Definitions of abnormality
1. Deviation from social norms
Abnormality can be defined in terms of standards of social behaviour. For example, it is acceptable to wear very little clothing on a beach, but not when walking down the street. Such standards are socially agreed and culturally-based, though there are many cross-cultural similarities.Many people who are labelled as clinically abnormal do behave in a socially deviant way, for example, schizophrenics behave anti-socially and erratically.
- Advantages of this approach
- This has the benefit of including some consideration of the effect of deviant behaviour on others.
- Limitations of this approach
- Social deviations vary according to prevailing moral perspectives and this approach allows serious abuse of inidividual rights. Examples of deviation through history have been witchcraft, homosexuality and unmarried motherhood.
- Social deviation is related to social and cultural context. What is deviant in Britain may not be deviant elsewhere, and vice versa.
- Social deviation can be a good thing, as in the case of people who resisted German occupation in the Second World War, so it may be dangerous to regard deviancy as automatically abnormal.
2. Failure to functiom adequately
Certain behaviours are distressing and dysfunctional for the individual. For example, being depressed disrupts a persons ability to work, to look after him/herself and/or conduct satisfying relations with other people.
Rosenhan and Seligman (1989) suggested that certain elements jointly determine abnormality. Singly, they may cause no problem, but when several co-occur, they are symptomatic of abnormality and are related to a failure to function adequately. These elements are suffering, maladaptiveness (personally and socially), irrationality and incomprehensability, unpredictability and loss of control, vividness and unconventionality, observer discomfort and violation of moral standards.
(2) adv. and disadv.
Advantages of this approach
- Using the concepts of dysfunction and distress awknowledges the subjective experience of the individual.
Limitations of this approach
- In some situations, apparently dysfunctional behaviour may be functional, for example, depression can be an adaptive response to stress.
- Personal distress may not be a good indicator of an undesirable state. Although many people do seek psychiatric help because they feel distressed, not all mental disorders are accompanied by a state of distress (e.g. anti-social personality disorder). However, in other situations, distress is a 'healthy' response up to a point (e.e. the death of a close friend). This means having to make subjective decisions about how much distress is tolerable. It might be helpful to include the distress of others as a criterion of adaptive behaviour.
- Diagnoses of dysfunction and distress require judgements to be made by others, which are inevitably influenced by social and cultural values.
3. Deviation from mental health
Dcotors use the concept of physical health as a yardstick to measure ill-health, for example, a body temperature outside the normal range indictaes illness. Jahoda (1958) suggested that we could similarly define psychological well-being in terms of signs of psychological health in order to recognise mental illness. The key features would be self-acceptance, potential for growth and development, autonomy, accurate perception of reality, environmental competence, and positive interpersonal relations.
- Advantages of this approach
- It is preferable to have some absolutes (signs of healthiness) rather than relying on subjective criteria that are prone to cultural relativism.
- Limitations of this approach
- Such approaches are nevertheless influenced by cultural attitudes, for example, autonomy is not a universal ideal.
- The list is idealistic - few people actually manage to achiever most of the behaviours identified.
- It is possible to meausre physical illness objectively (e.e. blood pressure), but the concepts for metal health are too vague for the purpose of diagnosis.
Psychoanalysis is derived from Freud's theory of personality. Psychoanalysis is both the theory and the method for dealing with mental disorders. Freud believed that mental disorder arises from early experiences that create anxiety and so the associated feelings are repressed into the unconscious mind. However, unconscious thoughts and feelings affect behaviour and create mental disorder. Cure relies on the therapists ability to make the unconscious conscious and guide the patient in resolving thir conflicts. The following techniques are used:
- Free association - The therapist introduces a topic and the patient talks freely about anything that comes into his/her mind. This enables unconscious thoughts and feelings to be uncovered.
- Rich interpretation - The therapist explains the patients thoughts and feelings using Freuds dynamics or personality development. If a patient resist the interpretation offered, this can be taken as evidence that the therapist is correct because he/she has uncovered isssues that create anxiety and are repressed.
- Analysis of dreams - Dreams express the innermost workings of the mind. By talking through a patients dreams the therapist accesses the 'royal road to the unconscious'. In Freudian therapy, dreams are repressed 'wishes'.
- Transference - The patient transfers their feelings about others onto the therapist, therefore, recreating some of the original anxietes. For example, the therapist may become the hated parent. The therapist then has to deal with these transferred feelings and, therefore, deals with the original repressed anxieties.
Evaluation of Psychoanalysis
- Eysenck (1952) examined 10,000 patient histories and found a 44% improvement in patients recieving psychoanalysis, but higher rates for mixed therapies. However, when Bergin (1971) reanalysed the same data using different outcome criteria the psychoanalysis success rose to 83& and the mix group feel to 65%
- The emphasis on early conflicts means that present conflicts may be overlooked.
- Pyschoanalysis has limited applicability. It is suitable for intelligent and verbally-able patients, and for wealthy clients with time on their hands, as appointments are usually several times a week over a period of years.
- It is only suitable for those mental ilnesses where some insight is retained, i.e. it is not helpful with schizophrenics.
- Therapy may create false memories. This has led to some serious court cases in the USA.
Systematic de-sensitisation is mainly used to treat phobias, such as fear of flying or snake phobias. It was a method devised by Wolpe (1958) in which a patient learns to pair the feared thing with relaxation, rather than anxiety.
- Relaxation - The patient is taught deep muscle relaxation. Relaxation will later become associated with the feared object, replacing the existing link between feared object and anxiety. Relaxation also works through recipricol inhibition - the fact that it is impossible to maintain two incompatible emotional responses simultaneously (anxiety and relaxation).
- De-sensitisation hierachy - The patient constructs a hierachy of increasingly threatening situations. Typically, there might be 15 items in the hierachy, such as looking at a picture of the feared object, watching someone else holding it, touching it and so on.
- Visualisation - The patient is asked to imagine each scene whilst deeply relaxed. At any time, if the patient feels anxious, the images is stopped and relaxation is regained. This may take several attempts.
- Progression - When a particular scene can be imagined without creating anxiety, then the patient can move on to the next step in the hierachy, finally mastering the feared situation.