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Defining
Abnormal
Behaviour
Learning aims
At the end of this chapter you should: x Understand the complexity in distinguishing between abnormal and normal behaviour x Understand the various definitions of abnormal behaviour x Be familiar with the differences between deviance and dysfunction x Comprehend the complexities of legal definitions and insanity.
INTRODUCTION
CASE STUDY
Matt is a 42-year-old construction worker. He has been married for 20 years, has two nearly grown children, served four years in the military and has been employed at the same construction company since he left military service. He is described as steady and reliable. Yet, there is one thing that
22 Understanding Abnormal Psychology
doesn’t seem quite right; he carries small brass bells with him wherever he goes. He has carried these bells since he was a child and will tell people that they are for luck. The reality is that Matt carries them to keep evil spirits away. He stopped telling people his real reason for carrying bells because people were less understanding than if he just said he carried them for luck. Matt’s beliefs do not interfere in his life, he has never been treated for a mental illness, and he doesn’t appear to use them to control anything else in his life. His behaviour has made him the butt of jokes. He has been called harsh names; he has been physically and mentally abused by others and yet he continues to carry his bells. Time has taught him to hide them in his clothing and he has taken to sewing them in the seams of his shirts and trousers. How would you describe Matt’s behaviour? Is Matt mentally ill?
WHAT IS ABNORMAL BEHAVIOUR?
What is abnormal behaviour? How do we define what is abnormal? We can identify behaviour that is ‘weird’ when we see it but how do we ‘define’ it. The majority of us avoid what we define for our- selves as ‘odd’ behaviour, for example we would probably choose not to sit next to someone acting in an odd fashion or dressed in odd clothing on a bus or train. We don’t like individuals who smell unclean and whenever possible stay away from them. On the whole, we would define abnormality as being outside the parameters of what is accepted in our society. But how is this defined and what does ‘normal parameters’ really mean? Who decides what is abnormal vs. normal? If normal behaviour is defined by a society, what is a society? A society is a collective of individuals who are defined by the language that is spoken, religious practices and ethnic diversity. Societies are fluid and constantly changing. What was the norm for a society one hundred years ago may not be the norm of the same society today. How an individual behaves within a group is defined by the constraints of the society. Rules and norms govern what are deemed to be normal parameters. If you lived a solitary existence, how you behaved would not be dictated by others as you would be free to do as you chose. Your behaviour would not impinge on anyone else. When an individual lives within a group, the definition of normal behaviour is usually classified by a consensus of what is considered to be normal for that group. Occasionally, certain groups of people can push the boundaries but even this has limitations. For example, many normal behaviours are classified by age ranges. A 16-year-old who chooses to dye their hair a bright lime green colour would probably not be classified as abnormal; perhaps unusual, but not extreme. We would probably agree that this behaviour is pushing the boundaries, but we would also define it as youthful behaviour and therefore acceptable. However, if a 70-year-old engages in the same behav- iour, our evaluation of this individual would be outside of normal boundaries. The norms that gov- ern behaviour at different age categories have unwritten rules that guide behaviour. Although it is certainly not illegal to dye hair any colour, at any age, certain colours would be governed by rules of what is considered age-appropriate behaviour and anyone acting outside these boundaries would probably be classified as behaving in an abnormal way. This is also complicated by the number of inappropriate behaviours. If the only behaviour that is outside of the norm, i.e. lime green hair, and
4 Understanding Abnormal Psychology
HISTORICAL PERSPECTIVES OF ABNORMAL BEHAVIOUR
Ancient societies believed that events and people were controlled by the supernatural and when individuals in the community acted outside of what was considered ‘normal’ they were then placed at the mercy of evil spirits that could cause affliction, inhabit their bodies or cause terrible events to happen to family members. History is filled with stories of individuals who intentionally exchanged their souls in order to obtain wealth and power. Therefore, ancient societies looked for physical evidence of evil and found it in anything that deviated from the norm (Millon, 2004). Physically and mentally abnormalities were proof of demonic possession. Individuals were generally held to be responsible for their own ailments or had committed some act to place family members in danger. The treatments used by many early societies in order to purge the person from evil generally involved extreme physical measures in order to make the corporeal manifestation of the demon unpleasant and allow the evil spirit to leave the body. Unfortunately the extreme physical ‘treat- ment’ often proved fatal but nevertheless was considered a success as it kept the rest of the commu- nity safe from harm (Porter, 2002). The idea that evil spirits were responsible continued for thousands of years, until Hippocrates, a Greek physician, began to change the way illness was perceived. Hippocrates believed that imbal- ances and disorders were not the result of evil spirits and instead were problems within the brain and body. He relied on observations and explanations which would be the beginning of the scien- tific method. Hippocrates greatly influenced medicine by shifting the ideology from corporeal to tangible. He correctly assumed that the most important area of the body was the brain and that it was central to intellectual activity and abnormal behaviour was as a direct result of disease. Hippocrates introduced the theory of heredity and environmental factors into the concept of mental illness and developed more compassionate treatments which subjected individuals to less cruel and violent methods (Porter, 2002). Hippocrates was also the first to classify abnormal behaviour into three distinct categories; mania, melancholia and phrenitis, giving each detailed clinical descriptions. Others would follow the direc- tion that Hippocrates proposed. Plato continued the belief that abnormal behaviours occurred as a result of brain and body dysfunction and would insist that these individuals should be cared for by their families and not punished for their behaviour. Galen made major contributions with his sci- entific examination of the central nervous system and how this contributed to abnormal behaviour (Porter, 2002). Just as mankind appeared to be striding forward, they took a gigantic step backward with the rise of Christianity. Religious dogma reinstated the ancient ideas that abnormal behaviour was the result of supernatural contact; however instead of random, unnamed evil spirits the culprit was the devil. Scientific attempts to understand, classify and explain became less important than accepting disease and dysfunction as a manifestation of God’s will. The influence of Christianity did not promote science and instead actively discouraged it. Physicians were no longer allowed to conduct scientific experiments to determine the cause of death. Anyone who challenged Christian doctrine was denounced as a heretic and condemned. Initially, those who continued the teachings of Hippocrates and Plato were denounced and when
Defining Abnormal Behaviour^5
this proved an ineffective deterrent they were executed by the church and all their papers and books were seized and burned. Scientific thought was in conflict with church doctrine and reli- gious leaders found it abhorrent to mutilate the dead when clearly the death was at God’s will (Porter, 2002). Illness, whether physical or mental, was now seen as punishment for sin. The sick person was guilty by the hand of God for wrongdoing and relief could only come from repentance. The treatment of individuals at this time was imbalanced; some individuals were treated with compassion while others were subjected to cruel punishments designed to elicit confessions. The downward decline of positive treatment continued and individuals displaying abnormal behaviour, mental and physical ill- nesses were subject to prayers, curses, flogging, starvation and immersion in hot water. Church lead- ers deemed what was abnormal behaviour and corrected the inconsistencies (Foucault, 2006). During the fifteenth and sixteenth centuries religious leaders were constantly battling social and religious reforms. In an effort to quash protests which threatened the Church’s power, the Church claimed that these insurrections were the acts of the devil and began to actively endorse demonic possession and witches (Eghigian, 2010). In 1484 Pope Innocent VIII issued a decree calling on the clergy to identify and exterminate any- one thought to be in league with the devil. This resulted in the publication of the malleus malefi- carum (the witches’ hammer). The document acted to confirm the existence of witches and also outlined various ways of detecting them (Alexander & Selesnick, 1966). An individual displaying any behaviour that was deemed to be abnormal in any way was sus- pected of witchcraft. It is probable that anyone with any type of mental illness would certainly have been condemned as being a witch. Individuals behaving outside of traditional norms were seen by the Church as being undesirable or uncooperative and were tortured in order to obtain confes- sions, with thousands of individuals being burned alive and mutilated in the name of the Church (Alexander & Selesnick, 1966).
Ancient societies ^ mental illness caused by demonicpossession
three distinct categories of mental illness Hippocrates mania, melancholia and phrenitis
Plato ^ abnormal behaviour is the result of brainand body dysfunction
scientific examination of the central Galen nervous system
Figure 1.
Defining Abnormal Behaviour^7
in charge of a hospital for insane men. He changed the hospital practices to include humane treat- ment, moral guidance and respectful techniques which were termed the ‘moral treatment move- ment’. Pinel ordered that patients be released from chains and confinement and encouraged to exercise outdoors. Patients were treated with kindness and respect, which appeared to foster their recovery and improve behaviour. Tuke also changed the way individuals were treated; he abhorred the inhumane practices of confining individuals in crowded, cramped cells, often chained to walls or the floor. He established a retreat at York where patients worked, prayed and talked about their problems (Arnold, 2009; Borthwick et al., 2001). While physical treatment was improving for many individuals, the mental factors that were believed to be at the heart of mental illness were being investigated. Two distinct schools of thought emerged: the biological viewpoint and the psychological viewpoint. The biological viewpoint was headed by Emil Kraepelin who believed that mental illness was a result of bio- logical factors. Kraepelin would later be considered to be the father of the classification sys- tem otherwise known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The second school of thought was led by Josef Breuer and Sigmund Freud and became the
decline of positive treatment
Witches hammer and prosecution
Renaissance and changes in treatment – more positive
the rise of the asylums
Science denounced and illness is seen as a punishment from God
Figure 1.
8 Understanding Abnormal Psychology
psychological perspective. This ideology held that psychological processes were the reason for mental illness (Kent, 2003). The early 1900s saw a reversal of the moral treatment movement. Several factors were respon- sible; severe money and staffing shortages, decline in recovery rates, and a new wave of prejudice and fear from the public (Bockoven, 1963). Quickly public mental hospitals were back to provid- ing custodial care and became filled to over-capacity. With the overcrowding came poor treatment and abuse of the patients. Although many mental health reforms had been passed and hospitals attempted to put humane practices into place, the sheer numbers of individuals with mental illness often made these practices unrealistic. Additionally the humane practices were not sufficient for all cases (those that were dangerous or endangered others) and clearly something more was needed. Psychological treatment was available but was generally only accessible to individuals who had the means to pay for this type of intervention. Individuals who could not afford psychological therapies and private care were relegated to the public mental hospitals (Kent, 2003). In 1949 the Australian psychiatrist John Cade reported on the success of giving lithium to long- term hospitalized manic patients that calmed them enough for them to be released. In 1950 the drug thorazine was synthesized, which was extremely effective in the treatment of psychotic patients. It has been claimed that this drug alone has been responsible for the single greatest advances in the twentieth century (Andreasen, 1984; Lickey & Gordon, 1991). Suddenly long-term hospitalized patients were able to be released. A new class of drug, the psychotropic medications came in three
Sanguine − impulsive and pleasure- seekers
Phlegmatic − consistent- relaxed/calm
Melancholic − introverted- thoughtful
Choleric − aggressive- passionate
Blood Yellow bile
Phlegm Black Bile
Figure 1.4 The four humours and associated temperaments – kept in balance, allowed the person to be physically as well as mentally healthy
10 Understanding Abnormal Psychology
GENDER
Our gender plays a major role in our perceptions and how we define ourselves. Being male or female affects the way our parents raise us, our role in life, the way other people respond to us and the way we are treated by society. It has historically also been used to determine normal and abnormal behaviour. Gender defines the range of behaviour that is considered appropriate and permissible and generally the range is narrower for women than for males. Women who do not conform to the current defined roles of femininity are more likely to be labelled as mentally ill (Scheff, 1966). Until relatively recently it was widely accepted that the only desirable roles for a woman were those of wife and mother and that a woman’s entire life should revolve around these roles. Even today in the UK archaic remnants of masculine/feminine social definitions continue to exist, e.g. if a woman hasn’t married before the age of 25 she is deemed a spinster by the UK Registrar’s Office. In com- parison, there are no offensive terms for an unmarried man of any age. Traditional roles form the basis for social behaviour. If we as a society determine that there are certain traditional roles for a group of people, anyone acting outside of these roles would be behav- ing in abnormal ways. We continue to be influenced by traditional roles that determine that certain types of jobs and careers are preferable to others. A female wanting to work in non-traditional roles is no longer considered abnormal but she is still far from the norm. For example, a female plumber may have a difficult time securing jobs independently as many would feel that only a male plumber would provide good service. In the past 30 years women were denied opportunities to many different types of professions such as: accountancy, engineering, politics, medical and legal careers although this is slowly changing and women are being trained and securing jobs in these professions. Unfortunately these changes did not occur without a great deal of discord and women were forced to fight for their rights. Many became pioneers and had to break down barriers in order to overcome gender discrimination. Various studies have documented how boys and girls are socialized into traditional sex roles. Witt (1997) found that children learn at a very young age what the difference in gender means and through a variety of activities, opportunities and positive and negative reinforcement, experience the process of gender role socialization. Sandtrock (1994) found that as children develop they internalize the process of gender roles and these become firmly entrenched and part of a child’s self-concept. Rubin, Provenzano and Luria (1974) found that parents have different expectations of sons and daughters as early as 24 hours after birth. Further studies have documented that a child internalizes the parental messages regarding gender at a very early age and their defined self-identity and self-concepts of gender come from parents (Lauer & Lauer, 1994; Santrock & Warshak, 1979; Kaplan, 1991). Hoffman (1977) found that reasons given by women for preferring a son over a daughter were to please their husbands, carry on the family name and to be a companion for their husband. Reasons for wanting a daughter included having a companion for themselves and to have fun dressing a girl and doing her hair. Stereotyping is defined as attaching an usually unfavourable and inaccurate perception to a group of people. Stereotypes often make it easier to justify unequal treatment of the stereotyped person or group. Among the traditional stereotypes of women is the belief that they are naturally passive, domestic and weak. However unrealistic and inaccurate these stereotypes may be, many
Defining Abnormal Behaviour^11
individuals in society believe them to be true. One of the unfortunate effects of stereotyping is that even people who are victimized by these labels tend to believe that they are true. They become self-fulfilling prophecies, i.e., if a woman believes that being a car mechanic is an occupation that women are incapable of doing because they are not strong enough, she will not take her car to a female car mechanic, believing her to be incapable, nor will she consider the idea of becoming a car mechanic herself or encourage female children to consider that occupation. Goldberg (1972) found that women value professional work that they think was done by a man more highly than the same work if they think it was done by a woman. Horner (1970) found that many women were motivated to avoid success, fearing that the more ambitious and successful they became, the less feminine they would be. The norms of a society are an important source of prejudice and discrimination. Anyone outside of these norms will subject themselves to a variety of conforming social pressures and when these do not work, can be labelled as abnormal and even insane. If an entire society believes that women are less valuable, more mentally unstable, emotional and weak, these definitions will be accepted by most members as being accurate. In early civilization women were equal partners and revered as the bringers of life and fertil- ity (Eisler, 1988). This ideology began to change with the origin of the patriarchal structure most associated with warfare (Brown & Harris, 1978). With warfare, invasions and destruction became the norm and male dominance and enslavement of women became common. Engels (1983) fur- ther stated that the changing status of women also came with the beginning of private ownership of land that coincided with warfare. Society moved from a transient state to a static phase where land ownership, social class and patrilineal inheritance became important. As a result of these changes, women have been dominated by men in every aspect of their lives including reproductive rights and sexual freedom. Chastity and fidelity became important societal virtues and in order for men to ensure that women remained ‘pure’ and that they retained control they designed chastity belts. These devices first appeared in Europe in the fifteenth century and were used until the late 1800s, first by fathers and then by husbands. They enabled men to have complete sexual and reproductive control which included the prevention of masturbation. The most important role for a woman to have was as wife and mother. Any woman who chose a life outside of these roles was considered abnormal. Working- class women were expected to work until they had children. These women tended to have more chil- dren than upper- and middle-class wives. In the middle of the nineteenth century, the average married woman gave birth to six children. Over 35 percent of all married women had eight or more children. It wasn’t until the early 1900s that women began advocating for changes in reproductive rights. Marie Stopes in 1918 wrote a guide for women concerning contraception which caused turmoil with the leaders of the Church of England and the Pope, who believed that the use of birth con- trol was wrong and condemned all forms of contraception. Again, the idea that a woman should be allowed to choose outside of the traditional roles and deny her husband children was considered abnormal behaviour and anyone participating in this behaviour was reprimanded by society as well as the religious organization they were associated with. The first pharmaceutical form of birth control became available in 1957 and for the first time in history women gained control of their reproductive rights as they no longer were required to have
Defining Abnormal Behaviour^13
psychoanalytic concepts and psychiatric diagnoses, the misuse of medication, and sexual miscon- duct in therapy (Geller, 1995). Differences in gender have been noted in the literature concerning depression and anxiety (Culbertson, 1997). What accounts for the higher rates of depression and anxiety in comparison to their male counterparts? Many believe that the higher levels of depression and anxiety are a direct result of women being subject to the impact of social forces that they have to endure; the sale of young girls for marriage or prostitution, restriction of liberty and education for women and the con- siderable control that males exercise on the lives of women in many patriarchal societies around the world (Locke, 1992; McGoldrick, Pearce & Giordano, 1982). Women’s individual differences in the field of abnormal psychology have gone relatively unad- dressed. Many researchers believe there is a need to provide a meaningful context for sociocul- tural understanding, attending to women’s individual differences within and across cultural groups, and to the forces of gender socialization and the impact on identity and self-esteem (Jordan, 1991; Steele, 1997).
MULTICULTURAL PERSPECTIVES
Early research supported the idea of a cultural universality that defined abnormal behaviour. In other words, there was a well defined idea of what were normal patterns of behaviour that existed in spite of the differences in culture and these patterns were world wide. For example, if schizophrenia was a universal disorder that appeared in all cultures and societies the processes would be more similar than dissimilar and the disorder would be similar in origin, process and manifestation. Additional research in this area found that the idea of cultural universality in patterns of abnormal behaviour did not exist (Draguns, 1997). If lifestyles, culture and world views affect how we behave overall it would logically follow that it affects the expression and determination of abnormal behaviour. Therefore the importance of culture and diversity cannot be denied in the manifestation of abnormal behaviour which may or may not lead to a mental disorder. Statistics indicate that mental illness appears in greater numbers in cultures that place emphasis on monetary success. How does this fac- tor into third-world nations? Does mental illness exist in smaller numbers because it goes undiag- nosed or is it a factor of culture? We return to the discussion of what is normal. What can be outside of the realm of normal behaviour without being judged abnormal? What specifically is the relation- ship between cultural norms, values and attitudes and the manifestations of abnormal behaviour? How does an individual move from being abnormal to being mentally ill? All behaviours, whether normal or abnormal, begin from a cultural context. Culture plays a major role in our understanding of human behaviour. But what is culture? Culture is defined as ‘shared learned behaviour which is transmitted from one generation to another for purposes of individual and societal growth, adjustment and adaptation’ (Marsella & Kameoka, 1989). Culture is not syn- onymous with a race or ethnic group. Race and/or ethnic groups are surrounded by their own cul- tural context within the greater society as a whole. The cultural context may be similar or completely different. Individuals may completely embrace their cultural heritage or disregard it completely. Culture can be a powerful determinant of world views and it can affect how we define normal and abnormal behaviours as well as how we treat mental disorders within a defined culture.
14 Understanding Abnormal Psychology
The concept of cultural relativism originates from an anthropological tradition and emphasizes the belief that lifestyles, cultural values and world views affect the expression and determination of abnormal behaviour. What is universal in human behaviour that is also relevant to understand- ing abnormal behaviour? Can it be outside the realm of normal behaviour without being abnormal? Our definition is still problematic. If behaviour is common and is embraced by a community of peo- ple, can it still be defined as abnormal? For example, binge drinking, defined by an excessive use of alcohol within a short time frame, is a common theme among 16−30-year-olds in the UK. Often this type of behaviour clashes with outside cultures when British youth decide to go abroad and continue with this behaviour in other countries. Evidence shows that this type of behaviour is having serious effects on the health and welfare of an entire generation of people (Crabbe, Harris & Koob, 2011). Although the individuals taking part do not recognize it as deviant, distressing, dysfunctional and even dangerous, a large number are becoming alcohol dependent, which will eventually interfere with their personal life as well as cause lifelong health problems. Would we consider this abnormal behaviour? Would we consider this a mental disorder?
ABNORMAL AS DEFINED AS DEVIATION FROM IDEAL MENTAL HEALTH
The concept of ideal mental health was proposed as a criterion of normality by humanistic psy- chologists Carl Rogers and Abraham Maslow in the 1950s. Deviations from the ideal are taken to
Table 1.1 Examples of culture-bound syndromes as defined by the DSM
Amok Malaysia Mad uncontrollable rage Brain fag West Africa Mental exhaustion – vague somatic symptoms, depression Dhat syndrome India Anxiety and hypochondriacal concerns associated with semen Ghost sickness Native Americans/ North America
Sickness attributed to contact with the dead or dying
Latah Indonesia Trance-like reflex where the victim engages in repetitive speech or movements Shenkui Chinese Unresolved anger which disturbs the balance of the five bodily elements hwabyeong Korean Evil eye Mediterranean A look that brings ill health and general bad luck that is cast from a person with unnatural powers Susto Central America Lifelong damage resulting from a severe or frightful experience Taijin kyofusho Japan A form of social anxiety and fear of interpersonal relations zaar Ethiopia Possession of an individual by a spirit (Adapted from the American Psychiatric Association, 2012)
16 Understanding Abnormal Psychology
time of admission. The only individuals who could identify them as normals were the in-patients. This experiment was somewhat embarrassing, as individuals who were in charge of mental health facilities believed that they had the training and experience to recognize mental illness, when in fact this experiment cast a shadow of doubt upon the way we classify mental illness and the fact that trained professionals could not distinguish mentally ill individuals from the mentally well.
MEDICAL DEFINITION
A medical classification of abnormal behaviour describes the characterization by the presence of specific symptoms that define abnormality. Certain symptoms are the basis of determining whether an individual is experiencing an underlying disorder. There are two basic variations of the medi- cal definition that can be distinguished as either organically based or psychologically based. The organic based definition characterizes a group of disorders that have a biological foundation. Many abnormal behaviours are known to have a biological foundation and the medical classifications are sufficient to clearly identify these disorders. The second variation of the medical definition of abnor- mal behaviours is more difficult to define in terms of parameters. The psychological element to mental disorders without the presence of a biological determinant can be difficult to classify. These disorders are referred to as functional disorders. Examples of psychological symptoms that can be underlying a mental illness are mood, attitudes and traits. Symptoms such as delusions, hallucina- tions and depression would be signs of a mental disease (Kutchins & Kirk, 2003). The medical classification of defining abnormal behaviour is that it departs from the norm and harms the affected individual. This definition does allow for the various criteria and perspectives concerning mental illness as well as implying that there is no specific designation from normal to abnormal but is based soley on harm. A mental disorder under this classification implies recogniz- able pattern behaviour (Kutchins & Kirk, 2003). One of the major problems with the medical definition of abnormal behaviour is that mental illness differs from physical disease and the medical approach is difficult to apply. Many mental
Table 1.2 An operational point of view in defining mental illness
1 Exposure to psychiatric treatment 2 Labelled mentally ill by psychiatric diagnosis 3 The individual sensing abnormality seeking assistance 4 Identified as mentally ill by psychological testing 5 Dysfunctional behaviour 6 Dangerous to self or others 7 The absence of positive mental health
Defining Abnormal Behaviour^17
illnesses cannot be detected in the early stages and often appear difficult to distinguish from normal behaviour. Often the precipiting cause is difficult to identify and the identification and etiology are often debated. In addition, the classification is defined by the presence of symptoms as the sole basis for identifying abnormality. Physiological disorders can be easily detected; fever, swelling, skin rashes are symptomatic of many physical disorders and can be measured and evaluated. A change in mood cannot be evaluated so easily. Another significant difference in the two types of medical classification is that the psychological categorization is also related to the reactions of others and is relative to social norms and desired behaviours (Kutchins & Kirk, 2003). Many social factors can contribute to abnormal behaviour with the individual struggling to cope before they are diagnosed with a mental illness. It is only when the individual becomes harmful to themselves or others that the abnormal behaviours shift to mental illness. A further complexity in the medical definition of functional disorders is the designation of what symptoms are related to which disorders. Currently, there is a commonly used system of psychiatric classification describing a wide range of psychological disorders that is often utilized to overcome the complexity of determining psychological dysfunction. This system is published as a manual by the American Psychiatric Association and is referred to as the Diagnostic and Statistical Manual (Kutchins & Kirk, 2003). Guidelines based on research and clinical practice have been collected and documented to pro- vide a basis for what constitutes mental disorders, normal and abnormal psychological development and psychological dysfunction. Although this classification system appears to be a reliable way to classify mental disorders, the reality is much more complicated. If we were to take one of the cul- tural based disorders such as Ghost sickness, the classification system would quickly evaluate the individual as having some type of psychotic disorder. When culture is taken into consideration this classification would be inadequate; clearly the classification has some significant drawbacks.
CLASSIFICATION OF ABNORMAL BEHAVIOURS
Why is it important to classify abnormal behaviour? Without a systematic structure each abnormal behaviour would have to be evaluated as a separate and distinct element, a decision would have to be reached whether or not the behaviour is abnormal and then whether it is problematic. Without a classification system patterns could not be established, treatment could not be standardized and researchers would not understand each other’s categories. Classification systems allow decisions to be made in terms of the treatment and progression of the illness.
DSM-IV-R The first classification system was developed in the nineteenth century by Emil Kraepelin. He developed a comprehensive model of classifications based on his clinical observations and focused his system on distinctive features, or symptoms associated with abnormal behaviour patterns. His classification systems established the groundwork for future systems that are in
Defining Abnormal Behaviour^19
individual functions socially, the manner in which the problem is manifested and how an individual meets obligations and expectations of others. As a final problem, the statistical definition implies that being average is desirable or healthy and while society functions on the basis of normality and social conformity, it also restricts the freedom and individualism of people living in a community. There is also the issue of defining standards. Standards for acceptable performance vary markedly as a function of socioeconomic standing, cultural and ethnic relationships, race, sex, age and various other demographic variables. One prob- lem is that they fail to take into account differences in place, community standards and cultural val- ues. If deviations from the majority are considered abnormal, then many ethnic and racial minorities that show strong subcultural differences from the majority will be classified as abnormal. When we use a statistical definition, the dominant or most powerful group generally determines what consti- tutes normality and abnormality. How does one evaluate such personality traits as assertiveness and dependence in terms of statistical criteria? People who strike out in new directions − artistically, politically or intellectually − may be seen as candidates for psychotherapy simply because they do not conform to normative behaviour. Our example of lime green hair would fall into this definition of ‘least frequently’ as there does not appear to be a huge number of people who choose this col- our. So under our definition we would classify this behaviour as abnormal – but would you consider someone with this hair colour to be dysfunctional? Definitions based on statistical deviation may at first seem sufficient, but they actually present many problems.
Social definition A social definition defines abnormal behaviour within the view of conformity. Individuals in society follow norms and widely accepted standards of behaviour. Conformity to these standards defines normal behaviour whereas deviation from these standards defines abnormal behaviour. Behaviours that violate social norms are likely to be those labelled as abnormal. The social definition recognizes that behaviours viewed outside of social parameters as dangerous, disruptive or merely beyond comprehension are likely to be singled out as deviant. Individuals who violate role expectations are
Figure 1.
50%
25% 25%
20 Understanding Abnormal Psychology
likely to be labelled as deviant or mentally ill. The social definition acknowledges the importance of the community that defines when a member is behaving in a socially unacceptable way (Bowers, 2000). Those who identify an individual as behaving abnormally play a major role in defining and detecting deviant behaviour. The social definition of abnormality generally begins with someone being bothered by the behaviour as violating the standard rules of conformity. Abnormal behaviour is not described as disturbed but disturbing to someone other than the individual participating in the behaviour. The identification of deviant behaviour and mental illness involves others who interact with the individual whose behaviour is considered deviant. The behaviour is then socially defined in terms of the particular relative standards for behaviours and expectations of those with whom the individual interacts. These standards are not absolute, but vary according to the social refer- ence group to which the individual belongs. A social definition of abnormal behaviour is whatever society says is a mental illness or psychological impairment. Unacceptable behaviours are defined by people in everyday life who decide what is sufficiently deviant to single out as mental illness (Horwitz, 2004). There are a few problems with the social definition of abnormality. First, it does not meet the characteristics of many mental health professionals who believe that mental illness is more than a violation of social norms. The social definition does describe an important element of abnormality as there is a social component present in many individuals with disturbed behaviour. For example individuals who are actively hallucinating can be frightening to others, as they interact with people and objects that only they can see, even though the interactions may be harmless. If this person lived outside of a community, there would be no one to define the disturbance. Thomas Szasz (2004), a noted psychiatrist and social critic of the scientific foundations of mod- ern psychopathology, believes that mental illness is a myth and is a creation by society to use, con- trol and change behaviour. According to Szasz, people may suffer from problems in adjusting to the complicated struggle with living in society and not from mental illness. His argument stems from three beliefs: behaviour is labelled abnormal because it is different not wrong; abnormal behaviour is a reflection of something wrong in society and not the individual; and individuals are labelled mentally ill because their behaviours violate the social order. Szasz further asserted that the concept of mental illness is dangerous and is used as a form of social control by those in power. His critics have dismissed his ideology and state that mental illness is not simply a factor of social definition with the new scientific methodologies and techniques as confirmation.
ADAPTIVE AND MALADAPTIVE BEHAVIOUR
Another element of social definition and abnormal behaviour is adaptation. Adaptation is defined as a dynamic process between the attributes of an individual and their environment (Horwitz, 2004). Our environments are constantly changing requiring individuals to modify how they respond and react. Two elements that must be kept in balance are our personal characteristics (skills, education, attitudes, physical condition) and the confronting situations (divorce, physical illness, failures). Maladaptive behaviour implies that the individual is not coping with the changes that they are required to make. For some individuals the stress causes abnormal behaviour. For example an
