Defining psychopathology Flashcards
(8 cards)
statistical infrequency
Perhaps the most obvious way to define anything as ‘normal’ or ‘abnormal’ is according to how often we come across it. Statistics are about numbers. According to the statistical definition any relatively usual behaviour or characteristic can be thought of as ‘normal, and any behaviour that is unusual is ‘abnormal!. This is what is meant by statistical infrequency. We can, for example, say that at any one time only a small number of people will have an irrational fear of buttons or believe for no good reason that their neighbours are zombies.
Example: 1Q and intellectual disability disorder
This statistical approach comes into its own when we are dealing with characteristics that can be reliably measured, for example intelligence. We know that, in any human characteristic, the majority of people’s scores will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score. This is called the normal distribution.
You can see the normal distribution of IQ below left
The average IQ is set at 100. In a normal distribution, most people (68%) have a score (in this case IQ) in the range from 85 to 115. Only 2% of people have a score below 70. Those individuals scoring below 70 are very unusual or ‘abnormal, and are liable to receive a diagnosis of a psychological disorder - intellectual disability disorder (IDD).
Deviation from social norms
Most of us notice people whose behaviour represents a deviation from social norms, i.e. when a person behaves in a way that is different from how we expect people to behave. Groups of people (hence social) choose to define behaviour as abnormal on the basis that it offends their sense of what is acceptable or the norm. We are making a collective judgement as a society about what is right.
Norms are specific to the culture we live in
Of course those social norms may be different for each generation and different in every culture, so there are relatively few behaviours that would be considered universally abnormal on the basis that they breach social norms. For example, homosexuality was considered abnormal in our culture in the past and continues to be viewed as abnormal (and illegal) in some cultures (e.g. in April 2019, Brunei introduced new laws that make sex between men an offence punishable by stoning to death).
Example: antisocial personality disorder
A person with antisocial personality disorder (psychopathy) is impulsive, aggressive and irresponsible. According to the DSM-5 (the manual used by psychiatrists to diagnose mental disorder) one important symptom of antisocial personality disorder is an absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour.
In other words we are making the social judgement that psychopaths are abnormal because they don’t conform to our moral standards. Psychopathic behaviour would be considered abnormal in a very wide range of cultures.
failure to function adequately
Failure to function adequately
A person may cross the line between ‘normal’ and ‘abnormal’ at the point when they can no longer cope with the demands of everyday life. This is described as a failure to function adequately. We might decide that someone is not functioning adequately when they are unable to maintain basic standards of nutrition and hygiene. We might also consider that they are no longer functioning adequately if they cannot hold down a job or maintain relationships with people around them.
When is someone failing to function adequately?
David Rosenhan and Martin Seligman 1989) have proposed some additional signs that can be used to determine when someone is not coping. These include:
• When a person no longer conforms to standard interpersonal rules, for example maintaining eye contact and respecting personal space.
• When a person experiences severe personal distress.
• When a person’s behaviour becomes irrational or dangerous to themselves or others.
Example: intellectual disability disorder
On the previous spread we looked at the example of intellectual disability disorder and saw that one of the criteria for diagnosis was having a very low IQ (a statistical infrequency). However, a diagnosis would
not be made on this basis only - an individual must also be failing to function adequately before a
diagnosis would be given.
deviation from ideal mental health
A very different way to look at normality and abnormality is to ignore the issue of what makes someone abnormal but instead think about what makes anyone normal. In other words we consider deviation from ideal mental health. Once we have a picture of how we should be psychologically healthy then we can begin to identify who deviates from this ideal.
What does ideal mental health look like?
Marie Jahoda (1958) suggested that we are in good mental health if we meet the following criteria:
• We have no symptoms or distress.
• We are rational and can perceive ourselves accurately.
• We self-actualise (strive to reach our potential).
• We can cope with stress.
• We have a realistic view of the world.
• We have good self-esteem and lack guilt.
• We are independent of other people.
• We can successfully work, love and enjoy our leisure.
Inevitably there is some overlap between what we might call deviation from ideal mental health and what we might call failure to function adequately. So we can think of someone’s inability to keep a job as either a failure to cope with the pressures of work or as a deviation from the ideal of successfully working
ASPEAR
-accurate perception of
reality
-self actualisation
-positive view of oneself
-environmental mastery
-autonomy
-resistance to stress
Evaluation-statistical infrequencies
Real-world application
One strength of statistical infrequency is its usefulness.
Statistical infrequency is used in clinical practice, both as part of formal diagnosis and as a way to assess the severity of an individual’s symptoms. For example a diagnosis of intellectual disability disorder requires an 1Q of below 70 (bottom 2%). An example of statistical infrequency used in an assessment tool is the Beck depression inventory (BDI). A score of 30+ (top 5% of respondents) is widely interpreted as indicating severe depression.
This shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes.
Unusual characteristics can be positive
One limitation of statistical infrequency is that infrequent characteristics can be positive as well as negative.
For every person with an IQ below 70 there is another with an IQ above 130. Yet we would not think of someone as abnormal for having a high IQ. Similarly, we would not think of someone with a very low depression score on the BDI as abnormal. These examples show that being unusual or at one end of a psychological spectrum does not necessarily make someone abnormal.
This means that, although statistical infrequency can form part of assessment and diagnostic procedures, it
is never sufficient as the sole basis for defining abnormality.
Evaluation-Deviation from social norms
Real-world application
One strength of deviation from social norms is its usefulness.
• Deviation from social norms is used in clinical practice. For example, the key defining characteristic of antisocial personality disorder is the failure to conform to culturally acceptable ethical behaviour i.e. recklessness, aggression, violating the rights of others and deceitfulness. These signs of the disorder are all deviations from social norms.
Such norms also play a part in the diagnosis of schizoptypal personality disorder, where the term ‘strange is used to characterise the thinking, behaviour and appearance of people with the disorder.
This shows that the deviation from social norms criterion has value in psychiatry.
Cultural and situational relativism
One limitation of deviation from social norms is the variability between social norms in different cultures and even different situations.
A person from one cultural group may label someone from another group as abnormal using their standards rather than the person’s standards. For example, the experience of hearing voices is the norm in some cultures (as messages from ancestors) but would be seen as a sign of abnormality in most parts of the UK. Also, even within one cultural context social norms differ from one situation to another. Aggressive and deceitful behaviou in the context of family life is more socially unacceptable than in the context of corporate deal-making.
This means that it is difficult to judge deviation from social norms across different situations and cultures.
Evaluation-failure to function adequately
Represents a threshold for help
One strength of the failure to function criterion is that it represents a sensible threshold for when people need professional help.
Most of us have symptoms of mental disorder to some degree at some time. In fact, according to the mental health charity Mind, around 25% of people in the UK will experience a mental health problem in any given year. However, many people press on in the face of fairly severe symptoms. It tends to be at the point that we cease to function adequately that people seek professional help or are noticed and referred for help by others.
This criterion means that treatment and services can be targeted to those who need them most.
Discrimination and social control
One limitation of failure to function is that it is easy to label non-standard lifestyle choices as abnormal.
In practice it can be very hard to say when someone is really failing to function and when they have simply chosen to deviate from social norms - consider, for example, the table on the right. Not having a job or permanent address might seem like failing to function, and for some people it would be. However, people with alternative lifestyles choose to live ‘off-grid. Similarly those who favour high-risk leisure activities or unusual spiritual practices could be classed, unreasonably, as irrational and perhaps a danger to self.
This means that people who make unusual choices are at risk of being labelled abnormal and their
freedom of choice may be restricted
evaluation-deviation from ideal mental health
A comprehensive definition
One strength of the ideal mental health criterion is that it is highly comprehensive(covers a wide and complete range of factors)
Jahodas concept of ideal mental health includes a range of criteria for distinguishing mental health from mental disorder(good mental health vs bad mental health) In fact it covers most of the reasons why we might seek (or be referred for help with mental health. This in turn means that an individual’s mental health can be discussed meaningfully with a range of professionals who might take different theoretical views e.g. a medically-trained psychiatrist might focus on symptoms whereas a humanistic counsellor might be more interested in self-actualisation.
This means that ideal mental health provides a checklist against which we can assess ourselves and
others and discuss psychological issues with a range of professionals.
May be culture-bound
One limitation of the ideal mental health criterion is that its different elements are not equally applicable across a range of cultures.
Some of Jahoda’s criteria for ideal mental health are firmly located in the context of the US and Europe generally. In particular the concept of self-actualisation would probably be dismissed as self-indulgent in much of the world. Even within Europe there is quite a bit of variation in the value placed on personal independence, e.g. high in Germany, low in Italy. Furthermore what defines success in our working, social and love-lives is very different in different cultures.
This means that it is difficult to apply the concept of ideal mental health from one culture to another.
