CONCEPT OF ABNORNALITY AND MENTAL HEALTH
DEFINITION OF ABNORMALITY AND MODELS OF PSYCHOLOGIAL DISORDER
The definition of abnormality seems easier said, noticed and it can be seen everywhere. But the study of abnormality is a very sensitive one that needs a critical and sensible way of approaching it.
Abnormality or normality is seen from which perspective you are looking at it. Abnormality can be redefined with the environment at which it is seen, with the culture and norms of that community. What is interpreted as an abnormal to a community can be normal in another community. What is acceptable at a time, might not be acceptable at a different time. The dressing that is acceptable in in the winter may be seen as suicidal in the winter. The use of words that is acceptable in the work area may be seen as being too porch in the play environment.
Therefore, the study of abnormality is a wide and difficult to explain, norms, race, age, generation, culture, belief determines the normality or abnormality of a thing.
1.1 What is normality?
According to dictionary, normality can be defined as the state of being usual, typical or expected. Graham Hill defined abnormality based on statistical infrequency; as deviation from the average when statistical common behaviour is defined as normal.
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But, does statistical infrequency shows the meaning of abnormality? No, recently in the United Kingdom, a party rose up and said smoking of “weed” is acceptable; and a petition was posted on the social media, if a thousand people sign the petition, then the house of assembly will approve the use of weed and it will no longer be seen as a drug and restriction will be lifted. If this petition gone through, does that make the use of weed polite despite the mis-used of this substance in the past? Therefore, abnormality can only be determined by the norms, social trend, cultural belief of the community it is seen. The practical criteria to determine abnormality includes deviance, distress, dysfunction and danger.
Deviance– simply means any behaviour that is different from what the society considered appropriate or accepted for a social group. Therefore, behaviour, thought or action that is not in agreement with societies’ believe or norms can be seen and labelled under deviance.
Distress- is another key to determine abnormality. It is normal for every human being to feel depress at a particular time of a loss, sickness or any unpleasant situation that happened. But when such symptoms continue than normal, then it becomes psychological distress and classified as abnormal behaviour.
Dysfunction– is any impairment, disturbance, or deficiency in behaviour or operation that is interfere with everyday functioning. It often manifested in role performance and may be an indicator of abnormality.
Danger– is a state in which any individuals become likely to do harm either to themselves or to others. This is characterised as abnormality and it is considered ultimate.
There are two main diagnostic tools used in the classification of mental illness.
(1) The International Classification of Diseases (ICD) and
(2) The Diagnostic and Statistical Manual of Mental Disorders (DSM)
1 The International Classification of Diseases was first created in 1948 by the World Health Organisation. It is the recognised international standard for reporting, diagnostic, classification for all clinical and research purposes. ICD defines the universal of diseases, disorders, injuries and other related health conditions. It is arranged in a comprehensive, easy storage, retrieval and analysis of health information for evidence-based decision making. It is for sharing and comparing health information between hospitals, continents and countries. It is used for monitoring and controlling of incidence, recording of death and diseases, injuries, symptoms and general causes of diseases. It is now on its eleventh edition known as ICD-11 which was released in June 2018 (Lee A.C et al 2017).
2 The Diagnostic and Statistical Manual of Mental Disorders is currently in its fifth edition (DSM – 5). It is a diagnostic book published in 1952 by American Psychiatric Association. It is the hand book for health and professionals in the united State and in many parts of the world. It is the authoritative guide to the diagnosis of mental disorders. It contains descriptions, symptoms and other criteria for diagnosing mental illness. It gives common language for clinician to communicate about their patients and consistent and reliable diagnoses that can be used in the research of mental illness. It was periodically reviewed since it first publishes and it was reviewed twenty years ago (American Psychiatric Association Journal 2018).
2.1 How atypical behaviour is explained biologically, behaviourally and psychoanalytically models.
- Biological Approach believes that psychological problems are caused by physiology, such as brain chemistry, hormones, brain damage or genetic inheritance. It assumes mental disorders can be understood as illness in the same way as physical conditions. They can be diagnosed and treated by the medical professions the same way diseases are treated. It believes abnormality can he inherited, disorders of the brain and nervous system cause psychological disorders. The emphasis is on physiology rather than behavioural, cognitive or emotional difficulties. It assumed that scientific research will discover the biological causes of all types of mental disorder (Psych Teach UK).
Therefore, in case of Katie in appendix 1, her depression suggested that she could inherit the illness from her mother because her mother suffered depression and died of the illness.
- Psychodynamic approach believes that most forms of mental disorder occur as a result of maladaptive learning, through a process of either classical or operant conditioning. It believes that abnormality comes from the psychological causes rather than the physical causes that unresolved conflicts between the Id, ego and superego can all contribute to abnormality. Katie was raped by a family while she was younger and she could not relate the story to anyone because no one will believe her. According to the psychodynamic approach, the unresolved issues, especially a psychological childhood experience in the subconscious mind could result in abnormality.
- Behavioural approach believes that our actions are determined largely by the experience we have in life, rather than by underlying pathology of unconscious forces. Also believes that all behaviour is learned from the environment and can be unlearned. In the appendix 1, Katie became alcoholic and drug addicted when she was in college, her addiction was learnt and could be the reason for the depression she is suffering from.
- Evaluation of Biological, Psychodynamic and Behavioural approaches
- Biological approach believes that children can inherit an abnormality through gene.
Assumptions and influences – mental disorders can be understood as illness in the same way as physical illnesses. They can be diagnosed and treated by medical profession in the same way as physical disease. The emphasis is on physiology rather than behavioural, cognitive or psychodynamic problems. It assumes that scientific research will discover the causes of mental illness.
Treatments for atypical behaviour (depression) – Antidepressant drugs is prescribed. Antidepressants as the name suggests, helps to elevate mood. The possible side effects are; serious reactions with some food, increased risk of cerebral haemorrhage, also can take three to four weeks to take effect.
Evaluative comment: – It is found out that antidepressants are effective in short term with severe depression, and may be less effective, over a period of time, discovered by Fisher and Greenberg (1995) as cited in (Lynda T 2013). They suggested that other more psychological methods may be needed to discover the cause of their depression.
The Psychodynamic approach was originated by Freud as cited by (Lynda T 2013). He believed that the major causes of psychological problems were restraints. This thought is usually concerned with childhood memories. It believes that the personality is formed during the first five years of childhood. Any traumatic experiences in childhood are associated with later mental health problems, that these early experiences are stored in the subconscious mind which can not be accessed by individual.
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Despite Freud’s attempt to be scientific, his theories are usually criticised for not being scientific enough. Karl Popper argued that true scientific theories are falsifiable. Although, it is difficult to falsify Freud’s idea but the mind of man is totally inaccessible. This means there is no way to prove that it is not exist or that some behaviour is not caused by it. Karl argued further that theories cannot only be approved by presenting an evidence, but how ambiguous the evidences are.
In spite of the argument that Freud’s theories are not scientific, they are being used in the therapy called psychoanalysis.
Psychodynamic treatment for depression: – One of the first practitioners was Freud who suggest the ‘talking cure’ also known as psychoanalysis. The purpose of this treatment is to help the patient to access the repressed conflicts hidden in their subconscious mind. Freud though this could be achieved by using free association technique. The client is asked to talk anything that comes to his mouth, the therapist edict the irrelevant ideas. Freud believed the unconscious thought would be revealed. Also, the client’s dreams and behaviour were analysed to uncover the unconscious conflicts from childhood (David and Neale, 2001).
Evaluative comment: – The aforementioned treatments are the most effective with individual who is willing to overcome their problems, can make their feelings known and have time and money to undertake the sessions. (David and Neale, 2001). The weakness of this method is that it is lengthy, costly and it is unlikely to be effective for bipolar disorder.
Behaviourist; believes that environment is the main cause of every behaviour learnt. The new behaviour is learnt through classical or operant conditioning. It believes that every man is born with a blank mind. He believes all behaviour, no matter how complex can be reduced to a simple stimulus response association. Watson (1930) as cited by Simple Psychology
A noticeable advantage of a behaviourism is its ability to define behaviour and measure changes in behaviour clearly. Behaviourists looks for simple explanations of human behaviour from a scientific viewpoint. However, behaviourism provides only a partial account of human behaviour, which can be objectively viewed. There are other important factors like emotions, expectations, higher-level motivation that are not considered. For the behaviourist explanation to be considered, further research from other perspective might be needed to uncover some hidden factors.
In addition, humanism (Abraham H.M) , rejects the scientific method of using experiments to measure and control variables because it creates and artificial environment and with low ecological validity. It also assumes that humans have free will to make life decision and do not need to follow the deterministic laws of science. Also rejects the nomothetic approach of behaviourism as they view human as being unique and that humans cannot be compared with animals.
The psychodynamic approach (Freud) criticizes behaviourism as it did not consider the influences of unconscious mind on behaviour but focuses on the physical observable behaviour. He also refuses the idea that people are; born with blank minds rather than with instincts. Behaviour in the other hand states that all behaviour has a physical cause, and the role of nature over nurture is emphasised.
Despite these criticisms, behaviourism has contributed to psychology in different capacities, which includes insight into learning, language development, moral and gender development which can be seen in some of the practical applications; behaviour therapy a behaviour modification which is the major approaches to the treatment of abnormal behaviour and are readily in use in clinical psychology.
The strengths of behaviourist – Clear prediction of approach is provided. Meaning, the explanations can be scientifically tested and with evidences supported. Real life applications provided and emphasizes objective measurement with many experiments to support theories. It identified comparisons between animals and humans.
Limitations:- It is a reductionist, humanism, humans cannot be compared with animals. It ignores mediational processes, It did not consider biological influence on atypical behaviour.
2.3 Evaluation of mood disorders treatment and therapies that arises from biological, behaviourist and psychoanalytical models.
Major depression is defined as a depressive episode of the presence of: depressed mood, fatigue or loss of energy, feelings of worthlessness or excessive guilt, physical agitation, significant weight loss or gain, or increase in or loss of appetite, diminished interest or pleasure in almost all activities. At least four of these episodes will be present before it can be classified as a major depression and last for at least two weeks (American Psychiatric Association 2000).
Biological treatment of mental illnesses and abnormality are: drug treatment, electroconvulsive therapy and psychosurgery. All these treatments have been found to be accurate in treating illnesses with a quick and seen improvement. For example, antidepressant drugs may relieve the symptoms of depression for some time and may have side effect like a suicidal thought. Antidepressant can reduce the mood but the actual cause of depression is not cured. Fruoxetine, was reported of breast tumours increase in rodents (Coogan e al, 2005 as cited by Paul B)
Electroconvulsive therapy is a treatment involved in sending and electric current through the brain to trigger an epileptic seizure to relieve the symptoms of some mental health problem. It is often used with severely depressed patients among the elderly who may present an immediate and serious suicidal risk. Despite the effectiveness of this treatment with the evidence recorded it cannot be used independently, it usually required mood stabilizing drug to prevent relapse.
Psychotherapy is effective in the treatment of unipolar depression. The evidence suggests that this specialised forms of psychotherapy for depression alone or in combination with drugs decreases the likelihood of relapse within a two year follow up period (Holton et al., 2005).
Psychanalytic therapy: The effectiveness of psychoanalytical therapy with a cognitive intervention is examined in the treatment of generalised anxiety disorder, the result is less supportive compared to analytic therapy. Twenty percent of those receiving psychoanalytic therapy achieved this principle in comparison with sixty six percent of those in the cognitive therapy condition (Paul B 2007).
- Graham Hill (2008) AS & A Level Psychology. Oxford University Press.
- World Health Organisation (1992) Printed in Switzerland.
- Simply Psychology (Saul L 2018) Abnormal Psychology
- David S, Derald W S, Stanley S (2000) Understanding Abnormal Behaviour, Sixth Edition.
- Lynda T (2009) Advanced Psychology: Atypical Behaviour
- Paul B (2007) Abnormal and Clinical Psychology 2nd Edition. Open University Press
- James N.B et al (2010) Abnormal Psychology 14th Edition. Published by Pearson International Edition.
Katie is a 47 years old accountant and has worked for twenty years. Katie lost her mother to chronic depression a decade ago, she took her own life.
Katie became drug and alcohol addict when she was in college, but despite her struggle with addiction, she was successful because she was hard working. However, now, she divorced six months ago.
Katie, lately withdraws herself from her daily chores. She is feeling worthless, easily loses concentration and weight. She has lost interest in most things, feeling unloved by even her family. She has tried to commit suicide, twice in six months.
While in a counselling session with a psychologist, she related she was raped when she was a child by a family member. She kept the incident to herself and told no one because of the status of the person in question, so Katie thought no one would believe her.