Normality versus abnormality

Approaches to defining abnormality

1. Societies are always different and changeable. What is considered normal 10- years ago may be considered abnormal now, and vice versa

2. Abnormality can be seen as a means of social control because society decided what behaviors are acceptable.

3. Some patterns of behavior may be socially acceptable, but harmful to others

   • Example: Someone could think that there is nothing unacceptable about a person being afraid to walk out of their house. Whereas that person has the inability to leave the house due to irrational fears.

4. Abnormality must be evaluated in the context

   • Example: The way you behave in school and the way you behave at a party would be different, but it is acceptable in the given context.

Abnormality as inadequate functionality

Rosenhan and Seligman have seven criteria that can establish abnormality:

1. Suffering- subjective experience of one’s state as wrong

2. Maladaptive- inability to achieve major life goals

   • Example: inability to establish positive interpersonal relationships

3. Unconventional behavior- behavior that stands out and differs substantially from that of most people

4. Unpredictable/ loss of control- lack of consistency in actions

5. Irrationality- others cannot understand why the person behaves in this way

6. Observer discomfort- it makes other people uncomfortable to witness this behavior

7. Violation of moral standards- behavior goes against the common moral norms established in the society

• Degrees of abnormality are based on how many of the criteria of abnormal behavior are met. They also argue that people can meet more than one criterion of abnormality.

Abnormality as a deviation from ideal mental health

Ideal mental health criteria were proposed by humanistic psychologists.

• Humanistic psychologists are known for their belief that psychology should focus on positive aspects of human experiences (health, happiness, self-realization) rather than mental illness

  Marie Jahoda identified six characteristics of ideal mental health:

  1. Efficient self-perception

  2. Realistic self-esteem

  3. Voluntary control of behavior

  4. Accurate perception of the world

  5. Positive relationships

  6. Self-direction and productivity

• This approach means that mental health is defined positively, through what a person needs to achieve by embracing interpersonal relationships, self-perception, perception of the world, etc

• A weakness of this approach: it may be hard to fully achieve all 6 parameters of mental health.

  • Parameters are difficult to measure or quantify.

Abnormality as statistical infrequency

Statistical infrequency is used as a criterion of abnormality. This approach shows that a characteristic of behavior or trait of personality is classified as abnormal if it is statistically unusual

• A distribution graph is used:

  • The “norms” of the threshold is 95%. If an individual is different from the 95% (score of less than 70 or more than 130), they are not statistically “normal”

    • Falling in the 99% range can be classified as severely abnormal

Limitations to this approach:

1. Statistical norms change

2. Individuals outside of the statistical norm can be seen as desirable

• Example: People with higher IQs are outside the norm

Classification Systems

The classification widely used is the DSM (Diagnostic and Statistical Manual)

• The DSM is what clinicians use to arrive at a diagnosis by matching the individual's behavior with the symptoms

• There are DSM I-IV

Prevalence Rates and Disorders

Prevalence rates of major depressive disorder

The main parameters used to characterize the spread of a disorder are prevalence rate and onset age

• Point prevalence rate: proportion of people in the population currently diagnosed with the disorder

• Period prevalence: proportion of a population that has the same disorder at some time during a given period

• Onset age: the average age when individuals in a given population first develop the disorder

Factors influencing prevalence rate estimates

1. Classification system

   • DSM

2. Clinical biases in diagnosis

   • Reluctancy to report mental health illness

Validity and reliability of diagnosis

Realiability and validity of diagnosis: the concepts

• Diagnosis is made on the basis of symptoms:

  • Validity

  • Reliability

    • Inter-rater reliability: different clinicians using the same classification system should arrive to the same diagnosis for the same patient

      1. Clinician conducting interview with patient and interview gets recorded and used by another clinician

      2. Test-retest reliability: different clinicians make a diagnosis but the recording of the clinicians make a difference

• Metaphor of shooting at a target if used to illustrate the ideas of validity and reliability in a diagnosis.

The role of clinical biases in diagnosis

Clinician variables in diagnosis

1. Clinicians attitudes and beliefs

2. Clinician’s abilities, such as perspective, self-reflection, tolerance for uncertainty, tolerance for difference

3. Clinician’s cognitive biases

Explanation for disorders

The concept of etiology

Science purses 4 goals:description, explanation, prediction, and control.

• Description: achieved by classification systems

• Explanation: predict the course of disease and patient’s response to interventions

  • Explanation opens door to prediction and control

Genetic heritability

1. The falconer model

2. Gene-environment interaction

3. Gene-enviorment correlation

4. Neurotransmitters

Cognitivative explanations

• Thoughts and beliefs as major cause of deppressive behavior

  • “automatice thought”

Sociocultural explanations

• Provoke depression in women:

  • having 3 or more children under age of 14

  • lack of intimate relationship

  • lack of employment

  • loss of mother before age of 11

Assessing the effectiveness of treatment

1. Severity of the disorder

2. Treatment outcomes

3. Measuring the therapy outcome

4. exact mechanism of change

Placebo effect

Approaches to assessing the effectiveness of treatment

• Randomized control trials

• Qualitative research studies

• Meta-annalyses

Biological treatment of depression

• Antidepressants

• Selective seotonin reuptake inhibitors (SSRIs)