DEFINITIONS OF ABNORMALITY
Definitions of abnormality, and problems with defining and diagnosing abnormality
The definition of “abnormality” is incredibly fluid; there is no single definition. Generally, abnormality refers to:
- a deviance from statistical norms or social norms
- a deviance from the “ideal” mental health
- the failure to function adequately.
However, all these definitions have a problem. With regards to statistical norms, we can ask: if something is infrequent or rare, does that mean it is really abnormal? As for social norms, they are different all over the world. In some societies, homosexuality is seen as an abnormality whereas in other societies it is just another lifestyle choice.
Marie Jahoda made an attempt to define the “ideal mental health”. She gave six groups that she said were a condition of normality: positive self-esteem and a strong sense of identity, personal growth and development, ability to cope with stressful situations, autonomy and independence, accurate perception of reality, and a successful mastery over one’s environment. As straightforward as this seems, it is still limited. One problem is that the given categories cannot be exactly measured in a person the same way that we can measure something like IQ points. Also, it is described as being too “Western”; in many countries and cultures, autonomy is not highly-valued and independence is often replaced with close-knit ties and interdependence.
Finally, the failure to function adequately was discussed by Rosenhan and Seligman. They said that abnormality can be indicated by several of the following: suffering, maladaptation, vividness and unconventionality, unpredictability and loss of control, irrationality and incomprehensibility, observer discomfort, and violation of moral or ideal standards. They have been criticised for the heavy subjectivity in their approach and their failure to differentiate between abnormal behaviour and behaviour that is just rebellious or eccentric.
Numerous models (also called perspectives, schools or approaches) have been introduced to define abnormal behaviour but the concept itself is difficult to classify in simple terms; there are many exceptions and many opinions.
Emil Kraepelin, a German psychiatrist who is often credited as the “founder of modern scientific psychiatry”, introduced his own classification system in which different syndromes were characterised by a group of defining symptoms. This later formed the basis of the World Health Organisation’s (WHO) International Classification of Diseases (ICD), which has been revised no less than ten times.
The current most widely accepted method of classification is the Diagnostic and Statistical Manual (DSM), first published in 1952. It was developed by the American Psychiatric Association (APA) and has been revised multiple times. It has five axes on which an individual’s mental health can be evaluated:
AXIS 1: presence or absence of most clinical syndromes (schizophrenia, moods, anxiety, sexual/eating disorders).
AXIS 2: presence or absence of stable long-term conditions (personality disorders and learning disabilities).
AXIS 3: relevant information on the individual’s physical health.
AXIS 4: psychosocial and environmental problems.
AXIS 5: rating of an individual’s global level of functioning.
MODELS OF ABNORMALITY
The medical/biological model
This is an approach that discusses abnormality from a biological and medical viewpoint. Its basis is that our moods and behaviours are regulated by the brain and its chemicals. The focus is on biological bodily process, like genetic inheritance. The main assumption of this model is that mental illness resembles physical illness and can therefore be diagnosed and treated in a similar way; a diagnosis would be given and the diagnosis would be treated, not the individual themselves.
For example: a patient of depression with symptoms like suicidal tendencies and insomnia would be diagnosed as having a problem that is resulting from a chemical imbalance in the brain. This would be treated medically with things like prescription drugs.
Strengths of the medical model:
- This approach is based on credible and well-established science, such as medicine.
- It provides an objective and logical system for diagnosis and treatment.
- Evidence shows that biochemical and genetic factors do play a part in some mental illnesses.
Weaknesses of the medical model:
- For most mental illnesses, there is no proof of any physical cause.
- The model does not explain the success of purely psychological treatments for mental illness.
- This approach ignores social and cultural factors which have a statistical relationship with mental illness, such as the high rates of depression among poor people.
The behavioural model
This approach states that our behaviour is the result of our environment, not our biology. Behaviourists have a deterministic view of mental disorders; they believe our actions are largely determined by our experiences in life. They see abnormal behaviour as a learned response that was conditioned into an individual. It follows that if abnormal behaviour can be learned, it can also be unlearned. The goal of behaviourists is to move psychology towards a scientific model that focuses only on strictly observable and measurable behaviour.
For example: a patient with a phobia of dogs would be interpreted as having experienced “classical” conditioning. Behaviourists will assume that the patient has had a traumatic incident involving dogs in their past, an incident that caused them to associate the emotion of fear with the stimulus of a dog. The patient would be treated with desensitisation to the stimulus.
Strengths of the behavioural model:
- This model has led to the development of numerous successful behavioural therapies.
- Behaviourists rightly point out that once the symptoms of a problem are reduced, the patient no longer complains about their problem.
Weaknesses of the behavioural model:
- This is a reductionist approach; it reduces complex human behaviours to basic behavioural responses and simple environmental stimuli.
- Behaviourists only treat the observable symptoms of a disorder, not the underlying causes.
The psychodynamic model
The psychodynamic model was introduced by Sigmund Freud, the Austrian founding father of psychoanalysis and the reason behind most ‘your mum’ jokes.
The core theory of this approach is that the roots of mental illness are psychological, are related to the unconscious mind, and are the result of failed defence mechanisms. Most mental illnesses in adulthood are interpreted as unresolved conflicts and repressed desires, usually stemming from early childhood.
For example: a patient with anxiety would be encouraged to explore his past, particularly his formative childhood years. The theory would be that the anxiety is rooted in a past conflict but was displaced and directed at something else, the new source of anxiety for the individual. The patient would be treated through psychoanalysis and psychotherapies.
Strengths of the psychodynamic model:
- A significantly large amount of people with mental illnesses do have recollections of childhood trauma, such as abuse or neglect.
- It is said that Freud “re-humanised” the mentally ill by making their problems more understandable.
- This is a very optimistic model that supports the view that all mental illnesses can be treated.
Weaknesses of the psychodynamic model:
- Older methods of psychoanalysis tend to overlook the influence of current conflicts over childhood conflicts.
- There is a blatant lack of scientific evidence behind the major theories of this approach.
- This model underestimates the role of a situation and context, overlooking them for an overemphasis on internal conflicts.
The cognitive model
Cognitive psychology is seen as a strand of or a reaction to the behaviourist approach. Cognition refers to all mental, brain-related processes. This could be anything from memory capacity to language skills. The basic assumption of this approach is that mental events result in behaviour because humans interpret the environment before reacting to it; therefore, abnormal behaviour is the result of our cognitive interpretations. Also, emotional problems would be related to distorted cognitive processes. These distortions could be over-generalisations, irrational beliefs, illogicality or negative thoughts.
For example: a patient suffering from a depressed mood after failing a driving test may be having illogically negative thoughts that generalise to all areas of their life. Basically, they may believe they are now a “total” failure and will never be successful. These irrational and polarised thoughts would result in the depressed mood. A cognitive psychologist would aim to teach the patient how to reduce negative thoughts and would emphasise the importance of positivity.
Strengths of the cognitive model:
- Evidence has shown that maladaptive (faulty) thought processes are common in the mentally ill.
- This model promotes positivity by encouraging people to take control of their emotions and choices.
Weaknesses of the cognitive model:
- This model overlooks the possibility of distorted cognitions being the result of mental illness, rather than the cause.
- There is sometimes an overemphasis on autonomy and individualism, meaning that the importance of support systems is sometimes forgotten.
TREATMENTS OF ABNORMALITY
Treatments derived from models
The medical model treats abnormality by looking for physical causes. After making a diagnosis, the doctor would prescribe treatment in the form of prescription drugs, psycho-surgery or electro-convulsive therapy.
Treatment by drugs refers to when patients are prescribed drugs for their illness. Drugs do not actually eliminate a problem, they simply reduce its symptoms. So, taking drugs will not magically cure depression, but they will reduce the symptoms associated with depression (e.g. insomnia). Research shows that over 50% of patients benefit from drug therapy. The main problem, however, is drug dependence. It is possible that patients become addicted to the drug or become completely dependent on it (they may feel hopeless or nervous without the drug). Relapse is another problem; will the patient fall back to their mental illness if their drug is discontinued? Some examples of drugs used to treat abnormalities are antidepressants and tranquillisers.
This treatment is usually introduced as a rare, last resort. It is very risky, unpopular and controversial. It basically involves burning or cutting out a person’s brain nerve fibres that are thought to be causing a disorder. The most common type of psycho-surgery is a “pre-frontal lobotomy”, and I won’t even begin to pretend that I know what this is. Some other types are biomedial, orbital, bilateral and limbic lobotomies. Lobotomies were introduced by António Egas Moniz, a Portuguese neurologist, in 1935.
ECT was introduced by Ugo Cerletti and Lucio Bini in the mid-1930s. It basically involves a patient who is given anaesthesia and a muscle relaxant. The muscle relaxant disturbs breathing so the patient is also given oxygen. An electrical current is then passed through the patient’s brain, thus resulting in a seizure (fit). The electric shock lasts for a few seconds. The patient becomes conscious after a while and may or may not have side effects such as short-term memory loss and dizziness. ECT was more widespread when it was first introduced; it is now used as more of a last resort in more serious cases of mental illness.
Psychotherapy is a kind of “talk therapy”. Since it is based on Freudian theories of the unconscious mind and its conflicts and desires, this therapy focuses on the individual themselves. It is not very different from the mainstream image of a patient laying on a sofa and talking about their issues with a psychologist. Freud himself encouraged his patients to relax and talk about their childhood, desires, fears and thoughts. This is quite a subjective method as it depends on the psychologist’s interpretations. It is also a lengthy process that would take time and patience. Psychotherapy aims to resolve abnormalities by delving into a person’s unconscious mind and determining the source of disturbance and distress.
Cognitive-behavioural therapy is based on the belief that our cognitions, emotions and behaviour are all interactive. This means that our thoughts and feelings determine our behaviour. CBT encourages patients to become aware of their distorted cognitions and negative emotions that result in abnormal behavioural patterns. The patient would be encouraged to develop alternative interpretations to alleviate their psychological distress. Two very early forms of CBT are rational-emotive behavioural therapy and cognitive therapy.
Rational-emotive behavioural therapy:
REBT was created by Albert Ellis, an American psychologist. He developed it in the 1950s and it was inspired by many teachings of Asian, Greek, Roman and modern philosophers. Since this is a type of cognitive-behavioural therapy, the belief behind this therapy is that a person’s thinking pattern influences their emotional state. The goal is to help people alter their thinking pattern into something more healthy and realistic. Ellis also stated that the psychologist using this technique should be blunt, honest and logical instead of simply being warm and supportive. It follows that REBT can be highly directive, persuasive and confronting.