Transcript abnormal - Marshalldy @ ISM

IB Syllabus Says:
• Examine the concepts of
normality and abnormality.
Abnormality: Definitions and Introduction
• ‘Abnormal Psychology’ or ‘Psychopathology’ is the field of
Psychology that deals with mental, emotional, and behavioural
problems.
• ‘Dysfunctional Behaviour’ used to be the favoured terminology
from the IB – because ‘abnormal’ implies that there is
something wrong with the whole person, and ‘dysfunctional’
only a part. However, the term ‘abnormal’ is now being used
again
• Research is carried out into classification, etiologies
(causation), diagnosis, prevention and treatment
• Its hard to define the term ‘abnormal’ – there is no single
characteristic that applies to all instances of abnormal
behaviour.
• According to the Webster Dictionary (2008) ‘abnormal’ means
– ‘deviating from the norm or differing from the typical’
• People make judgements about what is ‘abnormal’, and these
are influenced by social and cultural factors.
Starter:
• Activity: Have a look at the ‘getting you
thinking’
• Read the statements and think about
these questions:
• Which of the behaviours described do
you consider normal or abnormal?
• How do you decide what is normal or
abnormal?
• Textbook P. 136
Concepts of Normality & Abnormality
Questions….
1. Why is defining abnormal behavior
difficult?
2. Why is making a correct diagnosis
important?
3. What is the role of culture and society?
4. What can happen to definitions of
abnormality over time?
Key terms…
Option 1: Presentations
• In five groups, familiarize yourself with one of the definitions of
abnormality and present to the rest of the class on that topic
• You have 30 minutes to prepare your presentation – use the slides
given – you will stand up in front of the class with those slides
• Describe and explain that model of abnormality
• Outline strengths & limitations of that model of abnormality
• Use the notes and the readings given on blog and see text p.136
onwards
• Prepare questions to check the rest of the class understanding of the
topic – make the presentations memorable and interactive
Presentation Rubric
Option 2: Seminar/ Discussion
• In five groups, you have 30 minutes to prepare to
participate in a seminar on this topic
• You should present your section and also engage the
rest of the group by asking 5 pertinent questions at
the end
• You can bring notes in on an index card
• Make sure you are well prepared!
Seminar Rubric
Deviation from
Social norms
Statistical
infrequency
The mental
Illness criteria
Defining
Abnormality
Failure to function
adequately
Deviation
from ideal
mental health
Definitions of Abnormality
• There are five main definitions of abnormality
and each of them has its strengths and
limitations:
1.
2.
3.
4.
5.
Statistical infrequency
Deviation from social norms
Deviation from ideal mental health
Failure to function adequately
The mental illness criteria
Definitions of Abnormality:
1)Statistical Infrequency
• This definition uses statistical data as its basis.
• This definition presumes that most people don’t stray
from the norm or average.
• Any behaviour that is not statistically frequent and
deviates from the statistical average is considered as
abnormal
• Researchers who take a statistical approach assess
how characteristics are distributed in the general
population – this can be shown through the normal
distribution: a bell shaped curve – where most people
score around the middle in any given population
Statistical infrequency
• The normal distribution also tells us where a
percentage of a population falls within the
spread of scores.
• This is called the standard deviation
• Mathematicians have calculated that 68% of
a population normally fall within 1 standard
deviation either side of the mean, and 95%
within two standard deviations (either side of
the mean)
• So scores outside this range are unusual
(only 2.5% fall above or below it)
Statistical infrequency
• In psychology – behaviour and personality
traits can be measured in terms of
population distribution.
• They assume that individuals are normal if
they do not deviate to far from the average
– for example IQ. So a very high or a very
low IQ is considered as ‘Abnormal’ using
this defintion
Statistical Infrequency: the normal distribution
patter of IQ scores
Average IQ in the
population is 100pts.
frequency
The further from 100
you look, the fewer
people you find
70
100
IQ Scores
130
frequency
Statistical Infrequency
A very small subset of
the population (<2.5%)
have an IQ below 70pts.
Such people are
statistically rare. We
regard them as having
abnormally low IQs
70
100
IQ Scores
130
Evaluation
Strengths of the statistical infrequency
definition of abnormality
• Relies on real statistical data on the
occurrence of a behaviour in a population
• Gives an overview of what is normal and
not normal in a particular population
• Its an objective and unbiased measure
Evaluation
Limitations of Statistical infrequency as a definition
Social desirability & measurement vs.
description
• All statistical frequency does is give a method for
measuring abnormality
• It does not suggest what types of behaviour/
personality are linked to abnormal behaviour
• With statistical abnormality, very low scores or very
high scores are seen as ‘abnormal’ (e.g. this would be
the case for anxiety scores)
• But its not always the case – mental retardation=
IQ<70 (approx 2.5%) but those with IQ>130 not
considered a mental disorder
• Social Desirability (how desirable it is to have that
attribute) plays a part – if its desirable (e.g. high IQ) its
Evaluation
Limitations of Statistical infrequency as a definition
Where to draw the line between
normal and abnormal?
• Its hard to define the cut off point using the
statistical approach.
• There is no agreed point in the scale at which
behaviour can be classified as abnormal, and its
hard to categorise abnormal states in such clear
cut terms such as 1 or 2 standard deviations from
the mean
• E.g. there are many degrees of disorders such as
depression and anxiety
Evaluation
Limitations of Statistical infrequency as a definition
What about common disorders?
• Depression & anxiety are classified as mental disorder because
they have a negative effect on normal functioning
• But in statistical terms, they are not that unusual.
• Angst (1992) found that 1 in 20 Americans severely depressed
and there is a 1 in 10 chance of having a serious depressive
episode in your lifetime
• Kessler et al. (1994) 48% of people had suffered from at least
one psychological disorder in their lives
• So some mental disorders are not statistically infrequent
Evaluation
Limitations of Statistical infrequency as a definition
Misleading statistics
• Statistical infrequency may be useful in general
terms, but it falls short when applied to mental
disorders.
• You can only use statistics for mental disorders
diagnosed by a clinician, this may not be a clear
picture of the true occurrence of a disorder as many
people don’t seek professional help
• Gender differences: Females are more likely to
many to consult doctors for anxiety disorders, and
men are more likely to deal with problems in physical
ways e.g. sport. Our socialisation encourages men
and women to cope in different ways – and this is
reflected in the statistical data
Evaluation
Limitations of Statistical infrequency as a definition
Cultural issues (cultural relativism)
• Mental disorders are more statistically infrequent in some groups than
others, this may be due to culture.
• E.g. in rural Indian societies people with mental disorders are sometimes
seen as cursed and are looked down upon. Therefore psychological
disorders may appear less frequent in such societies.
• Rack (1982) points out that people with mental disorders are also looked
down upon in China. Chinese tend to only diagnose Psychotic behaviour
(delusions/ hallucinations) rather than depression, which appears absent
as a specific mental disorder in some East Asian cultures. However, the
disorder itself may be equally common among Asians.
• Furthermore, Rack (1982) concluded that East Asians rarely contact their
doctors for emotional distress, but only for physical problems
• So statistical infrequency reflects the likelihood of seeking help, rather
than whether a mental disorder is present or absent in a culture.
Definitions of Abnormality:
2)Deviation from social norms
• Every society has rules for behaviour based on a set of
moral standards
• Some are explicit, such as the law, and some are implicit
– a convention (e.g. not standing too close to someone
when talking to them, sitting quietly in a cinema)
• These are all codes of conduct are social norms and
someone who deviates from these is seen as deviant or
abnormal
• E.g. inappropriate emotional responses/phobias
• The strength of this approach is that it’s a useful way to
identify mental problems – we learn what to expect from
people, and become concerned if it deviates from this- and
people can then help people to get help
Limitations of the deviations from social norms definition
Evaluation
Cultural issuesEccentric or abnormal?
In western societies –
Deviating from social norms may not always
Behaviour of white majority is
indicate psychological abnormality. The may simply
always seen as the norm.
be eccentric, but walking down the street talking out
Deviating from social norms
loud to an invisible person would be seen as
may also be used for political
abnormal. So only some types of ‘abnormal’
purposes (Soviet Russia) and
behaviour are regarded as a mental disorder.
norms vary between cultures.
(Cultural relativism)
Norms change with the timesWhat's the difference between abnormal or
Beliefs about what is abnormal or
criminal behaviour under this definition?
normal change with the times.
Breaking legal norms means criminal
E.g. attitudes towards unmarried
behaviour-and its not normally seen as being
Mothers in catholic countries has
due to a mental disorder, apart from
Changed – a century ago they
when a crime is extreme – e.g. mass murderers
Were put in mental institutions
are normally regarded as ‘abnormal’.
(e.g. In the Republic of Ireland)
The role of context in the deviation for social norms
definition A lot of behaviour is context-specific, and may
seem ‘abnormal’ outside of its original context.
This is why we may see this behaviour as abnormal.
Definitions of Abnormality:
3)Deviation from ideal mental health
• The humanistic psychologist Jahoda (1958)
put forward the idea of ideal mental health.
• These are his six ‘criteria for optimum living’,
and if you don’t have these, then you are
vulnerable to mental disorders:
1) Positive attitudes towards self
2) Self-actualisation of one’s potential
3) Resistance to stress
4) Personal autonomy
5) Accurate perception of reality
6) Adapting to the environment
Jahoda’s (1958) criteria for ideal mental health
1) Positive attitudes towards self
• Confidence, self reliance,
self acceptance.
• People who have learnt to
live with themselves –
accepting their strengths
and limitations
• People must ‘know who
they are and like what
they see’
Jahoda’s (1958) criteria for ideal mental health
2) Self-actualisation of one’s potential
• Maslow (1968) stated
that we are all thriving
to fulfil our potential –
if we are prevented
from doing this then it
leads to ill health
• Jahoda believes that
this is an important
component of ideal
mental health
Jahoda’s (1958) criteria for ideal mental health
3) Resistance to stress
• To develop good coping strategies for
dealing with stressful situations
• ‘the ability to tolerate anxiety without
disintegration’
Jahoda’s (1958) criteria for ideal mental health
4) Personal autonomy
• To be reliant on ones
own resources, not
dependent on other
people
• ‘The ability to makes
ones own decisions
based on what's right
for oneself’
Jahoda’s (1958) criteria for ideal mental health
5) Accurate perception of reality
• Seeing oneself
and the world
around in realistic
terms, not through
‘rose tinted
glasses’ or too
pessimistically.
• Its important to be
balanced in ones
view of the world
Jahoda’s (1958) criteria for ideal mental health
6) Adapting to the environment
• To be content with all
areas of ones life, an
to be flexible and
able to adapt to
change.
• Not fixed in a
particular way of
thinking.
Evaluation
Evaluation of the deviation from
ideal mental health definition
• A strength to this definition is it focuses on
the positive aspects of life rather than the
negative ones
• but the six criteria appear quite
demanding: most people are likely to fall
short on at least one of them. These are the
specific limitations:
• The difficulty of self actualising
• Possible benefits of stress
• Cultural issues
Definitions of Abnormality:
4)Failure to function adequately
• People with mental disorders often experience a lot of suffering and
distress, as well as an inability to cope with everyday activities such as
going to work or taking part in social activities.
• The main system doctors used to diagnose mental disorders is the DSMIV Diagnostic and Statistical Manual of Mental Disorders, (American
Psychiatric Association, 1994) - it requires clinicans to assess people on
a number of psychological and physical measures.
• One of the DSM-IV measures is the Global Assessment of
Functioning (GAF) scale – this is a its an important scale which
clinicians use to rate their clients. The make an overall assessment of
the person.
• If a behaviour seems ‘abnormal’ to others, but is not harming themselves
or anyone else, and not preventing them from living a normal life – then
no intervention is required.
• However, this means that some people with a mental disorder that fall
outside the criteria for serious mental disorder may not get the help
they need.
Global Assessment of Functioning (GAF) scale
This scale considers psychological, social and occupation functioning on a
hypothetical continuum of mental health to illness.
91-100 Superior functioning in a wide range of activities, life's problems never seem
to get out of hand, is sought out by others because of his or her many qualities. No
symptoms.
81-90 Absent or minimal symptoms, good functioning in all areas, interested and
involved in a wide range of activities, socially effective, generally satisfied with life, no
more than everyday problems or concerns.
71-80 If symptoms are present they are transient and expectable reactions to
psychosocial stresses; no more than slight impairment in social, occupational, or
school functioning.
61-70 Some mild symptoms OR some difficulty in social, occupational, or school
functioning, but generally functioning pretty well, has some meaningful interpersonal
relationships.
51-60 Moderate symptoms OR any moderate difficulty in social, occupational, or
school functioning.
41-50 Serious symptoms OR any serious impairment in social, occupational, or
school functioning.
31-40 Some impairment in reality testing or communication OR major impairment in
several areas, such as work or school, family relations, judgment, thinking, or mood.
21-30 Behavior is considerably influenced by delusions or hallucinations OR serious
impairment in communications or judgment OR inability to function in all areas.
11-20 Some danger of hurting self or others OR occasionally fails to maintain
minimal personal hygiene OR gross impairment in communication.
1-10 Persistent danger of severely hurting self or others OR persistent inability to
maintain minimum personal hygiene OR serious suicidal act with clear expectation of
death.
0 Not enough information available to provide GAF.
Evaluation of failure to function
adequately definition
• A strength of this approach is that it may
most humane way of addressing mental
disorders because it addresses the degree
to which a condition is affecting a person.
• A persons GAF score is based on
clinicians observations of their behaviour
and reports from family and friends.
• It is a also a very useful tool for clinicians
to decide whether a person needs
professional help.
Limitations of failure to function adequately
definition
Activity: Read and highlight the positive and negative evaluative points in this section
Definitions of Abnormality:
5)The Mental Illness Criteria
• The mental illness criterion is rooted in a view from
the medical world that abnormal behavior is of
physiological origin, for example the result of
disordered neurotransmission.
• This is called the medical model. Consequently,
treatment addresses the physiological problems,
primarily through drug treatment.
• Abnormal behavior is referred to as
psychopathology—that is, psychological (Or mental)
illness that is based on the observed symptoms of a
patient.
The Mental Illness Criteria
• The term “mental disorder” is used in the Diagnostic and
Statistical Manual of Mental Disorders published by the
American Psychiatric Association (called DSM-IV); a
handbook used by psychiatrists in the US to identify and
classify symptoms of psychiatric disorders.
• A strength of this a approach is that it is a standardized
system for diagnosis based on factors such as the
person’s clinical and medical conditions, psychosocial
stressors and the extent to which a person’s mental state
interferes with his or her daily life ( the Global Assessment
of Functioning scale).
• A limitation to this approach is that there are several
ethical concerns about the use of the medical model to
define abnormal behavior. This model argues that it is
better to regard someone suffering from a mental disorder
as sick rather than morally defective because
responsibility is removed from the patient.
The Mental Illness Criteria
• According to Gross (2002), there have been examples of
misuse of the medical model and these highlight this
approaches limitations, since the criteria used for diagnosis
are not objective and can be influenced by culture and politics.
In the former Soviet Union political dissidents were diagnosed
as schizophrenic, implying that they were not responsible for
their deviant political beliefs.
• In the UK in the last century, women who were pregnant
without being married could be admitted to an asylum. Today,
psychiatrists diagnose using a classification system that is
supposed to be objective.
• The traditional medical model in psychiatry is now assumed to
be reductionist, and most psychiatrists use a biopsychosocial
approach to diagnosis and treatment.
• However, this does not prevent a psychiatric diagnosis resulting
in the patient being labeled as different, or “not normal’.
The Mental Illness Criteria
• One of the most radical critics who highlighted the
limitations of the concept of“mental illness” was the US
psychiatrist Thomas Szasz, who argued against the
concept of mental illness”.
• In The Myth of Mental Illness (1962), he argued that
while some neurophysiological disorders were diseases of
the brain most of the so-called “mental disorders” should
be considered as problems in living.
• By saying this, Szasz went against the idea of organic
pathology in psychological disorders.
• Szasz’s view, even though people behave strangely and
this is classified as mental illness by psychiatrists, such
behaviours are not a symptom of an underlying brain
disease. Consequently, the concept of mental illness is not
used correctly by psychiatrists.
The Mental Illness Criteria
• According to Frude (1998) there are relatively few
mental disorders that can be associated with
identifiable organic pathology.
• However, is Szasz’s argument still valid today?
Neuropsychologists have, in some cases, revealed
possible chemical abnormality in the brain (in the
temporal cortex) in people suffering from
schizophrenia (Pilowsky, 2006) but brain scans
haven’t yet provided an ultimate answer to the
questions raised by Szasz.
Activity: Review these five definitions and their strengths and limitations – you will be
tested on it in 8 minutes
Deviation from
Social norms
Statistical
The mental
infrequency
Illness criteria
Concepts of Normality
& Abnormality
Failure to function
adequately
Deviation
from ideal
mental health
Activity: Create a mind map paper which describes each of definitions
plus a strength and limitation (No notes)
Name:
Description:
Strength:
Limitation:
Name:
Description:
Strength:
Limitation:
Name:
Description:
Strength:
Limitation:
Concepts of Normality
& Abnormality
Name:
Description:
Strength:
Limitation:
Name:
Description:
Strength:
Limitation: