Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which may or may not be understood as precipitating a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology generally deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant (statistically, functionally, morally or in some other sense), and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind-body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.
The science of abnormal psychology studies two types of behaviors: adaptive and maladaptive behaviors. Behaviors that are maladaptive suggest that some problem(s) exist, and can also imply that the individual is vulnerable and cannot cope with environmental stress, which is leading them to have problems functioning in daily life.Clinical psychology is the applied field of psychology that seeks to assess, understand and treat psychological conditions in clinical practice. The theoretical field known as 'abnormal psychology' may form a backdrop to such work, but clinical psychologists in the current field are unlikely to use the term 'abnormal' in reference to their practice. Psychopathology is a similar term to abnormal psychology but has more of an implication of an underlying pathology (disease process), and as such is a term more commonly used in the medical specialty known as psychiatry.
Main article: History of mental disorders
Throughout time, societies have proposed several explanations of abnormal behavior within human beings. Beginning in some hunter-gatherer societies, animists have believed that people demonstrating abnormal behavior are possessed by malevolent spirits. This idea has been associated with trepanation, the practice of cutting a hole into the individual's skull in order to release the malevolent spirits. Although it has been difficult to define abnormal psychology, one definition includes characteristics such as statistical infrequency.
A more formalized response to spiritual beliefs about abnormality is the practice of exorcism. Performed by religious authorities, exorcism is thought of as another way to release evil spirits who cause pathological behavior within the person. In some instances, individuals exhibiting unusual thoughts or behaviors have been exiled from society or worse. Perceived witchcraft, for example, has been punished by death. Two Catholic Inquisitors wrote the Malleus Maleficarum (Latin for "The Hammer Against Witches"), that was used by many Inquisitors and witch-hunters. It contained an early taxonomy of perceived deviant behavior and proposed guidelines for prosecuting deviant individuals.
The act of placing mentally ill individuals in a separate facility known as an asylum dates to 1547, when King Henry VIII of England established the St. Mary of Bethlehem asylum in London. This hospital, nicknamed Bedlam, was famous for its deplorable conditions. Asylums remained popular throughout the Middle Ages and the Renaissance era. These early asylums were often in miserable conditions. Patients were seen as a “burden” to society and locked away and treated almost as beasts to be dealt with rather than patients needing treatment. However, many of the patients received helpful medical treatment. There was scientific curiosity into abnormal behavior although it was rarely investigated in the early asylums. Inmates in these early asylums were often put on display for profit as they were viewed as less than human. The early asylums were basically modifications of the existing criminal institutions.
In the late 18th century the idea of humanitarian treatment for the patients gained much favor due to the work of Philippe Pinel in France. He pushed for the idea that the patients should be treated with kindness and not the cruelty inflicted on them as if they were animals or criminals. His experimental ideas such as removing the chains from the patients were met with reluctance. The experiments in kindness proved to be a great success, which helped to bring about a reform in the way mental institutions would be run..
Institutionalization would continue to improve throughout the 19th and 20th century due to work of many humanitarians such as Dorethea Dix, and the mental hygiene movement which promoted the physical well-being of the mental patients. "Dix more than any other figure in the nineteenth century, made people in America and virtually all of Europe aware that the insane were being subjected to incredible abuses." Through this movement millions of dollars were raised to build new institutions to house the mentally ill. Mental hospitals began to grow substantially in numbers during the 20th century as care for the mentally ill increased in them.
By 1939 there were over 400,000 patients in state mental hospitals in the USA. Hospital stays were normally quite long for the patients, with some individuals being treated for many years. These hospitals while better than the asylums of the past were still lacking in the means of effective treatment for the patients, and even though the reform movement had occurred; patients were often still met with cruel and inhumane treatment.
Things began to change in the year 1946 when Mary Jane Ward published the influential book titled “The Snake Pit” which was made into a popular movie of the same name. The book called attention to the conditions which mental patients faced and helped to spark concern in the general public to create more humane mental health care in these overcrowded hospitals.
In this same year the National Institute of Mental Health was also created which provided support for the training of hospital employees and research into the conditions which afflicted the patients. During this period the Hill-Burton Acts was also passed which was a program that funded mental health hospitals. Along with the Community Health Services Act of 1963, the Hill-Burton Acts helped with the creation of outpatient psychiatric clinics, inpatient general hospitals, and rehabilitation and community consultation centers.
In the late twentieth century however, the public view on the mentally ill was no longer in such a positive light. A large number of mental hospitals ended up closing down due to lack of funding and overpopulation. In England for example only 14 of the 130 psychiatric institutions that had been created in the early 20th century remained open at the start of the 21st century. In 1963, President John Kennedy launched the community health movement in the United States as a "bold new approach" to mental health care, aimed at coordinating mental health services for citizens in mental health centers. In the span of 40 years, the United States was able to see an about 90 percent drop in the number of patients in Psychiatric hospitals.
This trend was not only in the England and the United States but worldwide with countries like Australia feeling the pain of too many mentally ill patients and not enough treatment facilities. Recent studies have found that the prevalence of mental illness has not decreased significantly in the past 10 years, and has in fact increased in frequency regarding specific conditions such as anxiety and mood disorders.
This led to a large number of the patients being released while not being fully cured of the disorder they were hospitalized for. This became known as the phenomenon of deinstitutionalization. This movement had noble goals of treating the individuals outside of the isolated mental hospital by placing them into communities and support systems. Another goal of this movement was to avoid the potential negative adaptations that can come with long term hospital confinements. Many professionals for example were concerned that patients would find permanent refuge in mental hospitals which would take them up when the demands of everyday life were too difficult. However, the patients moved to the community living have not fared well typically, as they often speak of how they feel “abandoned” by the doctors who used to treat them. It also has had the unfortunate effect of placing many of the patients in homelessness. Many safe havens for the deinstitutionalized mentally ill have been created but they are not as effective as needed. It is estimated that around 26.2% of people who are currently homeless have some form of a mental illness. The placing of these individuals in homelessness is of major concern as the added stress of living on the streets is not beneficial for the individual to recover from the particular disorder with which they are afflicted. In fact while some of the homeless who are able to find some temporary relief in the form of shelters, many of the homeless with a mental illness "lack safe and decent shelter".
Explaining abnormal behaviour
People have tried to explain and control abnormal behavior for thousands of years. Historically, there have been three main approaches to abnormal behavior: the supernatural, biological, and psychological traditions. Abnormal psychology revolves around two major paradigms for explaining mental disorders, the psychological paradigm and the biological paradigm. The psychological paradigm focuses more on the humanistic, cognitive and behavioral causes and effects of psychopathology. The biological paradigm includes the theories that focus more on physical factors, such as genetics and neurochemistry.
In the first supernatural tradition, also called the demonological method, abnormal behaviors are attributed to agents outside human bodies. According to this model, abnormal behaviors are caused by demons, spirits, or the influences of moon, planets, and stars. During the Stone Age, trepanning was performed on those who had mental illness to literally cut the evil spirits out of the victim's head. Conversely, Ancient Chinese, Ancient Egyptians, and Hebrews, believed that these were evil demons or spirits and advocated exorcism. By the time of the Greeks and Romans, mental illnesses were thought to be caused by an imbalance of the four humors, leading to draining of fluids from the brain. During the Medieval period, many Europeans believed that the power of witches, demons, and spirits caused abnormal behaviors. People with psychological disorders were thought to be possessed by evil spirits that had to be exercised through religious rituals. If exorcism failed, some authorities advocated steps such as confinement, beating, and other types of torture to make the body uninhabitable by witches, demons, and spirits. The belief that witches, demons, and spirits are responsible for the abnormal behavior continued into the 15th century. Swiss alchemist, astrologer, and physicianParacelsus (1493–1541), on the other hand, rejected the idea that abnormal behaviors were caused by witches, demons, and spirits and suggested that people's mind and behaviors were influenced by the movements of the moon and stars.
This tradition is still alive today. Some people, especially in the developing countries and some followers of religious sects in the developed countries, continue to believe that supernatural powers influence human behaviors. In Western academia, the supernatural tradition has been largely replaced by the biological and psychological traditions.
In the biological tradition, psychological disorders are attributed to biological causes and in the psychological tradition, disorders are attributed to faulty psychological development and to social context. The medical or biological perspective holds the belief that most or all abnormal behavior can be attributed to a medical factor; assuming all psychological disorders are diseases.
The Greek physician Hippocrates, who is considered to be the father of Western medicine, played a major role in the biological tradition. Hippocrates and his associates wrote the Hippocratic Corpus between 450 and 350 BC, in which they suggested that abnormal behaviors can be treated like any other disease. Hippocrates viewed the brain as the seat of consciousness, emotion, intelligence, and wisdom and believed that disorders involving these functions would logically be located in the brain.
These ideas of Hippocrates and his associates were later adopted by Galen, the Roman physician. Galen extended these ideas and developed a strong and influential school of thought within the biological tradition that extended well into the 18th century.
Medical: Kendra Cherry states: "The medical approach to abnormal psychology focuses on the biological causes on mental illness. This perspective emphasizes understanding the underlying cause of disorders, which might include genetic inheritance, related physical disorders, infections and chemical imbalances. Medical treatments are often pharmacological in nature, although medication is often used in conjunction with some other type of psychotherapy."
According to Sigmund Freud's structural model, the Id, Ego and Superego are three theoretical constructs that defines the way an individual interacts with the external world as well as responding to internal forces. The Id represents the instinctual drives of an individual that remain unconscious; the superego represents a person's conscience and their internalization of societal norms and morality; and finally the ego serves to realistically integrate the drives of the id with the prohibitions of the super-ego. Lack of development in the Superego, or an incoherently developed Superego within an individual, will result in thoughts and actions that are irrational and abnormal, contrary to the norms and beliefs of society.
Irrational beliefs that are driven by unconscious fears, can result in abnormal behavior. Rational emotive therapy helps to drive irrational and maladaptive beliefs out of one's mind.
The term sociocultural refers to the various circles of influence on the individual ranging from close friends and family to the institutions and policies of a country or the world as a whole. Discriminations, whether based on social class, income, race, and ethnicity, or gender, can influence the development of abnormal behaviour.
The number of different theoretical perspectives in the field of psychological abnormality has made it difficult to properly explain psychopathology. The attempt to explain all mental disorders with the same theory leads to reductionism (explaining a disorder or other complex phenomena using only a single idea or perspective). Most mental disorders are composed of several factors, which is why one must take into account several theoretical perspectives when attempting to diagnose or explain a particular behavioral abnormality or mental disorder. Explaining mental disorders with a combination of theoretical perspectives is known as multiple causality.
The diathesis–stress model emphasizes the importance of applying multiple causality to psychopathology by stressing that disorders are caused by both precipitating causes and predisposing causes. A precipitating cause is an immediate trigger that instigates a person's action or behavior. A predisposing cause is an underlying factor that interacts with the immediate factors to result in a disorder. Both causes play a key role in the development of a psychological disorder. For example, high neuroticism antedates most types of psychopathology.
Recent concepts of abnormality
- Statistical abnormality – when a certain behavior/characteristic is relevant to a low percentage of the population. However, this does not necessarily mean that such individuals are suffering from mental illness (for example, statistical abnormalities such as extreme wealth/attractiveness)
- Psychometric abnormality – when a certain behavior/characteristic differs from the population's normal dispersion e.g. having an IQ of 35 could be classified as abnormal, as the population average is 100. However, this does not specify a particular mental illness.
- Deviant behavior – this is not always a sign of mental illness, as mental illness can occur without deviant behavior, and such behavior may occur in the absence of mental illness.
- Combinations – including distress, dysfunction, distorted psychological processes, inappropriate responses in given situations and causing/risking harm to oneself.
- Somatogenic – abnormality is seen as a result of biological disorders in the brain. This approach has led to the development of radical biological treatments, e.g. lobotomy.
- Psychogenic – abnormality is caused by psychological problems. Psychoanalytic (Freud), Cathartic, Hypnotic and Humanistic Psychology (Carl Rogers, Abraham Maslow) treatments were all derived from this paradigm. This approach has, as well, led to some esoteric treatments: Franz Mesmer used to place his patients in a darkened room with music playing, then enter it wearing a flamboyant outfit and poke the "infected" body areas with a stick.
The standard abnormal psychology and psychiatry reference book in North America is the Diagnostic and Statistical Manual of the American Psychiatric Association. The current version of the book is known as DSM-5. It lists a set of disorders and provides detailed descriptions on what constitutes a disorder such as Major Depressive Disorder or anxiety disorder. It also gives general descriptions of how frequently the disorder occurs in the general population, whether it is more common in males or females and other such facts.
The DSM-5 identifies three key elements that must be present to constitute a mental disorder. These elements include:
- Symptoms that involve disturbances in behavior, thoughts, or emotions.
- Symptoms associated with personal distress or impairment.
- Symptoms that stem from internal dysfunctions (i.e. specifically having biological and/or psychological roots).
The diagnostic process uses five dimensions, each of which is identified as an "axis", to ascertain symptoms and overall functioning of the individual. It is important to note that the DSM-5 no longer uses this axis system. These axes are as follows:
- Axis I – Clinical disorders, which would include major mental and learning disorders. These disorders make up what is generally acknowledged as a disorder including major depressive disorder, generalized anxiety disorder, schizophrenia, and substance dependence. To be given a diagnosis for a disorder in this axis the patient must meet the criteria for the particular disorder which is presented in the DSM in that particular disorders section. Disorders in this axis are of particular importance because they are likely to have an effect on the individual in many other axes. In fact the first 3 axes are highly related. This axis is similar to what would be considered an illness or disease in general medicine.
- Axis II – Personality Disorders and a decrease of the use of intellect disorder. This is a very broad axis which contains disorders relating to how the individual functions with the world around him or herself. This axis provides a way of coding for long lasting maladaptive personality characteristics that could have a factor in the expression or development of a disorder on Axis I although this is not always the case. Disorders in this axis include disorders such as antisocial personality disorder, histrionic personality disorder, and paranoid personality disorder. Mental retardation is also coded in this axis although most other learning disabilities are coded in Axis I. This Axis is an example of how the Axes all interact with one another help to give an overall diagnosis for an individual.
- Axis III – General medical conditions and "Physical disorders". The conditions listed here are the ones that could potentially be relevant to the managing or understanding of the case. Axis III is often used together with an Axis I diagnosis to give a better rounded explanation of the particular disorder. An example of this can be seen in the relationship between major depressive disorder and unremitting pain caused from a chronic medical problem. This category could also include use of drugs and alcohols as these are often symptoms of a disorder themselves such as substance dependence or major depressive disorder. Due to the nature of Axis III it is often recommended that the patient visit a medical doctor when he or she is being assessed in order to determine if the problem could potentially require medical intervention such as surgery. When the first 3 axes are used multiple diagnosis are often found which is actually encouraged by the DSM.
- Axis IV – Psychosocial/environmental problems, which would contribute to the disorder. Axis IV is used to inspect the broader aspects of a person’s situation. This axis will examine the social and environmental factors that could affect the person’s diagnosis. Stressors are the main focus of this axis and particular attention is paid to stressors that have been present in the past year; however it is not a requirement that the stressor had to form or continued in the past year. Due to the large number of potential stressors in an individual’s life, therapists often find such stressors via a checklist approach which is encouraged by the DSM. An example of the checklist approach would be examine the individual’s family life, economic situation, occupation, potential legal problems and so on. It is crucial that the patient is honest in this section as environmental factors can have a huge impact on the patient especially in certain schools of therapy such as the cognitive approach.
- Axis V – Global assessment of functioning (often referred to as GAF) or "Children's Global Assessment Scale" (for children and teenagers under the age of 18). Axis V is a score given to the patient which is designed to indicate how well the individual is handling their situation at the current time. The GAF is based on a 100-point scale which the examiner will use to give the patient a score. Scores can range from 1 to 100 and depending on the score on the GAF the examiner will decide the best course of action for the patient.“According to the manual, scores higher than 70 indicate satisfactory mental health, good overall functioning, and minimal or transient symptoms or impairment, scores between 60 and 70 indicate mild symptoms or impairment, while scores between 50 and 60 indicate moderate symptoms, social or vocational problems, and scores below 50 severe impairment or symptoms”. As GAF scores are the final Axis of the DSM the information present in the previous 4 axes are crucial for determining an accurate score.
The major international nosologic system for the classification of mental disorders can be found in the most recent version of the International Classification of Diseases, 10th revision (ICD-10). The ICD-10 has been used by World Health Organization (WHO) Member States since 1994. Chapter five covers some 300 mental and behavioral disorders. The ICD-10's chapter five has been influenced by APA's DSM-IV and there is a great deal of concordance between the two. WHO maintains free access to the ICD-10 Online. Below are the main categories of disorders:
- F00–F09 Organic, including symptomatic, mental disorders
- F10–F19 Mental and behavioral disorders due to psychoactive substance use
- F20–F29 Schizophrenia, schizotypal and delusional disorders
- F30–F39 Mood [affective] disorders
- F40–F48 Neurotic, stress-related and somatoform disorders
- F50–F59 Behavioral syndromes associated with physiological disturbances and physical factors
- F60–F69 Disorders of adult personality and behavior
- F70–F79 Mental retardation
- F80–F89 Disorders of psychological development
- F90–F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
- F99 Unspecified mental disorder
Perspectives of Abnormal psychology
Psychologists may use different perspectives to try to get better understanding on abnormal psychology. Some of them may just concentrate on a single perspective. But the professionals prefer to combine two or three perspectives together in order to get significant information for better treatments.
- Behavioral- the perspective focus on observable behaviors
- Medical- the perspective focus on biological causes on mental illness
- Cognitive- the perspective focus on how internal thoughts, perceptions and reasoning contribute to psychological disorders
- Investigated through family studies, mainly of monozygotic (identical) and dizygotic (fraternal) twins, often in the context of adoption. Monozygotic twins should be more likely than dizygotic twins to have the same disorder because they share 100% of their genetic material, whereas dizygotic twins share only 50%. For many disorders, this is exactly what research shows. But given that monozygotic twins share 100% of their genetic material, it may be expected of them to have the same disorders 100% of the time, but in fact they have the same disorders only about 50% of the time
- These studies allow calculation of a heritability coefficient.
Biological causal factors
- Neurotransmitter [imbalances of neurotransmitters like norepinephrine, dopamine, serotonin and GABA (Gamma aminobutryic acid)] and hormonal imbalances in the brain
- Genetic vulnerabilities
- Constitutional liabilities [physical handicaps and temperament]
- Brain dysfunction and neural plasticity
- Physical deprivation or disruption [deprivation of basic physiological needs]
- Effects of urban/rural dwelling, gender and minority status on state of mind
- Generalizations about cultural practices and beliefs may fail to capture the diversity that exists within and across cultural groups, so we must be extremely careful not to stereotype individuals of any cultural group
- Family systems
- Negatively Expressed Emotion playing a part in schizophrenic relapse and anorexia nervosa.
- Illness dependent on stress "triggers".
- Psychoanalysis (Freud)
Psychoanalytic theory is heavily based on the theory of the neurologist Sigmund Freud. These ideas often represented repressed emotions and memories from a patient's childhood. According to psychoanalytic theory, these repressions cause the disturbances that people experience in their daily lives and by finding the source of these disturbances, one should be able to eliminate the disturbance itself. This is accomplished by a variety of methods, with some popular ones being free association, hypnosis, and insight. The goal of these methods is to induce a catharsis or emotional release in the patient which should indicate that the source of the problem has been tapped and it can then be helped. Freud's psychosexual stages also played a key role in this form of therapy; as he would often believe that problems the patient was experiencing were due to them becoming stuck or "fixated" in a particular stage. Dreams also played a major role in this form of therapy as Freud viewed dreams as a way to gain insight into the unconscious mind. Patients were often asked to keep dream journals and to record their dreams to bring in for discussion during the next therapy session. There are many potential problems associated with this style of therapy, including resistance to the repressed memory or feeling, and negative transference onto the therapist. Psychoanalysis was carried on by many after Freud including his daughter Ana Freud and Jacques Lacan. These and many others have gone on to elaborate on Freud's original theory and to add their own take on defense mechanisms or dream analysis. While psychoanalysis has fallen out of favor to more modern forms of therapy it is still used by some clinical psychologists to varying degrees.
- Behavioral therapy (Wolpe)
Behavior therapy relies on the principles of behaviorism, such as involving classical and operant conditioning. Behaviorism arose in the early 20th century due to the work of psychologists such as James Watson and B. F. Skinner. Behaviorism states that all behaviors humans do is because of a stimulus and reinforcement. While this reinforcement is normally for good behavior, it can also occur for maladaptive behavior. In this therapeutic view, the patients maladaptive behavior has been reinforced which will cause the maladaptive behavior to be repeated. The goal of the therapy is to reinforce less maladaptive behaviors so that with time these adaptive behaviors will become the primary ones in the patient.
- Humanistic therapy (Rogers)
Humanistic therapy aims to achieve self-actualization (Carl Rogers, 1961). In this style of therapy, the therapist will focus on the patient themselves as opposed to the problem which the patient is afflicted with. The overall goal of this therapy is that by treating the patient as "human" instead of client will help get to the source of the problem and hopefully resolve the problem in an effective manner. Humanistic therapy has been on the rise in recent years and has been associated with numerous positive benefits. It is considered to be one of the core elements needed therapeutic effectiveness and a significant contributor to not only the well being of the patient but society as a whole. Some say that all of the therapeutic approaches today draw from the humanistic approach in some regard and that humanistic therapy is the best way for treat a patient. Humanistic therapy can be used on people of all ages; however, it is very popular among children in its variant known as "play therapy". Children are often sent to therapy due to outburst that they have in a school or home setting, the theory is that by treating the child in a setting that is similar to the area that they are having their disruptive behavior, the child will be more likely to learn from the therapy and have an effective outcome. In play therapy, the clinicians will "play" with their client usually with toys, or a tea party. Playing is the typical behavior of a child and therefore playing with the therapist will come as a natural response to the child. In playing together the clinician will ask the patient questions but due to the setting; the questions no longer seem intrusive and therapeutic more like a normal conversation. This should help the patient realizes issues they have and confess them to the therapist with less difficulty than they may experience in a traditional counselling setting.
- Cognitive behavioural therapy (Ellis and Beck)
Cognitive behavioural therapy aims to influence thought and cognition (Beck, 1977). This form of therapy relies on not only the components of behavioral therapy as mentioned before, but also the elements of cognitive psychology. This relies on not only the clients behavioral problems that could have arisen from conditioning; but also there negative schemas, and distorted perceptions of the world around them. These negative schemas may be causing distress in the life of the patient; for example the schemas may be giving them unrealistic expectations for how well they should perform at their job, or how they should look physically. When these expectations are not met it will often result in maladaptive behaviors such as depression, obsessive compulsions, and anxiety. With cognitive behavior therapy; the goal is to change the schemas that are causing the stress in a persons life and hopefully replace them with more realistic ones. Once the negative schemas have been replaced, it will hopefully cause a remission of the patients symptoms. CBT is considered particularly effective in the treatment of depression and has even been used lately in group settings. It is felt that using CBT in a group setting aids in giving its members a sense of support and decreasing the likelihood of them dropping out of therapy before the treatment has had time to work properly. CBT has been found to be an effective treatments for many patients even those who do not have diseases and disorders typically thought of as psychiatric ones. For example, patients with the disease multiple sclerosis have found a lot of help using CBT. The treatment often helps the patients cope with the disorder they have and how they can adapt to their new lives without developing new problems such as depression or negative schemas about themselves.
According to RAND, therapies are difficult to provide to all patients in need. A lack of funding and understanding of symptoms provides a major roadblock that is not easily avoided. Individual symptoms and responses to treatments vary, creating a disconnect between patient, society and care givers/professionals.
Main article: Outline of abnormal psychology
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Saul McLeod published 2008, updated 2014
Abnormal psychology is a division of psychology that studies people who are "abnormal" or "atypical" compared to the members of a given society.
There is evidence that some psychological disorders are more common than was previously thought.
Depending on how data are gathered and how diagnoses are made, as many as 27% of some population groups may be suffering from depression at any one time (NIMH, 2001; data for older adults).
The definition of the word abnormal is simple enough but applying this to psychology poses a complex problem: what is normal? Whose norm? For what age? For what culture?
The concept of abnormality is imprecise and difficult to define. Examples of abnormality can take many different forms and involve different features, so that, what at first sight seem quite reasonable definitions, turns out to be quite problematical.
There are several different ways in which it is possible to define ‘abnormal’ as opposed to our ideas of what is ‘normal’.
Under this definition of abnormality, a person's trait, thinking or behavior is classified as abnormal if it is rare or statistically unusual. With this definition it is necessary to be clear about how rare a trait or behavior needs to be before we class it as abnormal
For instance one may say that an individual who has an IQ below or above the average level of IQ in society is abnormal.
However this definition obviously has limitations, it fails to recognize the desirability of the particular behavior.
Going back to the example, someone who has an IQ level above the normal average wouldn't necessarily be seen as abnormal, rather on the contrary they would be highly regarded for their intelligence.
This definition also implies that the presence of abnormal behavior in people should be rare or statistically unusual, which is not the case. Instead, any specific abnormal behavior may be unusual, but it is not unusual for people to exhibit some form of prolonged abnormal behavior at some point in their lives.
Strength: The statistical approach helps to address what is meant by normal in a statistical context. It helps us make cut – off points in terms of diagnosis.
Limitations: However, this definition fails to distinguish between desirable and undesirable behavior. For example, obesity is a statistically normal but not associated with healthy or desirable. Conversely high IQ is statistically abnormal, but may well be regarded as highly desirable.
Many rare behaviors or characteristics (e.g. left handedness) have no bearing on normality or abnormality. Some characteristics are regarded as abnormal even though they are quite frequent. Depression may affect 27% of elderly people (NIMH, 2001). This would make it common but that does not mean it isn’t a problem
The decision of where to start the "abnormal" classification is arbitrary. Who decides what is statistically rare and how do they decide? For example, if an IQ of 70 is the cut-off point, how can we justify saying someone with 69 is abnormal, and someone with 70 normal ?
Violation of Social Norms
Every culture has certain standards for acceptable behavior, or socially acceptable norms. Norms are expected ways of behaving in a society according to the majority and those members of a society who do not think and behave like everyone else break these norms so are often defined as abnormal.
Under this definition, a person's thinking or behavior is classified as abnormal if it violates the (unwritten) rules about what is expected or acceptable behavior in a particular social group. Their behavior may be incomprehensible to others or make others feel threatened or uncomfortable.
Social behavior varies markedly when different cultures are compared. For example, it is common in Southern Europe to stand much closer to strangers than in the UK. Voice pitch and volume, touching, direction of gaze and acceptable subjects for discussion have all been found to vary between cultures.
With this definition, it is necessary to consider: (i) The degree to which a norm is violated, the importance of that norm and the value attached by the social group to different sorts of violation. (ii) E.g. is the violation rude, eccentric, abnormal or criminal?
Limitations: The most obvious problem with defining abnormality using social norms is that there is no universal agreement over social norms. Social norms are culturally specific - they can differ significantly from one generation to the next and between different ethnic, regional and socio-economic groups. In some societies, such as the Zulu for example, hallucinations and screaming in the street are regarded as normal behavior.
Social norms also exist within a time frame, and therefore change over time. Behavior that was once seen as abnormal may, given time, become acceptable and vice versa. For example drink driving was once considered acceptable but is now seen as socially unacceptable whereas homosexuality has gone the other way. Until 1980 homosexuality was considered a psychological disorder by the World Health Organization (WHO) but today is considered acceptable.
Social norms can also depend on the situation or context we find ourselves in. Is it normal to eat parts of a dead body? In 1972 a rugby team who survived a plane crash in the snow-capped Andes of South America found themselves without food and in sub-freezing temperatures for 72 days. In order to survive they ate the bodies of those who had died in the crash.
Failure to Function Adequately
Under this definition, a person is considered abnormal if they are unable to cope with the demands of everyday life. They may be unable to perform the behaviors necessary for day-to-day living e.g. self-care, hold down a job, interact meaningfully with others, make themselves understood etc.
Rosenhan & Seligman (1989) suggest the following characteristics that define failure to function adequately:
o Maladaptiveness (danger to self)
o Vividness & unconventionality (stands out)
o Unpredictably & loss of control
o Causes observer discomfort
o Violates moral/social standards
One limitation of this definition is that apparently abnormal behavior may actually be helpful, function and adaptive for the individual. For example, a person who has the obsessive-compulsive disorder of hand-washing may find that the behavior makes him cheerful, happy and better able to cope with his day.
Many people engage in behavior that is maladaptive/harmful or threatening to self, but we don’t class them as abnormal
Smoking, drinking alcohol
Deviation from Ideal Mental Health
Under this definition, rather than defining what is abnormal, we define what is normal/ideal and anything that deviates from this is regarded as abnormal. This requires us to decide on the characteristics we consider necessary to mental health.
Jahoda (1958) defined six criteria by which mental health could be measured:
o Positive view of the self
o Capability for growth and development
o Autonomy and independence
o Accurate perception of reality
o Positive friendships and relationships
o Environmental mastery able to meet the varying demands of day-to-day situations
According to this approach, the more of these criteria are satisfied, the healthier the individual is.
Limitation: It is practically impossible for any individual to achieve all of the ideal characteristics all of the time. For example, a person might not be the ‘master of his environment’ but be happy with his situation. The absence of this criterion of ideal mental health hardly indicates he is suffering from a mental disorder.
Ethnocentric: Most definitions of psychological abnormality are devised by white, middle class men. It has been suggested that this may lead to disproportionate numbers of people from certain groups being diagnosed as "abnormal."
For example, in the UK, depression is more commonly identified in women, and black people are more likely than their white counterparts to be diagnosed with schizophrenia. Similarly, working class people are more likely to be diagnosed with a mental illness than those from non manual backgrounds.
Perspectives in Abnormal Psychology
Behaviorists believe that our actions are determined largely by the experiences we have in life, rather than by underlying pathology of unconscious forces. Abnormality is therefore seen as the development of behavior patterns that are considered maladaptive (i.e. harmful) for the individual.
Behaviorism states that all behavior (including abnormal) is learned from the environment (nurture), and that all behavior that has been learnt can also be ‘unlearnt’ (which is how abnormal behavior is treated).
The emphasis of the behavioral approach is on the environment and how abnormal behavior is acquired, through classical conditioning, operant conditioning and social learning.
Classical conditioning has been said to account for the development of phobias. The feared object (e.g. spider or rat) is associated with a fear or anxiety sometime in the past. The conditioned stimulus subsequently evokes a powerful fear response characterized by avoidance of the feared object and the emotion of fear whenever the object is encountered.
Learning environments can reinforce (re: operant conditioning) problematic behaviors. E.g. an individual may be rewarded for being having panic attacks by receiving attention from family and friends – this would lead to the behavior being reinforced and increasing in later life.
Our society can also provide deviant maladaptive models that children identify with and imitate (re: social learning theory).
The cognitive approach assumes that a person’s thoughts are responsible for their behavior. The model deals with how information is processed in the brain and the impact of this on behavior.
The basic assumptions are:
Maladaptive behavior is caused by faulty and irrational cognitions.
It is the way you think about a problem, rather than the problem itself that causes mental disorders.
Individuals can overcome mental disorders by learning to use more appropriate cognitions.
The individual is an active processor of information. How a person, perceives, anticipates and evaluates events rather than the events themselves, which will have an impact on behavior. This is generally believed to be an automatic process, in other words we do not really think about it.
In people with psychological problems these thought processes tend to be negative and the cognitions (i.e. attributions, cognitive errors) made will be inaccurate:
These cognitions cause distortions in the way we see things; Ellis suggested it is through irrational thinking, while Beck proposed the cognitive triad.
Medical / Biological
The medical model of psychopathology believes that disorders have an organic or physical cause. The focus of this approach is on genetics, neurotransmitters, neurophysiology, neuroanatomy, biochemistry etc.
For example, in terms of biochemistry – the dopamine hypothesis argues that elevated levels of dopamine are related to symptoms of schizophrenia.
The approach argues that mental disorders are related to the physical structure and functioning of the brain.
For example, differences in brain structure (abnormalities in the frontal and pre-frontal cortex, enlarged ventricles) have been identified in people with schizophrenia.
The main assumptions include Freud’s belief that abnormality came from the psychological causes rather than the physical causes, that unresolved conflicts between the id, ego and superego can all contribute to abnormality, for example:
- Weak ego: Well- adjusted people have a strong ego that is able to cope with the demands of both the id and the superego by allowing each to express itself at appropriate times. If, however, the ego is weakened, then either the id or the superego, whichever is stronger, may dominate the personality.
- Unchecked id impulses: If id impulses are unchecked they may be expressed in self-destructive and immoral behavior. This may lead to disorders such as conduct disorders in childhood and psychopathic [dangerously abnormal] behavior in adulthood.
- Too powerful superego: A superego that is too powerful, and therefore too harsh and inflexible in its moral values, will restrict the id to such an extent that the person will be deprived of even socially acceptable pleasures. According to Freud this would create neurosis, which could be expressed in the symptoms of anxiety disorders, such as phobias and obsessions.
Freud also believed that early childhood experiences and unconscious motivation were responsible for disorders.
An Alternative View: Mental illness is a Social Construction
Since the 1960’s it has been argued by anti-psychiatrists that the entire notion of abnormality or mental disorder is merely a social construction used by society. Notable anti-psychiatrists were Michel Foucault, R.D. Laing, Thomas Szasz and Franco Basaglia. Some observations made are;
- Mental illness is a social construct created by doctors. An illness must be an objectively demonstrable biological pathology, but psychiatric disorders are not.
- The criteria for mental illness is vague, subjective and open to misinterpretation criteria.
- The medical profession uses various labels eg. depressed, schizophrenic to exclude those whose behavior fails to conform to society’s norms.
- Labels and consequently treatment can be used as a form of social control and represent an abuse of power.
- Diagnosis raises issues of medical and ethical integrity because of financial and professional links with pharmaceutical companies and insurance companies.
Jahoda, M. (1958). Current concepts of positive mental health.
National Institute of Mental Health. (2001). Depression research at the National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml.
Rosenhan, D. L., & Seligman, M. E. P. (1989). Abnormal Psychology Second Edition. New York: W.W. Norton.
How to reference this article:
McLeod, S. A. (2014). Abnormal psychology. Retrieved www.simplypsychology.org/abnormal-psychology.html
Listen to a MIT undergraduate lecture on Defining Mental Illness.
Listen to a MIT undergraduate lecture on Causing Mental Illness.
BBC Radio 4 Broadcast on why some people have schizophrenia and others don't.
BBC Radio 4 Broadcast on David Rosenhan's Pseudo-Patient Study.
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