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…

Defining Abnormality Statistical infrequency Deviation from Social norms 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.Statistical infrequency 2.Deviation from social norms 3.Failure to function adequately 4.Deviation from ideal mental health 5.The mental illness criteria

Option 1: In class information sharing groupwork and presentations In four 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 limitations of that model of abnormality Use the notes and the readings given on wiki 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 four 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 pertinent questions at the end

Seminar Rubric

Definitions of Abnormality: 1)Statistical Infrequency 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)

E.g. Foot size – a shoe manufacturer will take this into account when deciding how many of each shoe size to produce – if they know that 95% of females fall into a shoe size of between 3-9 – then these will be the sizes they produce. 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 model Statistical infrequency

Statistical Infrequency: the normal distribution patter of IQ scores frequency IQ Scores Average IQ in the population is 100pts. The further from 100 you look, the fewer people you find

Statistical Infrequency frequency IQ Scores 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

Limitations of Statistical infrequency as a definition Which characteristics to choose? Where to draw the line? Common disorders Misleading statistics Cultural issues Activity: Write a sentence on each of these Evaluation

Which characteristics to choose? 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 130 not considered a psychological disorder Desirability (how desirable it is to have that attribute) plays a part – if its desirable (e.g. high IQ) its not seen as abnormal Limitations of Statistical infrequency as a definition Evaluation

Where to draw the line? 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 Limitations of Statistical infrequency as a definition Evaluation

Common disorders Depression & anxiety are classified as psychological 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 psychological disorders are not statistically infrequent Limitations of Statistical infrequency as a definition Evaluation

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 Limitations of Statistical infrequency as a definition Evaluation

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 mentally ill people 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 mentally ill people 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 psychological 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. Limitations of Statistical infrequency as a definition Evaluation

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 in schizophrenia (laughing at bad news)/ people with phobias 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 Eccentric or abnormal/ dysfunctional? The role of context Norms change with the times Abnormal or criminal? Cultural issues Evaluation Activity: Write a sentence on each of these

Eccentric or abnormal? Deviating from social norms may not always indicate psychological abnormality. The may simply be eccentric, but walking down the street talking out loud to an invisible person would be seen as abnormal. So only some types of ‘abnormal’ behaviour are regarded as a mental disorder. 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. Norms change with the times- Beliefs about what is abnormal or normal change with the times. E.g. attitudes towards unmarried Mothers in catholic countries has Changed – a century ago they Were put in mental institutions (e.g. In the Republic of Ireland) What's the difference between abnormal or criminal behaviour under this definition? Breaking legal norms means criminal behaviour-and its not normally seen as being due to a mental disorder, apart from when a crime is extreme – e.g. mass murderers are normally regarded as ‘abnormal’. Cultural issues- In western societies – Behaviour of white majority is always seen as the norm. Deviating from social norms may also be used for political purposes (Soviet Russia) and norms vary between cultures. (Cultural relativism) Limitations of the deviations from social norms definition Evaluation

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

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 3) Resistance to stress

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 4) Personal autonomy

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 5) Accurate perception of reality

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. Jahoda’s (1958) criteria for ideal mental health 6) Adapting to the environment

Limitations of the deviation from ideal mental health definition This is a refreshing approach because 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 Evaluation

The difficulty of self actualising Unfortunately, very few people achieve their full potential in life. This may be due to the environment they are in or through some failing within themselves If self actualisation is a criteria for mental health, then most of us would be mentally unhealthy Evaluation

Possible benefits of stress Some people actually work more efficiently under moderately stressful situations E.g. actors perform at their best when they experience a certain amount of anxiety Evaluation

Cultural issues (cultural relativism) Jahoda’s ideas are based on western individualistic societies In collectivistic societies (e.g. In some Asian cultures) – peoples future is planned for them by elders (e.g. who they marry) and it would seem ‘abnormal’ to pursue ones own individualistic goals In collectivist cultures duty to the group is more important than the individuals own goals Evaluation

Limitations of the deviation from ideal mental health definition Evaluation

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 DSM- IV Diagnostic and Statistical Manual of Mental Disorders, (American Psychiatric Association, 1994) - it requires doctors 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 – its an important scale in overall assessment – but a poor score on this scale alone is not enough to indicate a mental disorder. 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 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 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 If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning Serious symptoms OR any serious impairment in social, occupational, or school functioning Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication 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.

Limitations of failure to function adequately definition This may be the most humane way of addressing mental disorders, because its left to the person, and those close to them, to decide whether they wish to seek help. However, there are problems with this approach: Not the whole picture Exceptions to the rule Cultural issues

Limitations of failure to function adequately definition This may be the most humane way of addressing mental disorders, because its left to the person, and those close to them, to decide whether they wish to seek help. However, there are problems with this approach:

Failure to function adequately is not a true definition of abnormality, it simply determines the extent of a persons problems and the likelihood they will need professional help. Someone may be behaving abnormally E.g. someone on a hunger strike But it may not be a dysfunctional behaviour Not the whole picture Evaluation

Exceptions to the rule There are exceptions to the rule.... A student may show a lot of anxiety before an exam, but this is not necessarily regarded as abnormal On the other hand, psychopaths (people who don't understand others emotions) may show violent and aggressive behaviour, but may not experience personal suffering and distress. Evaluation

Cultural issues It is possible that the inability to cope with the demands of daily living may be the cause of mental disorder. This might be the reason why immigrants and ethnic minorities in western countries show higher incidence of mental disorders. Sashidhara (1995) points out how prejudice and racism have a negative impact of psychological wellbeing Evaluation

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. Definitions of Abnormality: 5)The Mental Illness Criteria Activity: Read and highlight the positive and negative evaluative points in this section

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. This 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 (GAF). 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, 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 of the concept “mental illness” was the US psychiatrist Tomasz 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. The Mental Illness Criteria