1.2 Defining Psychopathology

abnormal psychology

An aternative definition of psychopathology, albeit with stigmatising connotations relating to not being ‘normal’.

service user groups

Groups of individuals who are end users of the mental health services provided by, for example, government agencies such as the NHS.

What must we consider when defining psychopathology?

Not only whether a definition is useful in the scientific and professional sense but also whether it provides a definition that will minimise the stigma experienced by sufferers and facilitate the support they need to function as inclusive members of society.

statistical norm

The mean, average, or modal example of a behaviour.

Three important problems with using deviations from statistical norms as indications of psychopathology.

1. Rather than simply forcing an individual into a diagnostic category, a better approach would be to evaluate the specific needs of individuals with intellectual disabilities in a way that will optimise individual functioning.

2. Substantial deviation from the norm does not necessarily imply psychopathology because individuals with exceptionally high scores are also statistically rare - yet we would not necesarily be willing to consider this group of individuals as candidates for psychological intervention.

Where we draw our cut-off points between ‘normality’ and ‘abnormality’ will still be a subjective judgement.

3. Emotions such as anxiety and depression that underlie the most common mental health problems are not statistically rare emotions. They are experienced almost daily by most people.

Why is it so difficult to use deviations from social norms, or even violations of social norms, as a way of defining psychopathology?

• Different cultures often differ significantly in what they consider to be socially normal and acceptable (e.g., schizophrenia in Soviet Union).

• Cultural factors seem to significantly affect how psychopathology manifests itself.

  • Social and cultural factors will affect the vulnerability of an individual to causal factors (e.g., poor mental health is more prevalent in low income countries).

  • Culture can produce ‘culture-bound’ symptoms of psychopathology which seem confined to specific cultures and can influence how stress, anxiety, and depression manifest themselves.

ataque de nervios

A form of panic disorder found in Latinos from the Caribbean.

Research has found that it may be a form of panic disorder brought on by stressful life events (such as economic or marital difficulties), but whose expression is determined by the social and cultural norms within than cultural group.

seizisman

A state of psychological paralysis found in the Haitian community.

What is the problem with difining psychopathology solely in terms of maladaptive behaviour?

Not all maladaptive behaviour indicate a mental disorder, and not all psychopathological behaviours are maladaptive. For example, criminals may act maladaptively without having mental health problems, while some psychological symptoms (like certain phobias) may actually serce adaptive or protective purposes.

harmful dysfunction

Assumption that psychopathology is defined by the ‘dysfunction’ of a normal process that has the consequence of being in some way harmful.

For example: ‘hearing voices’ during episodes of psychosis may be caused by the brain’s inability to turn off unwanted thoughts, and these may give rise to potenially harmful consequeces such as the extreme behaviours which are consequences of severe paranoia.

What is the problem with the definition of ‘harmful dysfunction’?

We still know very little about the brains mechanisms that generate psychopathology symptoms (both biological and psychological mechanisms), so it is very difficult to know what ‘normal’ process might be dysfunctioning.

In order to be diagnosed as a mental health problem …

… the symptoms must cause ‘clinically significant distress or impairement in social, academic, or occupational functioning’.

Advantages of defining psychopathology in terms of the degree of distress and impairment expressed by the sufferer:

• It allows people to judge their own ‘normality’.

• It encourages help-seeking.

• Subjective experience of the sufferer is central.

• Independence from lifestyle or social conformity. This means we do not judge whether someone has a psychopathology purely on the basis of whether they are perceived as productively contributing to society or not, or whether they actively violate social norms but on the basis of how they are able to cope with the life they are living.

What are the difficulties with defining psychopathology in terms of distress and impairement expressed by the sufferer?

• It provides no clear standard for judging what level of distress or impairment qualifies as abnormal.

• Some people (e.g., a teenager with drug addiction) may experience distress, but it is unclear if that alone means they need treatment.

• Not all disorders involve personal distress - some individuals with certain condtions (e.g., personality disorders) may not feel impaired or distressed themselves.