Notes on Defining Abnormality, Stigma, and Biopsychosocial Causes

Observing signs of mental illness

• It might take a trained eye or a really keen observer to see signs of mental illness; signs are not always obvious and can be kept inside the person. Many people are suffering and we might not be aware without being skilled at questioning and observing.
• This emphasizes the importance of careful assessment rather than assuming visibility of distress.

Defining abnormality (mental illness): four criteria from DSM-based thinking

• The four criteria come from the DSM (Diagnostic and Statistical Manual of Mental Disorders).
• Criteria 1: Distress
  • Distress = psychological pain.
  • People with mental illness are often distressed (fearful, depressed, anxious).
  • Examples of related conditions to consider: phobias, PTSD.
• Criteria 2: Impairment
  • Impairment = reduction in functioning below the person’s prior level (social, vocational, educational).
  • May show up as worse grades, poor work performance, job loss, strained relationships with coworkers, partners, or children.
  • Insight (awareness of impairment) varies:
  • Some people have insight (they connect their symptoms to the impairment, e.g., depression causing poor grades).
  • Others lack insight, which can be a symptom itself (e.g., schizophrenia with delusions/hallucinations; mania with a false sense of well-being).
  • Substance use disorders often involve impaired insight into the role of substances in problems.
• Criteria 3: Risk to self or others
  • Mental health issues can erode the motive to survive, leading to self-harm or suicidal behavior, self-injury (cutting, starvation, drug abuse), and in rare cases homicidal behavior.
• Criteria 4: Socially and culturally unacceptable behavior
  • Abnormality is judged by comparing behavior to the surrounding society and cultural context.
  • Use society as a measuring stick and consider time and culture, since culturally acceptable behavior varies.
  • Requires understanding someone’s culture before labeling behavior as mental illness.

Common mistakes when judging abnormality

• Mistake 1: The behavior cannot be a socially acceptable response to a particular event.
  • If the reaction is a socially expected response to a specific event (e.g., sadness after a loved one’s death), it is not abnormal.
• Mistake 2: The behavior cannot be solely defined in terms of social rebellion.
  • In oppressive contexts, people may be labeled as mentally ill to silence protest; we must allow for some variation and avoid automatic labeling as illness.

Social impact of psychological disorders and stigma

• People generally do not like to disclose mental illness due to social impact and stigma.
• Stigma: a label that causes people to be regarded as different, defective, and at odds with mainstream society.
• Negative portrayals in media and society contribute to stigma, which can lead to discrimination (e.g., job-hiring discrimination, abuse, social distancing).
• Consequences of stigma
  • Deters help-seeking and treatment.
  • Increases burden of symptoms and can worsen outcomes.
  • Promotes avoidance by others and social exclusion.

The biopsychosocial model: causes of abnormality

• Current viewpoint: psychological disorders arise from complex interactions among biological, psychological, and sociocultural factors (biopsychosocial perspective).
• This view emphasizes that no single factor is solely responsible; each illness has varying weight of factors.
• We’ll break down each component to see how they contribute.

Biological causes

• Inside-the-body factors that contribute to mental illness:
  • Genetic inheritance
  • Mental illnesses often run in families; there can be a genetic predisposition.
  • Example with schizophrenia:
    • Baseline lifetime risk: $\frac{1}{100}$
    • If a parent or a sibling has schizophrenia: $\frac{1}{10}$
    • If an identical twin has schizophrenia: $\frac{1}{2}$
  • Medical conditions
  • Thyroid problems, cancer, multiple sclerosis (MS), etc., can cause mood fluctuations and other psychiatric symptoms.
  • This reflects mind-body interconnection.
  • Brain damage
  • Can result from accidents, tumors, stroke, prenatal harm (viruses), or shaking a baby.
  • Chronic traumatic encephalopathy (CTE) is increasingly discussed, especially in athletes, as repeated brain injury can contribute to mental illness.
  • Exposure to toxic substances
  • Environmental toxins (e.g., lead) and drugs (illicit or prescription) can induce mental illness.
  • Substance-induced mental illnesses are a recurring theme in DSM sections (e.g., substance-induced depression or psychosis).

Psychological causes

• Inside-the-mind factors:
  • Traumatic life experiences (e.g., rape, severe accidents) can trigger mental illness.
  • Learned associations (e.g., dog bite in childhood leading to a phobia later).
  • Faulty ways of thinking
  • Negative attributions or cognitive patterns (e.g., “I am a failure,” “I will fail at everything”).
  • These cognitive patterns are targets for cognitive-behavioral approaches.
  • Difficulties coping with stress
  • Poor coping skills increase vulnerability to mental illness.

Sociocultural causes

• External factors in the environment and society:
  • Discrimination and stigma, political and social unrest.
  • Relational problems (interpersonal conflicts, family dynamics).
  • These factors can increase risk and influence how disorders develop or are expressed.

Treatment perspectives and approaches

• Current treatment viewpoint emphasizes a combination of therapies and medications, often tailored to the individual:
  • Therapy (psychotherapy, various modalities) to address cognitive, emotional, and behavioral aspects.
  • Medication (psychiatric pharmacotherapy) to manage biological underpinnings.
  • Additional approaches mentioned: meditation or hypnosis.
  • In rare cases, surgical interventions may be used.
• As the course progresses, more depth will be provided on each treatment modality and how they are applied to different disorders.

Summary and takeaways

• Abnormality (mental illness) is defined by distress, impairment, risk, and socially/culturally contextual factors, not just by a single symptom.
• Important to consider insight into impairment; some individuals may have little awareness of their symptoms.
• Mistakes to avoid: equating normal emotional responses to abnormality or labeling political or social dissent as mental illness.
• Mental health is shaped by a biopsychosocial mix of biological, psychological, and sociocultural factors, with varying weight across disorders.
• Stigma and social impact influence help-seeking and quality of life; reducing stigma is a key part of improving outcomes.
• Treatment typically combines therapy, medication, and sometimes other modalities, with ongoing research and course-specific instruction to deepen understanding.