Abnormal Psychology

1. Abnormal Psychology Session 2: Concepts of Normality and Abnormality

2. Today’s Learning Outcome Examine the concepts of normality and abnormality

3. Concepts of normality and abnormality • It is not any easy task to define what is normal and what is abnormal. • Behavioral measures, such as intelligence and short-term memory tend to be normally distributed – that is, the distribution from a sample of people tends to fall within a bell-shaped curve. • Being normal falls within this bellcurve.

4. Statistical deviation from the norm

5. Abnormality as statistical deviation from the norm • There are problems using statistics in this way when dealing with abnormal behavior, because some things that are statistically normal– such as obesity are not desirable or healthy behaviors – and some that are statistically rare – such as high IQ – are not dysfunctional.

6. Evaluation of Abnormality as statistical deviation from the norm • Use of statistical frequency and deviation from statistical norm is not a reliable criterion to define abnormal behaviour since what is ‘abnormal’ in a statistical sense may be both desirable or undesirable • What may be considered abnormal behaviour in one culture may be normal in another so impossible to establish universal standards

7. Concepts of normality and abnormality • Abnormality is sometimes defined as the subjective experience of feeling “notnormal” – Example: feeling intense anxiety, unhappiness, or distress. • However, experiencing distress is not always a reliable indicator of serious psychiatric problems. Since patients with schizophrenia may be unaware of their condition. • Another way to define abnormality is to consider when behaviour violates social norms or makes others anxious.

8. Concepts of Normality and Abnormality • These variations illustrate the problems in diagnosing ‘abnormal behaviour’ • Rosenhan and Seligman (1984) suggested that there are seven criteria that could be used to decide whether a person or a behaviour is normal or not

9. Rosenhan & Seligman (1984) 7 criteria for defining abnormality • Suffering – does the person experience distress or discomfort? • Maladaptiveness – does the person engage in behaviors that make life difficult for him or her rather than being helpful? • Irrationality – is the person incomprehensible or unable to communicate in a reasonable manner? • Unpredictability – does the person act in ways that are unexpected by himself, herself or other people? • Vividness and Unconventionality – does the person experience things that are different from most people? • Observerdiscomfort – is this person acting in a way that is difficult to watch or that makes other people embarrassed? • Violation of moral or ideal standards – does the person habitually break the accepted ethical and moral standards of the culture?

10. Rosenhan & Seligman (1984) 7 criteria for defining abnormality • These criteria demonstrate the fine line between defining abnormality in ways that focus on distress to the individual, and defining it in terms of what is or is not acceptable to society • The first four criteria deal with how a person is living life. • The fifth represents a social judgment because is deals with what is seen as conventional or not. • The remaining criteria represent social norms.

11. Evaluation: Should social norms be incorporated into criteria of abnormality? Group Discussion • Read through the last four of Rosenhan and Seligman’s criteria again • Unpredictability – does the person act in ways that are unexpected by himself, herself or other people? • Vividness and Unconventionality – does the person experience things that are different from most people? • Observerdiscomfort – is this person acting in a way that is difficult to watch or that makes other people embarrassed? • Violation of moral or ideal standards – does the person habitually break the accepted ethical and moral standards of the culture? Can you see any problems with using these as a basis for identifying abnormality

12. Evaluation: Should social norms be incorporated into criteria of abnormality? • The danger of social judgment is that they often fail to consider the diversity in which people live their lives • Could lead to discrimination against minorities • Not an objective or stable criterion as it is related to socially based definitions that change across time and cultures (e.g. homosexuality) Because the norm is based on morals and attitudes could be vulnerable to abuse • There is an increasing awareness of how psychiatric diagnosis of ethnic minorities has been misapplied because doctors do not understand the cultural norms of the groups people come from Defining abnormality is not easy and has a lot to do with the implicit theories people have about what is normal and abnormal

13. Cultural variations in social norms Group Discussion Can you think of any cultural variations in social norms that might be seen as abnormal by others?

14. Cultural Variation in social norms • For about a thousand years, young Chinese girls had to undergo the painful and debilitating process of foot binding. To ensure small, desirable feet, girls between the ages of three and fourteen had their feet broken and bound with bandages, in order to prevent their feet from growing “too big”. Despite many attempts to ban this ritual, an effective prohibition of foot binding was not was not enacted until 1949. • While most cultures mourn the loss of family members, women of the Dani tribe in Indonesia must suffer great physical pain in addition to emotional pain. When a family member dies, female relatives must cut off a segment of one of their fingers. This practice is performed to satisfy ancestral ghosts. Luckily for the Dani women, this custom is rarely practiced anymore.

15. Cultural variations in social norms • Hallucinations are a great example of this discrepancy. Typically, in Western cultures, experiencing hallucinations is considered extremely abnormal. However, there are other cultures where one who experiences hallucinations might be worshiped as a god or holy person. The hallucinations might even be sought out and induced by consuming some type of substance. If that is the case, that behaviour may be normal for society, and for them. It may just be under reported due to the stigma attached to mental illnesses. • Suicide is another example. Suicide is considered a devastating tragedy in Western cultures, and one who is considering suicide could even be held for mandatory observation. However, in some middle eastern cultures, the religious implications of self inflicted suicide raised the individual to martyr status. • Substance abuse regardless of the environment might be considered abnormal. However, this could be up for discussion as the use and/or abuse of caffeine is considered normal for Western cultures, and certain Native American cultures find it normal to use hallucinogens. The types of acceptable substances would definitely change, and so it becomes difficult to determine whether this behaviour is abnormal or not.

16. The Mental Health Model of Normality criteria • Jahoda (1958) attempted to establish what is abnormal by identifying the characteristics of people who are normal. She identified six characteristics of mental health. • Ability to cope with stressful situations • Realistic self-perception and contact with reality • Voluntary control of behaviour • A strong sense of identity and realistic self-esteem • Ability to maintain healthy interpersonal relationships • Capacity for personal growth and productivity

17. Jahoda’s Mental Health Model of Normality Criteria Group Discussion • Take a close look at the Jahoda’s criteria • Ability to cope with stressful situations • Realistic self-perception and contact with reality • Voluntary control of behaviour • A strong sense of identity and realistic self-esteem • Ability to maintain healthy interpersonal relationships • Capacity for personal growth and productivity Can you see any problems?

18. Jahoda’s (1958) Mental Health Model Criteria Evaluation • If Jahoda’s list was applied, most of us would seem, somehow abnormal. • Szasz (1962) psychological normality and abnormality are culturally defined concepts which are not based on objective criteria • Taylor and Brown (1988) argue that the view that a psychologically health person is one that “maintains close contact with reality” is not in line with research findings. • Lewinsohn et al (1980) found people have ‘positive illusions’ about themselves and rate themselves more positively than others • The criteria in the model are culturally biased value judgments i.e. they reflect an idealised rather than realistic perception of what it means to be a human in Western culture • Jahoda stated that unemployed people were deprived of many of these characteristics and this might account for much of the reported mental ill health among the unemployed

19. An ongoing debate... • It seems pretty clear that what is considered as psychologically normal depends on the society and culture in which a person lives • There is ongoing debate amongst the psychiatrists who make the diagnostic tools about how to define abnormality • And these criteria are changing- sometimes because norms change

20. Oscar Wilde • The orthodox view was that homosexuality was abnormal • The story of the famous writer Oscar Wilde shows that society did not accept homosexuality (he was imprisoned for it)

21. An example of changing views on abnormal behavior: homosexuality • Older versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) viewed homosexuality as abnormal. • DSM-III (1980) declared that homosexuality is only abnormal if the individual has negative feelings about his or her sexual orientation. • The same is seen is DSM-IV (1994) outlined as “persistent and marked distress about one’s sexual orientation”

22. An example of changing views on abnormal behavior: homosexuality • In the UK, homosexuality between consenting adults was illegal until the 1960s. • Peoples’ attitudes to homosexuality have changed • Consequently, the conclusion must be that homosexuality can no longer be considered as abnormal • This example illustrates the inherent problem is classifying what is normal and abnormal

23. Be a thinker! • The DSM has classified transsexualism as a disorder. It is called “gender identity disorder” when people feel deep within themselves that they are a member of the opposite sex Should this be declassified as a disorder as homosexuality was? What are the arguments for and against declassification?

24. Session 2 Part 2 Examine the concepts of normality and abnormality

25. The medical model • Rooted in view that abnormal behaviour is of physiological origin e.g. Disordered neurotransmission • This is called the medical model • Treatment addresses the physiological problems primarily through drug treatment • Abnormal behaviour is defined as psychopathology i.e. Psychological illness based on observed symptoms of a patient • Refers to abnormality as mental illness

26. The medical model DSM-IV • Mental illness criteria • Diagnostic and Statistical Manual of Mental disorders • Published by American Psychiatric Associations • Handbook used by psychiatrists to identify and classify disorders

27. The mental illness criterion- the medical model DSM-IV • Standardised system for diagnosis based on factors such as: • Medical conditions • Psychosocial stressors • Extent to which person’s mental state interferes with daily life

28. Evaluation of the medical model • The model argues that it is better to regard someone suffering from a mental disorder as sick rather than morally defective • Supporters of the medical model argue it is an advantage to be diagnosed as “sick” because itremoves the responsibility from the patient

29. Evaluation of the medical model Ethical concerns • Gross (2006) there have been examples of misuse of medical model. Since the criteria used for diagnosis can be influenced by culture and politics. E.g. In the former Soviet Union political dissidents were diagnosed with schizophrenia implying they were not responsible for their political beliefs. • In the UK in the past, women who were pregnant without being married could be committed to an asylum

30. Evaluation of The medical model • Although DSM-IV is supposed to be an objective classification system this does not prevent a psychiatric diagnosis resulting in the person being stigmatised or labelled as ‘abnormal’

31. Evaluation of the Medical Model Szasz (1962) • Major critic against medical model • Argued that while some disorders were diseases of the brain, most of the so-called ‘mental disorders’ should be considered as ‘problems in living’ • Szasz’s view: though people behave strangely and this is classified as mental illness such behaviours are not underlying symptoms of a brain disease. Consequently the term ‘mental illness’ is not used correctly by psychiatrists

32. Evaluation of the Medical Model • Frude (1998) agrees there are very few psychological disorders that can be associated with identifiable organic pathology However, • Can this view still be valid today? • Neuropsychologists have in some cases revealed chemical abnormality in the brain in people suffering from schizophrenia but brain scans haven’t yet provided an ultimate answer to the question raised by Szasz.

33. Discussion: are you too shy? • A recent trend in schools is to diagnose very shy children with ‘social anxiety disorder’ • Not only are they being diagnosed they are being treated too • Shyness is so common amongst US children that 42% exhibit it. • By the time they reach college, up to 51% of men and 43% of women describe themselves as shy • Some psychiatrists say at least 1/8 of these needs medical attention

34. Discussion: are you too shy? • In 1990s one of the biggest international drug companies declared that its anti-depressant could be used to treat social anxiety disorder • Nudged along by a $92 million public awareness campaign (Imagine being allergic to people), social anxiety disorder became the third most diagnosed mental illness in the US

35. Discussion: Are you too shy? • It has been found that stress hormone cortisol is consistently lower in shy children than their extroverted peers • This discovery challenges the belief that shyness causes youngsters extreme stress

36. Summary • Statistical deviation from the norm • Jahoda’s (1958) mental health model • Rosenhan and Seligman (1984) 7 abnormal criteria • The medical model

37. Activity • Pick any celebrity (dead or alive) that you think is abnormal • Use the concepts for defining abnormality to support your opinion • You will be asked to share your ideas with the class