Discuss one or more concepts of normality versus abnormality.

Thesis

• Diagnosis of mental illness is linked to the identification of behavior that is considered 'abnormal'.

  • However, definitions of mental illnesses change over time as the definition of abnormal behavior changes

Key Points or Theories

• Main concepts of abnormality:

  • Deviation from social norms

  • Failure to function adequately

Studies

• Jahoda (1958)

• Mojtabai (2011)

Point 1 - Deviation from ideal mental health

• This is an holistic measure as it takes into account all facets and behaviours of a person

• This measure has good application as it can be used as the basis for therapy and treatments with its emphasis on the whole person and on positive mental health and wellbeing.

Jahoda (1958) - Aim and Participants

Aim: To investigate the idea that individuals with bereavement-related depressive episodes do not have a higher risk of depression overall compared with individuals who have not had depression in their lifetime i.e. simply suffering a bereavement will not lead to future depression in an individual.

Participants:  A community-based sample of participants (who were taking part in the National Epidemiologic Survey on Alcohol and Related Conditions) from the USA who were tested in two phases (43,093 in phase 1; 34,653 in phase 2).

Jahoda (1958) - Procedure

• The participants were part of a retrospective longitudinal study into grieving and depression conducted from 2001- 2002 and from 2004-2005

• The researchers used structured interviews, using the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version to guide the type of questions asked

• The interview schedule described above was designed as a diagnostic tool used to diagnose mood, anxiety, substance abuse, and other related disorders

• The researchers measured the participants’ demographic characteristics, including their age at the onset of their depression; any history of depression in their family; if they had used mental health services, and any new depressive episodes they experienced during the 3-year follow up period

• Major depressive episodes were defined as having a duration of at least 2 weeks, during which the participant would have experienced 5 or more of the nine DSM-IV symptoms, particularly impairment and/or distress

• The qualitative data collected via interview was translated into quantitative data via a specific scoring system

Jahoda (1958) - Results

• Participants with bereavement-related, single, brief depressive episodes tended to be older at onset, were more likely to be African-American, and were less likely to have had impairment, anxiety disorders or a previous psychiatric treatment history

• These participants were also less likely than other participants with bereavement-unrelated single, brief depressive episodes to experience fatigue, increased sleep, feelings of worthlessness, and suicidal thoughts

• These participants also had a much lower risk of developing depression during the follow-up period

Jahoda (1958) - Conclusion

Depressive symptoms associated with bereavement can be explained by the bereavement itself, they are not signs that a person is prone to depression generally so DSM-5 should exclude bereavement-related depression from the list of depressive episodes requiring treatment.

Jahoda (1958) - Limitations

• It is possible that some of the participants may have succumbed to social desirability bias when describing their depressive episodes (e.g. by over-playing or under-playing their symptoms depending on what may have seemed more socially acceptable to them) which would impair the validity of the findings

• The findings could - ironically - lead to some bereaved individuals feeling that it is ‘wrong’ to experience bereavement-related depressive episodes in the future and this may result in them under-reporting or hiding their symptoms

Jahoda (1958) - Strengths

• The two large sample sizes used in both phase 1 and phase 2 (more than 10,500 participants in the combined total) gives this study good reliability due to the robustness of the quantitative data collected

• The recommendation by Motjabai to challenge the idea that bereavement-related depression is a mental illness is one which could be helpful to those affected by grief and in turn this could lead to more acceptance that grief and its attendant low mood is a natural part of the grieving process

Deviation from ideal mental health - Evaluation

• Unrealistic Standards: This measure is almost impossible to live up to as it requires each individual to reach the highest levels of positive mental wellbeing (e.g. constantly self-actualising; being completely free of stress; being successful in love, work and leisure time) which may actually lead to people feeling demotivated and low in self-esteem.

• Cultural Bias: This measure is also prone to culture-bound syndrome as it emphasises the importance of the individual which is not aligned with the attitudes and beliefs of collectivist cultures.

• Pathologizing Normal Human Experience: The criteria risk labelling common emotional experiences (like sadness, anxiety, or uncertainty) as “abnormal,” potentially leading to over-diagnosis or unnecessary interventions.

Point/Theory  2 - Failure to Function Adequately

This measure provides clear guidelines for the classification and diagnosis of abnormality as it is focused on observable signs that an individual is not coping e.g. lack of hygiene, clear behavioural distress signals.

Mojtabai (2011) - Procedure

• The participants were part of a retrospective longitudinal study into grieving and depression conducted from 2001- 2002 and from 2004-2005

• The researchers used structured interviews, using the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version to guide the type of questions asked

• The interview schedule described above was designed as a diagnostic tool used to diagnose mood, anxiety, substance abuse, and other related disorders

• The researchers measured the participants’ demographic characteristics, including their age at the onset of their depression; any history of depression in their family; if they had used mental health services, and any new depressive episodes they experienced during the 3-year follow up period

• Major depressive episodes were defined as having a duration of at least 2 weeks, during which the participant would have experienced 5 or more of the nine DSM-IV symptoms, particularly impairment and/or distress

• The qualitative data collected via interview was translated into quantitative data via a specific scoring system

Mojtabai (2011) - Results

• Participants with bereavement-related, single, brief depressive episodes tended to be older at onset, were more likely to be African-American, and were less likely to have had impairment, anxiety disorders or a previous psychiatric treatment history

• These participants were also less likely than other participants with bereavement-unrelated single, brief depressive episodes to experience fatigue, increased sleep, feelings of worthlessness, and suicidal thoughts

• These participants also had a much lower risk of developing depression during the follow-up period

• Participants with bereavement-related, single, brief depressive episodes tended to be older at onset, were more likely to be African-American, and were less likely to have had impairment, anxiety disorders or a previous psychiatric treatment history

• These participants were also less likely than other participants with bereavement-unrelated single, brief depressive episodes to experience fatigue, increased sleep, feelings of worthlessness, and suicidal thoughts

• These participants also had a much lower risk of developing depression during the follow-up period

Mojtabai (2011) - Conclusion

Depressive symptoms associated with bereavement can be explained by the bereavement itself, they are not signs that a person is prone to depression generally so DSM-5 should exclude bereavement-related depression from the list of depressive episodes requiring treatment.

Mojtabai (2011) - Strengths

• The two large sample sizes used in both phase 1 and phase 2 (more than 10,500 participants in the combined total) gives this study good reliability due to the robustness of the quantitative data collected

• The recommendation by Motjabai to challenge the idea that bereavement-related depression is a mental illness is one which could be helpful to those affected by grief and in turn this could lead to more acceptance that grief and its attendant low mood is a natural part of the grieving process

Mojtabai (2011) - Limitations

• It is possible that some of the participants may have succumbed to social desirability bias when describing their depressive episodes (e.g. by over-playing or under-playing their symptoms depending on what may have seemed more socially acceptable to them) which would impair the validity of the findings

• The findings could - ironically - lead to some bereaved individuals feeling that it is ‘wrong’ to experience bereavement-related depressive episodes in the future and this may result in them under-reporting or hiding their symptoms

Failure to Function Adequately - Evaluation

• FTFA is an overly subjective measure as one person’s lack of hygiene may be another person’s eco-friendly refusal to use deodorant which means that the FTFA measure may lack validity.

• Some behaviours may appear to have the characteristics of FTFA but in fact are simply expressions of personal choice e.g. swimming with sharks may put a person’s life in some danger but it would be difficult to argue that their behaviour is abnormal based on this criterion alone.

Comparison

• Mojtabai (2011) shows that not all distress or symptoms (e.g. in bereavement) are signs of mental illness, challenging both models' assumptions about what constitutes abnormality.

• FFA may wrongly classify natural grief behaviours as dysfunctional, while DIMH may pathologize the absence of ideal traits during grieving.

• Both models may lead to over-diagnosis, by failing to differentiate between temporary emotional reactions and clinical disorders.

• Both definitions may lack cross-cultural validity and need to be interpreted in a cultural context.

Conclusion

• Both Deviation from Ideal Mental Health (DIMH) and Failure to Function Adequately (FFA) offer useful but flawed definitions of abnormality.

• DIMH promotes positive wellbeing but is unrealistic and culturally biased, risking over-diagnosis by pathologizing normal emotions like grief.

• Mojtabai (2011) challenges the validity of these models by showing that bereavement-related depression is often temporary and context-specific, not a true mental disorder.