersonalising as it clearly assigns an individual into categories, which “can be used derogatorily, in order to group people together as if they were all the same” (Bowers, 1998, P. 83), ignoring their status as a person. In conclusion to this essay it is apparent that it is exceedingly difficult to define abnormality, with a definition that captures its essential features, because of the ever changing perplexities that surround abnormal psychology.
Semantic problems are partly to blame, as the interchanging use of the words ‘insane’, ‘abnormal’, ‘mental illness’ exhibit different interpretations by different people within cultures. Thus a problem becomes a problem when it is perceived to be, as Szasz reflects that mental illness is merely a myth constructed to conceal moral conflicts, as it seems easier to label and impart blame upon people than too change the beliefs and assumptions about normal and abnormal behaviour. It seems that the battle to initiate change will never be won.
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