Transcript 1 Overview
DEFINING “ABNORMALITY” OR CONSTRUCTING PSYCHOPATHOLOGY?: LECTURE OUTLINE • Some warnings about “abnormality” • Difficulties defining abnormality • Thomas Szasz (1960) – the myth of mental illness • Rosenhan (1973) – on being sane in insane places • Myths and misconceptions • Various ways of defining abnormality SOME WARNINGS • Clinician’s bias – look for abnormality and you will find it • Tendency to focus on problems and ignore the whole person and her/his strengths • Fundamental attribution error – tendency to downplay the importance of the environment as contributing to problems – are people “abnormal” or doing the best they can to cope in stressful circumstances? SOME WARNINGS • Words can hurt – “crazy”, “wacko”, “psycho” are inappropriate • All this can lead us to turn the individual into one of “those people,” uncovering societal prejudices towards people with mental health problems that we may have internalized SOME WARNINGS • So, focus on the person first, the problem second; and look at the person in context • Use “people first” language – person’s proper name or more generally, e.g., “person experiencing depression”; avoid language like “a schizophrenic” SOME WARNINGS • Pay attention to how mental illness is portrayed in the media • Use STOP criteria to think about stigma – Stereotype, Trivialize, Offend, Patronize • Recognize the potential for recovery • Think critically, be a skeptic, question current views! DIFFICULTIES DEFINING ABNORMALITY • What is considered to be “abnormal” is a value judgment, assumption that normality is clearly defined. But what is normality? • Some warning signs for normality – serious, nice, always right, boring, obedient, gullible (Janet Foner, Support Coalition Survivor and Psychiatric Survivor) – please note this is a joke! DIFFICULTIES DEFINING ABNORMALITY • Values depend on social context, and values and social context are variable • Are individuals abnormal or are social conditions stressful? • Defining abnormality is a social act THE MYTH OF MENTAL ILLNESS • Psychiatrist Thomas Szasz argued that mental illness does not exist, but rather problems in living • No known lesions, defects, or diseases of the nervous system underlie any mental illness • “symptoms” of mental illness are not linked to anatomical context, but to social context THE MYTH OF MENTAL ILLNESS • Deviation from social norms is judged by mental health professionals • Whose agent is the mental health professional? (the person, relatives, organization, the state) • Psychiatry is different than other branches of medicine, more tied to problems of ethics and values ROSENHAN (1973) – ON BEING SANE IN INSANE PLACES • 8 “pseudo” patients sought admission to hospitals • voices – “empty”, “hollow”, “thud” • no simulation of symptoms after admission • all except 1 admitted with diagnosis of schizophrenia, discharged with “schizophrenia in remission” ROSENHAN (1973) – ON BEING SANE IN INSANE PLACES • this is an example of the clinician’s bias • detection • “stickiness” of diagnostic labels - stigma • experiences of hospitalization • powerlessness and depersonalization MYTHS AND MISCONCEPTIONS • People with mental illness are strange and different • People with mental illness should be treated differently • Mental illnesses are inherited • Mental illnesses are incurable • Mental illnesses are caused by the stresses of modern life MYTHS AND MISCONCEPTIONS • Mental illness and genius go hand in hand • Mental illnesses is caused by personal weakness and can be overcome through will power • People with mental illness are irrational and dangerous • People with mental illness need to be hospitalized MYTHS AND MISCONCEPTIONS • People with mental illness are poor • People with mental illness are less intelligent than others • All homeless people are mentally ill • Mental illness is a single, rare disorder SUMMARY • Abnormality and mental illness are problematic concepts because of values and social context • Remember that mental illness is not something absolute and unchangeable, but a concept that is constructed in a social context