The concepts of abnormality and mental health

What is abnormality? Who decides what abnormal behaviour? Is the society we live in deciding what normal is? People are very interesting to observe; especially when they are faced with situations they do not understand or are out of their comfort zone. People are very quick to pass judgement on others who clearly behave differently and which is deemed unacceptable in our society. Why is it unacceptable? Who decides what is normal and if it is acceptable. The difference between normal and abnormal behaviour is not one that is easily distinguishable.

Looking back in history thousands of years, abnormal behaviour was seen in many different ways. Ancient Egypt and also within Christian Churches, they believed evil spirits or demons has possessed the bodies of people who were thought to be acting abnormal. These possessed people were treated to the higest point of suffering where the evil spirits or demons were thought to leave the body. Flogging or starvation was common and also a procedure called trepanning was carried out. This is where a hole was made in the top of the skull with the expectation the evil spirit would exit by. The 1800’s saw the introduction of asylums for anyone showing the symptoms of the ‘illness’ lunacy. Asylums were appalling places. However, all persons showing mental illness were sent there and treated with corporal punishment and such cruelty. In the 1900’s, there was overcrowding issues in asylums. It was thought that very little could be done to help these people. One of the many treatments in the asylums was to be sat, tied to a revolving chair, which spun at high speed, with a hope to quieten the patient down.

Through all these centuries there have been many philosophers whose theories have been expanded on throughout the ages. The turn of the 17th century, saw the influential philosopher, Thomas Hobbes theory on human nature. The state of nature depicted conditions in the absence of political power or authority (highbeam.com). Hobbes’ theory suggested that human nature is being naturally competitive and violent. However, Jean-Jacques Rousseau, who was an 18th century philosopher, had a contrasting theory suggesting that a natural man is one living in harmony with nature (science.jrank.org). Theories on human nature continued and it was not until the 19th century, psychologist started to research what the term ‘normal behaviour’ was and what is meant by normal behaviour in a society. There have been many theories published and some are used today and also some were deemed unethical. One in particular was the Rosenhan study which took place in 1973. This study saw Rosenhan and seven other ‘normal’ subjects, present themselves to several different psychiatric hospitals in five different states in America (Tracey Cullis et al, p181). The aim of this research was to gain admission to the hospital by explaining they could hear voices. Once they were admitted, the subjects acted normally and denied hearing voices. The outcome of the study saw all eight subjects admitted and diagnosed with schizophrenia with the exception of one. However, the staff had already labelled the subjects as insane and once the research was explained to the hospital staff and they were released, the final diagnosis was schizophrenia in remission.

Abnormality can be defined in many ways in today’s society and cultures. The importance of understanding what is classed as abnormal so normality can be adhered to in society. In most theories, cultural difference (socio-cultural) does play a role, as individuals sense of self is influenced by the culture they live by, which has been suggested by the likes of Freud.

The statistical norm definition of abnormal behaviour is classed as abnormal if it is rare: in behaviour, thinking or trait. A ‘normal’ individual is simply classed as average: behaving in an average manner. However, life would be average if everyone was the same instead of a deviation of the statistical norm. If this was true, then we may not have had the likes of Einstein, as the quote says “a genius is one step from madness” (unknown).Both mental retardation and genius are both classed as statistically rare. However, limitations occur on how rare is rare by this definition. There are no clear boundaries set for rare behaviour, as an individuals rare behaviour may be classed as abnormal, but in another individual, it may be classed as quirky behaviour.

The social norm definition is defined as behaviour being abnormal if it does not conform to social rules. For example: a person whose thinking and/or behaviour being classed as abnormal because it violates the social rules of what is acceptable behaviour in a social group or culture. This behaviour or thinking of this individual may make others within society or culture, feel uncomfortable or threatened. Therefore, their behaviour is judged as abnormal. Limitations with regards to what other people consider what is or is not acceptable. With this in mind, this definition could be used as a means to social control individuals. Additionally, this may include imposing standards of others on to individuals. Behaviour that is seen as unacceptable in today’s society may be acceptable in other cultures. Behaviour such as: women exposing their breasts in public in the western world would be seen as abnormal behaviour. It would indeed make people feel uncomfortable. This is currently been an issue with breastfeeding mothers feeding their babies in a public place. However, in other cultures, tribal women only cover their bottom half, leaving their breasts exposed. This is the social norm for this culture and is not classed as abnormal.

Maladaptive is defined as behaviour that is abnormal if it physically or psychologically affects the individual ability to cope with life, or affects other individuals. The range of abnormal behaviour that falls into this criteria may be anything from a violent individual to someone with phobias or a condition like OCD( obsessive compulsive disorder), which prevents them from functioning normally. Rohsenhan and Seligman (1989) suggested the characteristics of failure to function in and adequate manner are: suffering, maladaptiveness (danger to self), vividness & unconventionality (stands out), unpredictably & loss of control, irrationality/incomprehensibility, and causes observer discomfort and violates moral/social standards (simply psychology).Limitations of this abnormal behaviour criterion may effect the human rights of the individual. By this we mean by discrimination and trying to use social control. Furthermore, judging individuals behaviour because they are not acting in the same way as others in society and this may stigmatise a person if their symptoms are overanalysed.

The mental illness definition that describes symptoms of illness which is abnormal. This can be shown in a variety of ways or symptoms. Szasz (1961) argued that the concept of mental illness is a myth, as the term ill implies there is something physically wrong (cullis et al, p182). He suggested that the mind is not physical and therefore it cannot be classed as being ill. However, diagnosis of mental illnesses can differ from psychologists in different countries; no two diagnoses are the same. Therefore, classification was needed to clarify disorders. Kraepelin (1896) was a German psychiatrist who research into mental disorders influenced the development of classification systems which are used today.

Two of the major systems are DSM (DSM-IV) and ICD (ICD-10). The DSM is mainly used in America and is the 4th version and has many more categories and was first printed in 1982 with 60 disorders. Recent versions show approximately 300 disorders. ICD is the European manual (includes Britain). Some of the early disorders have been removed due to more understanding and research and they are no longer considered a disorder of mental health. Both these manuals define a disorder along the guidelines of clinical symptoms. Once a diagnosis has been attained, treatment will then be decided for the patient. However, diagnosis using the classification system was not always reliable because of lack of consistency and disagreements among the professionals. Therefore, many trials to verify the reliability and validity of the manuals have been carried out.

The categories within the classifications state whether symptoms are associated with the particular disorder are: biological, cognitive or psychological. However, research suggests that within the classification of disorders, certain sub-cultural groups are more at risk of developing them more than others. For example; age, gender, poverty or ethnic origin. This is where influences are looked at.

Biological model of abnormality could mean hormonal imbalance, childbirth, menopause or genetics. It basically defines it as abnormal behaviour that is of consequence of a physical illness, which the sufferer has no real control over. Biological disorders are often treated with the use of prescribed medication or possibly electro-convulsive therapy (ECT). Drugs have proven invaluable but some treatments have unpleasant side effects and only alleviate symptoms of the disorder, which means they do not resolve the fundamental cause. Drug treatments are normally anti depressants or sometimes beta blockers. Anti depressants work by keeping the mood level at a constant, without highs or lows, this alleviates the mood swings. Beta blockers work by keeping the heart rate regulated which alleviates the anxiety feeling and other symptoms. Therapy is found to be the most productive and successful option of treatment. It is expensive and time consuming. However, individuals taking anti-depressants, may become heavily reliant on the medication, which would lead to problems weaning themselves off the prescribed medication. This too is a long process.

An example for biological is the condition bi-polar which is also known as manic depression. Mania is the highs and the depression the lows. However, it is not as clear cut as that. Bipolar has the ability to produce extreme episodes for several weeks. There are many complex factors involved, such as physical, social and envoi mental. However, the cause is not understood. What is understood is the belief that bipolar is a chemical imbalance in the brain. What this means is; the neurotransmitters( norepinephrine, serotonin and dopamine),which are the chemicals that are responsible for controlling the functions of the brain, fail to do their job if one or more of these have an imbalanced level. This in turn results in symptoms of bipolar. If norepinephrine levels are too high, this causes mania and if they are too low depression occurs.

Bipolar symptoms also have a genetic link so it becomes more significant to being a family member of someone who has bipolar. It is thought to have envoi mental triggers rather than a single gene. This could be a stressful situation: mental/physical abuse, death or relationship breakdown. Additionally, everyday stresses like money or work can also be a factor. Physical illness can also be the cause of the onset of an episode. Once a diagnosis has been determined by a psychiatrist, treatment will then be chosen which is suitable for your needs. This could be the drug lithium carbonate, which is prescribed for about 6 months. However, this may cause side effects if the wrong dose is taken. Lithium is a long-term means of treatment for episodes of mania, hypomania, and depression. Other treatments may be, if very severe, hospital treatment or hospitalisation under the mental health act may be required. Psychological treatment may be offered, which is talking through the depression finding the trigger or root cause. Furthermore, exercise is a good treatment.

Cognitive model of abnormality describes abnormality by irrational or faulty thinking. It emphasises cognitive distortions of dysfunctional thought processes. These thoughts could be innate or down to experiences and could very well be of consequence of a disorder rather than a cause. However, the individual is in control unlike in the biological model where it is determined by other factors out of the control of the individual. The abnormality is faulty control as in conditions such as: depression, schizophrenia and OCD (obsessive compulsive disorder). Albert Ellis was a psychologist who developed REBT (rational emotive behaviour therapy) in 1955.

CBT (cognitive behavioural therapy) is a particular therapy which are specifically there to help alleviate problems such as; phobias, depression and OCD. Ellis (1962) and Beck (1963) was cognitive psychologist who helped develop CBT. They suggested; thinking occurs between stimulus and response. CBT is effective with some forms of depression or anxiety disorders. How individuals cope with situations can affect the way they think, feel (positive/negative) and behave. Therefore, cognition (thinking) is changed alongside behaviour. Additionally, this may only work if the cause is not an underlying complication or illness.

Obsessive compulsive disorder (OCD) is a condition where the individual uses compulsions and rituals to help alleviate stress and anxiety of a situation. This behaviour can seriously inhibit their quality of life because they are unable to process their thoughts in the normal way. How OCD occurs, no one truly understands, however some research suggests the trigger may be an experience in childhood or just a fear over germs. In 1925, Freud wrote a book called “psychoanalysis”, where he called OCD, obsessional neurosis. He also believed that OCD existed on a spectrum ranging from obsessive-compulsive personality to psychosis (brain physics.com). The OCD cycle is obsession, anxiety, compulsions then relief. This format goes round and round in the brain of the individual. For example, anxiety or fears over germs. The ritual would be to wash the hands too many times a day, to make them feel better and to alleviate the thoughts. However, this is a non-stop cycle especially if they are overwhelmed by anxiety.

[online] Abnormal Psychology: Failure to Function Adequately.

http://www.simplypsychology.pwp.blueyonder.co.uk/abnormal-psychology.html

IAIN McLEAN and ALISTAIR McMILLAN [online] Definition of: State of Nature: The Concise Oxford Dictionary of Politics:jan 1st 2003. Available at: http://www.highbeam.com/doc/1O86-stateofnature.html

Has no author-State of Nature – Hobbes, Locke, And Rousseau: Hobbes and Rousseau.

http://science.jrank.org/pages/11339/State-Nature-Hobbes-Locke-Rousseau.html

Tracey cullis et al p181

Tracey cullis et al p182 (szasz quote)

http://www.bbc.co.uk/health/emotional_health/mental_health/disorders_bipolar.shtml#treatment_