PY 101 Exam 3 14.1

14.1 Conceptualizing Abnormality: What Makes Behavior Abnormal?

Learning Objective14.1

Provide examples of the criteria that psychologists must meet before considering any behavior abnormal, and describe why psychologists believe that labeling a psychological problem as an illness or a disorder can attach a stigma to it.

When you encounter someone who claims that voices in their head are busy plotting a conspiracy, it’s not difficult to categorize this behavior as abnormal; clearly, this person is in trouble and in need of some professional help. But sharp dividing lines don’t always exist between normal and abnormal behavior. Sometimes behavior that appears abnormal can turn out to be a reasonable reaction to a stressful event, such as the roommate’s reaction to the death of his parents. It’s also the case that a behavior that seems abnormal in one culture can appear to be perfectly normal in another (e.g., Koç & Kafa, 2019; Rathod, 2017). Entering a trance state and experiencing visual hallucinations is considered abnormal in Western cultures, but in other cultures it may not be (Bentall, 1990).

A trance state is likely to be classified as abnormal in Western cultures, but not necessarily in other cultures.

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Even within a culture, conceptions of abnormality can change over time. For many years, homosexuality was considered abnormal by the psychological community—in fact, it was considered a psychological disorder. But this view of homosexuality is rejected by psychologists today. Fifty years ago, a strong dependence on tobacco wouldn’t have raised an eyebrow, but today if you’re hooked on tobacco, you could easily be classified as having a substance-related disorder. Given these changing conceptions, psychologists are justifiably cautious when applying the label of abnormality. Behavior usually must meet a set of criteria before it’s considered abnormal (Frances & Widiger, 2012).

Characteristics of Abnormal Behavior

Over the years, researchers have proposed a number of defining criteria for abnormality. In each case, as you’ll see, the proposed criteria capture some but not all of the important features of what is agreed to be abnormal behavior.

Statistical Deviance

One way to define abnormal behavior is in terms of statistical deviance, or infrequency. Any given behavior, such as arguing with your neighbors or hearing voices, occurs with a certain probability in society at large. Most people have argued with their neighbors, but few actually converse with disembodied voices. According to the concept of statistical deviance, a behavior is abnormal if it occurs infrequently among the members of a population. As you’ve learned elsewhere in this text, it’s not unusual for psychologists to classify behavior on the basis of statistical frequency. For example, the term used to define superior intellectual ability—gifted—was defined with respect to statistical frequency, as was the concept of an intellectual disability. So, it should come as no surprise that statistical frequencies have been used to define abnormality.

Although Bill Gates and Yo-Yo Ma are statistically deviant in some respects, would you classify them as psychologically abnormal?

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But statistical deviance—that is, something that is extreme or different from the average—can’t be used as the sole criterion for labeling a behavior as abnormal. It’s easy to come up with a list of behaviors that are statistically infrequent but are not abnormal in a psychological sense. For example, LeBron James has skills on the basketball court that are extreme, and thereby statistically deviant, but to be a great athlete does not make one abnormal. Similarly, only a handful of individuals have reached the intellectual heights of Albert Einstein or Isaac Newton, but superior intelligence is not abnormal in the usual psychological sense of the word. Another problem is the cutoff point: Just how infrequent or unusual must a behavior be to be characterized as abnormal? So far, psychologists have failed to find a satisfactory answer to this question.

Cultural Deviance

Another criterion is cultural deviance, which compares a behavior to existing cultural norms. In this case, a behavior is considered abnormal if it violates the accepted standards of society. For example, it’s not considered normal or acceptable to walk to class in the nude. Such a behavior breaks the established rules of our culture, and if you do it, it’s likely that people will think you have a serious problem.

But once again, cultural deviance by itself fails as a sufficient criterion. Many people who have committed a crime violate the established norms of society—stealing cars or embezzling money, for example. Such behavior might be abnormal by both statistical and cultural standards, but that doesn’t mean all criminals suffer from psychological disorders. There are also many people who suffer from legitimate psychological problems, such as anxiety or depression, who never violate a law or established standard of society. Finally, as we just discussed, behaviors that are abnormal in one culture may be considered normal in another. There are cultures in the world, for instance, where nakedness in public breaks no established cultural rules. People who suffer from psychological disorders may indeed violate cultural norms in some instances, but often they do not.

Emotional Distress

A third characteristic of many kinds of abnormal behavior is the presence of personal or emotional distress. People who suffer from psychological disorders often experience great despair and unhappiness. They feel hopeless, lost, and alienated from others. In fact, it’s the emotional distress that usually leads them to seek professional help for their problems. But not all disorders make people unhappy; there are lots of people who have little contact with reality but seem perfectly content in their fantasy world. Likewise, there are many distressed people in the world—for example, those who have recently lost a loved one or a job—who would not be classified as abnormal by the psychological community.

Dysfunction

A final criterion for abnormality focuses on dysfunction: Has there been a breakdown in normal functioning that prevents the person from successfully following adaptive strategies? People who suffer from psychological disorders are often unable to function well in typical daily activities—they may not eat properly, clean themselves, or be able to hold a job. Their ability to think clearly may be impaired, which affects their ability to adapt successfully in their environment. As you’ll see later, the assessment of global functioning—defined as the ability to adapt in social, personal, and occupational environments—often plays a large role in the diagnosis and treatment of psychological disorders.

Summarizing the Criteria

You’ve seen that abnormal behavior can be statistically or culturally deviant, it can involve personal or emotional distress, and it can signal impairment or dysfunction. Normal behavior, then, could be any behavior that is relatively common, does not cause personal distress, or generally leads to adaptive consequences. However, none of the criteria that we’ve discussed is sufficient to diagnose a person with a psychological disorder. Crying hysterically for hours at a time may be a normal grief reaction, or it may signal a serious disorder. Even a behavior that seems to be clearly abnormal—such as a paranoid delusion that people are out to get you—might be adaptive in some environments.

You should also recognize that “abnormal” and “normal” are not rigid categories. Each of us can relate in one way or another to the criteria of abnormality we’ve just discussed. We all know people who have occasionally acted unusually, suffered from emotional distress, or failed to function well in everyday settings. Many psychological disorders are characterized by behaviors or feelings that are merely exaggerations of normal ones, such as anxiety, feelings of sadness, or concerns about one’s health. Consequently, it’s better to think about normal and abnormal behavior as endpoints on a continuum rather than as nonoverlapping categories (see Figure 14.1). For a summary of the main criteria for defining abnormality, see Concept Review 14.1.

Figure 14.1 The Normal-to-Abnormal Continuum

“Abnormal” and “normal” are not fixed categories but endpoints on a continuum. To a certain degree, everyone has acted unusually, suffered from emotional distress, or failed to follow an adaptive strategy.

Concept Review 14.1

Criteria for Defining Abnormality

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The Concept of Insanity

Behavior can mean different things depending on the context in which it occurs—something that’s abnormal in one situation may be quite normal in another. Yet regardless of where you travel in the world, some behaviors will always be recognized as abnormal: Consider the serial killer Jeffrey Dahmer, who admitted to butchering, cannibalizing, and having sex with the dead bodies of more than a dozen young men and boys. Everyone, including the mental health professionals who examined Dahmer, was in agreement—this was a man suffering from some serious psychological problems.

But from a legal standpoint Dahmer was judged by a jury to be perfectly sane. Despite the best efforts of his legal team to have him declared mentally unfit, and thus not responsible for his crimes, Dahmer was found legally sane. He stood trial and was convicted of his crimes (later, while serving his life sentence, he was brutally murdered by a fellow inmate). Sounds perplexing, but insanity is a legal concept rather than a psychological one; in fact, the term insanity has been out of favor among mental health professionals for about a century (see K. Weiss et al., 2019).

Its definition varies somewhat from state to state, but insanity is usually defined in terms of the defendant’s thought processes at the time of the crime: A criminal is insane, and therefore not guilty by reason of insanity, if, because of a “mental disease,” the individual fails to appreciate or understand that certain actions are wrong in a legal or moral sense. Dahmer was judged capable of understanding the wrongfulness of his actions; as a result, he failed the insanity test, even though he was clearly suffering from serious psychological problems.

Jeffrey Dahmer

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Most mental health professionals accept that people with serious psychological disorders are sometimes incapable of judging the appropriateness of their actions. As you’ll soon see, psychological disorders can lead to distorted views of the world—affected individuals not only act in ways that are abnormal, but their very thoughts, beliefs, and perceptions of the world can be wildly distorted as well. But exercise caution: It’s important not to confuse the concept of insanity with the concept of a psychological disorder.

The Medical Model: Conceptualizing Abnormality as a Disease

To understand how disorders are classified by the psychological community, we need to discuss the medical model of diagnosis. According to the medical model, abnormal behavior is caused by an underlying disease—a kind of mental illness—that can be cured with the appropriate therapy. This conception of abnormality has been quite influential. As you already know, there are good reasons to believe that behavior is strongly influenced by biological factors, such as the actions of neurotransmitters in the brain. In addition, biomedical therapies, such as the administration of psychoactive drugs, are often effective in treating psychological problems. It’s also the case that most psychological disorders can be classified in terms of symptoms. Depression, for example, typically leads to one or more of the following: sad mood, diminished interest in pleasure, difficulty in sleeping, feelings of worthlessness, and so on. The medical influence is deeply ingrained in the very language used by psychologists—they speak of mental health, mental illness, or psychopathology in much the same way a physician describes a medical condition.

But is the medical model an appropriate way to view abnormality? Some researchers believe it’s wrong to draw direct comparisons between physical illness and psychological problems (Szasz, 1961, 2000). Both strep throat and depression lead to a set of reliable symptoms. But we know that strep throat is caused by a physical problem—bacteria; at this point, the cause of depression is still being debated. In addition, people often seek treatment for psychological problems that are perhaps more accurately described as problems in living. How these adjustment problems are interpreted also seems to depend on the particular social or cultural context, which is not the case for most medical conditions. Some kinds of bizarre behavior thought to be abnormal in one culture can be considered normal in another, but strep throat produces fever and pain regardless of the cultural environment.

Problems Associated With Labeling

Critics of the medical model also express concern about diagnostic labeling effects. Labeling a psychological problem as an illness or a disorder tends to attach a stigma that can be difficult to overcome (Hipes et al., 2016). A number of studies have found that applying the label “mental patient” leads people to interpret behavior in a far different light than they would otherwise. In one study, professional therapists watched a videotape of a man describing his personal adjustment problems (Langer & Abelson, 1974). If, prior to viewing the tape, the therapists were told that the man was a mental patient, they rated his adjustment problems more negatively than did other therapists who were simply told he was a job applicant (see Figure 14.2). Methodological issues have been raised about these types of studies (e.g., ecological validity), but as we’ve stressed in previous chapters, people’s expectations clearly do importantly influence how they interpret new information.

Figure 14.2 Labeling Effects

In one study, therapists were asked to provide adjustment ratings for people labeled as “mental patient” or “job applicant.” The people were judged to be better adjusted when the therapists thought they were job applicants, not patients.

Source: Data from Langer & Abelson, 1974.

The Rosenhan Study

In one particularly influential study of labeling effects, David Rosenhan, along with seven other co-investigators, arrived separately at several psychiatric hospitals in the early 1970s with the complaint that they were hearing voices (Rosenhan, 1973). Actually, each of the participants was perfectly normal. They simply adopted the role of a pseudopatient—they feigned, or faked, a disorder to see how labeling would affect their subsequent treatment. On arrival they reported to the psychiatric staff that they were hearing a disembodied voice in their head, a voice that repeated things like “empty,” “hollow,” and “thud.” They were all admitted to hospitals, and virtually all received the diagnosis of schizophrenia (a condition, as you’ll see later, characterized by serious disturbances in thought and emotion).

Again, the purpose of the study was to see how an initial diagnosis of schizophrenia would affect subsequent treatment. From the point of admission, none of the participants continued to act strangely. In all interactions with the hospital staff, they acted normally and gave no indications that they were suffering from a disorder. However, despite their normal behavior, none of the staff ever recognized them as pseudopatients; indeed, written hospital reports later revealed that the staff members tended to interpret normal behaviors as symptomatic of a disorder. It was the real patients who felt the researchers somehow did not belong; several voiced their suspicions, claiming, “You’re not crazy. You’re a journalist or a professor” (these comments were partly made in reaction to the fact that the pseudopatients spent time taking notes). Once the pseudopatients had been admitted and labeled as “abnormal,” their behaviors were seen by the staff through the lens of expectation, and normal, sane behavior was never recognized as such. On average, the pseudopatients remained in the hospital for 19 days—the stays ranged from under a week to almost two months—and on release all were given the diagnosis of schizophrenia “in remission” (which means not currently active).

The Rosenhan study is considered important because it suggests that diagnostic labels can become self-fulfilling prophecies. Once you’re diagnosed, you’re likely to be treated as if you’re suffering from a disorder, and this treatment (1) may make it difficult to recognize normal behavior when it occurs, and (2) may increase the likelihood that you’ll act in an abnormal way. If the people in your environment expect you to act abnormally, you may very well start to act in a way that’s consistent with those expectations (see Chapter 13).

Since its publication in 1973, the Rosenhan study has been widely analyzed in psychological circles (see Cummins, 2017). Its lessons about the hazards of labeling are clear enough, but questions have been raised about the ethics of the study as well as the conclusions that were reached (Bartels & Peters, 2017). For example, the admission of the pseudopatients by the hospital staff, as well as their subsequent diagnosis, was reasonable given the patients’ reported symptoms. The diagnosis of a psychological disorder depends on what the patient reports, and the trained professionals in this case had no reason to assume that the patients were lying or manufacturing symptoms. In addition, it’s possible and even reasonable to dispute the claim that the attending staff failed to recognize that the pseudopatients were acting normally. After all, they were released with the label “in remission,” so the staff must have recognized that they were no longer acting in an abnormal way (Spitzer, 1975). More troubling, though, are recent suggestions that Rosenhan fabricated some of his data and selectively reported how some of the pseudopatients were treated (see Cahalan, 2019).