Category: Abnormal Psychology

Reading Time: 2 minutes

GRAY AREAS OF ABNORMALITY

For this thought experiment, we will need to determine whether or not these two students show signs of abnormality.

In the year between her 19th and 20th birthday, Donna, who is 5’8, dropped from 160 to 125 pounds.

The weight loss commenced when she had gotten sick with the flu and lost 15 pounds.

Her friends complimented her on her new physique and she gained the motivation to further decrease her weight. This included cutting her daily caloric intake to 1100, avoiding sugars and carbohydrates, and jogging several miles per day for exercise. There are times when she is so hungry that it takes a toll on her academic performance, as she could think about nothing else but eating. Despite this, she is extremely satisfied with her new physique and wants to keep it for as long as possible, so she is determined to eat as little as possible despite the overwhelming feeling of hunger. She feels also wouldn’t hurt to lose a few more pounds so she can fit into a smaller, cuter skirt she saw at the mall the other day.

Her twin brother Donald is what most people might consider to be an alcoholic. He drinks anywhere between 4-7 beers a day, and despite his excessive consumption of alcohol, does not feel drunk after it. Due to this, he might top off the night with a few shots of alcohol, especially on Saturday nights going out at a bar or nightclub.

He has received several citations for underage drinking, and proudly displays them on the wall in his dorm room as trophies. Donald’s grades are not up to their fullest potential and he does not take much interest in his classes. He also finds it difficult to complete assignments.

Are Donna and Donald’s behaviors abnormal to you? How would you assess their level of dysfunction, distress, deviance and danger for either of the twins?

QUESTIONS TO ASK ONESELF

1. What do you think is the mental health continuum model?
2. What is cultural relativism in your mind? What do you think are some advantages and disadvantages of using this approach to determining abnormality?
3. How do you use the criteria of unusualness to determine levels of abnormality? What do you think are some advantages and disadvantages for this criterion?
4. What do you think is the distress criteria for determining abnormality? What issues arise from it’s use, and how can it be effective in identifying and determining abnormal behaviors?
5. What do you think is the mental illness criteria for determining abnormality? What issues arise from it’s use, and how can it be effective in identifying and determining abnormal behaviors?
6. What are the four words that start with the letter D for determining abnormal behaviors?

Take what you know and thought about from the previous six questions and attempt to apply it to this scenario:

Chad has several arrests for sexual assault against a minor and had recently been convicted of throwing a bottle of water in the face of an elderly woman in an argument over a parking space. On his medical record are listed a number of diagnosis’s for mental health disorders, including attention deficit and hyperactivity disorder, conduct disorder and substance abuse issues. The judge at Chad’s last trial made the remark that Chad did not seem to care about the consequences of his own behavior nor the idea of going to jail. Which of the following criterion could be used to determine that Chad’s behavior is NOT abnormal?

A. Cultural Relativism

B. Unusualness

C. Distress

D. Mental Illness

Reading Time: 7 minutes

UNUSUALNESS

One trait or standard commonly used since the early days of psychology to diagnose certain behaviors as abnormal would be their level of “unusualness”. Those behaviors that deviate from what is usually considered normal tend to be categorized as unusual or abnormal, while those behaviors that fall within the scope of what is considered typical is considered normal, or “the usual”. This mode of categorization tends to fall within the scope of relativist modes of categorization, as they can directly correlate with the cultural norms that are used as a standard of comparison for what is considered to be normal behavior. To put this into perspective, how unusual would you, the reader, consider it to be for a bereaved family member to hysterically cry and scream in a public setting? The answer to this question highly depends on whether you happen to find yourself in Indianapolis or Beirut.

Using “unusualness” as a standard of comparison additionally presents other issues. For example, how does one measure a behavior’s level of abnormality? Should we say that behaviors exhibited by 10 percent of the population be considered abnormal, or set the bar higher for less than 1 percent of the population? A caricature of this conundrum would be two witches having a conversation and asking each other whether people hate them because they dress like witches, or they dress like witches because people hate them? As far as choosing a cutoff in relations to certain behaviors exhibited by a percentage of the population, and what percentage that should be as encompassing a greater or smaller number of behaviors, is as subjective and biased to determining abnormality as relying on the personal opinion of somebody to consider what is abnormal.

Another problem that arises out of giving a certain behavior the “unusual” label in order to determine whether it should be labeled as abnormal is the fact that many people who possess rare abilities or exhibit rare behaviors can be deemed to be beneficial both to the individual as well as to society as a whole. An expert piano player is seen as gifted instead of exhibiting some form of abnormality. Some people dabble in strange or uncommon activities and hobbies, that are fascinating to them but do not cause harm to themselves or other people.

These people can sometimes be called “eccentrics”. A good example to cite in this regard is that of Gary Holloway, an environmental planner employed by the city of San Francisco. This following case study describes his situation:

“A subject of Gary’s fascination is that of Martin Van Buren, the 8th president of the United States of America. Some two decades ago he found out that Van Buren was the only president to not have a society dedicated to him, so he established the Martin Van Buren Fan Club. Holloway proudly explained that ‘This man did absolutely nothing to further our national destiny, but despite this, I’ve managed to get hundreds of people following me in commemorating him.’ Holloway has been the president of the club for 18 consecutive terms, and has also won the Marty award for 18 consecutive years, an award giving it’s holder the prestigious title of excellence in Van Burenism. Aside from this, Gary is also greatly devoted to St. Francis of Assisi, and often wears the outfit of a Franciscan monk. Gary says ‘It’s fun to wear, comfortable and I like the response I receive when I wear it. People always offer me a seat on the bus.’ Gary also has an obsession with the British Commonwealth and possesses encyclopedic knowledge of such locales as Tristan da Cunha as well as Fiji. During the Falklands War he was in strong support of the British islanders whom inhabited the Falklands, going so far as to display the Falklands flag on the front lawn of his house. After the war he continued to celebrate the British victory in the Falklands, even by renaming his house to Falklands House and resuming to fly the flag on his lawn. His bedroom inside his Falklands House still retains much of his possessions that he has had since he was a child. He refers to his bedroom as the ‘Peanuts Room’ due to his large collection of Snoopies and other peanut related memorabilia. He has also slept on the same twin sized bed for 40 years, since he was a small child. He has dozens of toy airplanes in addition to his wall being covered in pennants. He continued to point out, humoristically ‘As a monk, I’m always doing pennants”. Many eccentrics are known for their sly sense of humor.”

Despite the eccentricity of Gary Holloway’s hobbies, would they be considered abnormal?

DISTRESS

For distress to be considered a criteria for abnormality, the patient must consider his symptoms to be causing him distress in a way that is negative, that he or she recognizes as distress and therefore wants to eliminate these symptoms and therefore the distress. The advantage to using this criterion to assess abnormality is that it avoids incorporating cultural norms when assessing for abnormal behavior. According to this criterion, a simplistic approach to assessing abnormality would be if the behavior described does not cause a person distress, yet goes against societal norms, it should not be considered abnormal.

There are many medical professionals who do not agree with this wholeheartedly, as many people who exhibit various types of behavior that they do not consider to cause distress to them can potentially be harmful to others. There are those who show symptoms of mental disorders such as psychosis, among others, in which the patient has either lost touch with reality or it has become distorted to them. Many would wander the streets without purpose, sometimes talking to themselves, ignoring basic needs such as sleep or hunger, which creates a danger for sleep deprivation, starvation and potentially getting sick from adverse weather.

People who exhibit these signs might not be conscious of their problems, and subsequently fail to ask for assistance in curing or treating their ailment. The issue raised here is that people who do not possess awareness as to their ailments would not seek help, so clinical intervention is recommended as those who are unaware and voluntarily do not seek help would not see the benefits of available treatment options.

There is also the argument that even though distress might not be caused to oneself, the person exhibiting certain behaviors might cause distress to others. A very simple example to illustrate this conundrum is those who engage in acts of lying, cheating, stealing and violence towards others – while it may not cause distress towards themselves it certainly does towards other people. They may not only not feel suffering as a result of their actions, but it would cause them great pleasure to commit these acts. As a result of this it is wise to consider these behaviors abnormal despite the fact that it does not cause distress for the people exhibiting them.

MENTAL ILLNESS

There are those who insist that behaviors should not be considered abnormal unless they fell within the scope of mental illness. This type of thinking would assume that some sort of process that is causing a disease, such as diabetes or hypertension, is allowing for this behavior to come to fruition. The assumption here takes the notion of a person showing symptoms of schizophrenia to have this disease show up on a blood test or another type of biologically based medical assessment, similarly to how hypertension can be revealed once a person’s blood pressure is taken.

Despite this, there is no known biological test available to assess any psychological abnormalities that are often common among the general population. This could possibly be due to the fact that many of the biological tests needed to adequately assess the existence of a mental illness in a patient simply do not yet exist as of publishing of this article. There are those who insist that mental illnesses are composed of a number of both biological and psycho-social factors, that make it next to impossible to get a definitive diagnosis when it comes to pinpointing exactly which mental disorder the patient is suffering from. In some cultures mental illnesses are also referred to “diseases of the soul”.

When a person’s symptoms are diagnosed to be a certain mental illness, they are more accurate depictions of the symptoms instead of being a sure cut label when it pertains to the mental illness itself. When we diagnose a person with obsessive-compulsive disorder, for example, we are actually referring to the set of symptoms that are observed through the exhibition of obsessive thoughts and compulsive behaviors in that individual. Therefore, the term “obsessive-compulsive disorder” is not indicative of the same physical process across all people exhibiting these types of symptoms and this type of behavior that we are capable of identifying through the use of biologically based medical assessments as when doing similar types of biologically based medical tests when attempting to identify cancer, for example.

ABNORMALITY DEFINED BY FOUR WORDS STARTING WITH THE LETTER D

In modern times, abnormality in the psychological sense is not something defined by the previous criteria but rather by the dynamics presented through the assessment of four dimensions – dysfunction, distress, deviance and dangerousness.

Emotions and actions are deemed to be dysfunctional when a person is not able to perform a job, form relationships or do any other activity that most people would consider to be a basic daily routine. The greater the level of dysfunction, the more plausible they are to be evaluated as abnormal by mental health service providers.

Abnormal behaviors are also assessed in terms of the level of distress they are able to cause to both the person exhibiting them as well as to the people around him that are observing these behaviors. Abnormality is also assessed through deviant behaviors, those including hearing voices when no one is around and constant lying and kleptomania.

The fourth definition vector, dangerousness, includes behaviors that denote the possibility of the individual to commit suicide or self harm, or rampant aggression towards others such as violent and homicidal tendencies. The combination of these definitive vectors together contribute to an observational and empirical assessment that results with the patient being evaluated as “abnormal”.

To reiterate: Any actions or emotions that are have the potential to inflict physical harm to oneself or to others, are unusual both in a cultural and human sense, impede on a person’s ability to perform daily tasks and causes them to suffer needlessly, are deemed to be abnormal.

The four words starting with the letter D provide a better, more accurate and impartial picture of abnormality as criteria for assessment such as cultural relativism, unusualness, distress and illness. Results from assessments will nevertheless end up being subjective.

Things like the level of emotional pain and suffering a person must be going through due to their mental illness, and the disruption of day to day functioning must be determined with the wisdom, knowledge and experience of the evaluator. What is the extent to the interruption of day to day functioning in order for the behavior to be classified as abnormal? What about it’s nature? The continuum model is helpful for visualizing the four words starting with the letter D and how they fall into place in defining abnormality. There are extents to which after a certain point a person’s behavior can be seen as distressing, dangerous, dysfunctional and deviant. But there is absolutely no defining line that determines true normality or abnormality.

Reading Time: 10 minutes

People That Stand Out:

Clifford Beers, the Man Who Found His Way

The story of Clifford Beers is an inspirational one, like many of those whom endured unnecessary struggle but managed to find their way out and into a period of peace, enlightenment, tranquility, pleasure, and gave the world

something extraordinary. When Clifford was still a child, he was always full of energy, yet moody and would lack the ability to exercise restraint and self control. This did not have a negative effect on his academic performance, however, as he was an intelligent child, ambitious as well, this carrying on into adulthood, and he continued on to graduate from collage. Despite this, there was a sudden negative shift, in which his moodiness and temper began to show fluctuations, most notably around the time his brother Sam began having heavy, violent seizures.

It was May 1890, as his brother was laying there on his death bed, Clifford’s moodiness eventually fell into gloom and desperation, in addition to a slew of paranoid thoughts flooding his mind. As time went on, his hopelessness turned into suicidal tendencies, and finally he decided to jump off a fourth floor window, but fortunately didn’t die and only suffered a number of broken bones. Because of this, Clifford was admitted to a hospital, initially in a private psychiatric facility but later on when his family ran out of money to keep him admitted there, they transferred him into a number of public psychiatric facilities, also referred to as a mental institution.

At the turn of the 20th century, medicine and treatment options in regards to Clifford’s ailment were scarce. He was administered drugs such as strychnine and arsenic tonics, that the physicians assumed would aid cure the symptoms of his ailment, the former of which is a highly toxic white crystalline alkaloid pesticide usually administered to poison rats and birds, and the latter of which is a cancerous, toxic byproduct of metals and alloys usually converted to uses such as insecticides, herbicides and for treating wood products. To add insult to injury, he was routinely beaten, choked, forced to strip naked and locked up in cold, dark cells for prolonged periods of time,as well as being locked up in a straight jacket for up to 3 weeks at a time.

Despite these trauma inducing experiences, Clifford’s symptoms eventually faded away, and after three years of being shuffled around different public psychiatric facilities, he was assessed by the doctors as to be finally fit for release. It was these experiences that led Clifford Beers to start a mental health reform movement which would later be known as the mental hygiene movement. In 1908 upon his release from the psychiatric facility, Clifford Beers wrote and published the book called “A Mind That Found Itself”, detailing his accounts and experiences endured inside the psychiatric facility. The book caused a paradigm shift that forever transformed the way doctors and the general population perceived mental health patients and the psychiatric facilities themselves.

Moving Forward:

The stories of those suffering from mental ailments is very synonymous to what people like Clifford Beers have been through, that manifests itself in the shape of mental, emotional and physical pain and suffering, are usually documented under the field of psychopathology. Those suffering from these ailments can sometimes be as bizarre as that of which this woman describes:

“My problems began slowly at first, eventually developing into something worse and worse, between the ages of 15 and 17. While this was going on, reality all of a sudden seemed to be distorted, seeming somewhat distant, everything was muddled up and it was to serve as a precursor for what would unfold later on. I also started experiencing visual hallucinations in which the people around me would metamorph into something resembling their character, the changes usually reflected what I perceived to be someone’s level of morality. To help put this into perspective, it would be something along the lines of say, a mother’s good friend would turn into a witch because to me this represented her evil, badhearted nature. Another visual hallucination that I experienced was during a family trip to Utah in which I began to see the faces of sad, crying women in the cliffs along the side of the road. At that time I did not know how to react or what to think of what I was perceiving, or why things were as they were. Sometimes I thought they were a gift from God, but sometimes I felt that something was horribly wrong.”

On the other hand, sometimes people who have psychopathological issues can have them manifest as experiences that are similar to the rest of us, but can take on more intense, extreme forms. For example, in the 1995 work from Kay Redfield Jamison called The Unquiet Mind, on page 110 is the following percept:

“From the time I was awake in the morning to the time I laid myself down to sleep in the night time, I was astonishingly depressed and it seemed as if I was not able to produce any thought or feeling of happiness and hopefulness. Everything I tried to do, every movement, every action, every word I said or thought that I thought, needed additional effort and felt difficult to do. That which used to move me emotionally, and used to bring joy, now carried no luster and was completely lifeless. Even how I thought of myself and felt about myself changed – I saw myself as uninteresting, incapable, incompetent, cold and withholding and without any warmth. I began to have doubts about myself, my self confidence waned, I felt like I was completely useless and could not do anything correctly. It felt as if my brain had slowed down and exhausted itself to the point of not even being functional. My brain only served it’s purpose in producing thoughts of feelings, torment, hopelessness and reminders of how pointless life was.”

Through examination and analysis of case studies one can get a glimpse into the minds of those suffering from psychopathological issues, how they think, how they feel, how they come to conclusions and how this modifies their behavior one way or the other as a result. In addition to this, one should launch an investigation to determine the currently known causes and treatments of the different types of ailments that exist within the spectrum of symptoms discovered. The point is not just to examine the facts and figures, information, theories and research related to the field of abnormal psychology, but it is crucial for one to understand the experience that would be carried with having these psychopathological symptoms, so we can best relate to our patients first hand. It is best to be able to know first hand, in order to know how to adequately solve the problem. It is wonderful to know that due to recent developments and upsoar of research conducted in the field of psychology and psychiatry, many biological and psychological treatments are available to cure or suppress many negative mental health symptoms and issues that exist.

What is Abnormal? THE DEFINITION

Let’s start off with a few examples of behavior that is currently or had previously been considered abnormal behavior by psychological experts
in the past:

1. A man kissing another man
2. A man using a hammer to ram a nail through his hand
3. A woman refusing to eat for several days in a row
4. A man barking like a dog and crawling on his knees and his hands
5. A widowed woman building a religious shrine for her deceased husband, in her house,
   complete with an altar, and then leaving him food, flowers and gifts at the altar of the shrine

Would you consider these behaviors to exhibit general abnormality? If your answer is “that depends”, then you are correct. You see, some of these behaviors are considered acceptable under varying circumstances and situations. In many countries and cultures around Europe, particularly Southern and Eastern Europe, men greeting each other with a kiss on the cheek is a widely accepted, customary type of behavior. In some religions and cultures, there are periods usually observed in which fasting, a form of spiritual and biological cleansing and self discipline process, is practiced, such as during certain holidays or other periods, and therefore are synonymous with the behavior of refusing to eat.

On the other hand, there are certain behaviors, such as that of the man barking like a dog, or ramming a nail through one’s hand, can be considered abnormal and therefore extreme behaviors in all circumstances, regardless of ethnic boundries or cultural norms, but even for these behaviors that are certain situations in which they are considered acceptable. In Mexico for example, there are some Christians who nail themselves to a cross in order to symbolically mark and acknowledge the crucifixion of Jesus Christ on Good Friday. The Yoruba shaman of Africa are known to bark like dogs during traditional healing rituals. In certain religions, such as Shinto and Buddhism, it is customary to build altars in one’s living room in order to honor dead relatives, provide them with gifts and food, and talk to them as if they were still alive and in the room with the person talking to them. So therefore it is safe to say that the context in which these behaviors are done can play a role in whether or not they
are determined to be abnormal.

Nevertheless, there are still a number of criteria, factors and metrics used to decide the abnormality of someone’s reported or observable behavior.

CULTURAL RELATIVISM

Cultural relativism is a perspective on abnormal behavior that states that abnormality should be determined on a basis that builds upon the idea that there should be no universal rules or standards when it comes to applying a label to specific behaviors that determine whether or not they are considered abnormal, or their level of abnormality. Instead of this, in this concept the idea of what is considered to be abnormal ranges across different cultures and established cultural norms. Those who have worked on the field of cultural relativism, as well as it’s supporters and advocates, will state that it is their belief that there are a range of acceptable behaviors that can differ drastically from culture to culture.

Bereavement practices, for example, are another custom that differs significantly across cultures, and can therefore be a basis for someone’s level of abnormality. In Western cultures, the general cultural norm regarding the passing of a loved one is that people are expected to mourn the loss of their loved ones for a span of a few weeks or months, and then to “let go” or “move on” with their lives, so to speak, at which point they are expected to normalize once again. Those who continue to think and talk about their dead loved ones after a certain period of time has elapsed will generally be advised to seek counselling or therapy in relation to their mourning, as by this time it will be considered abnormal to wallow for so long, as it can also attribute to a loss of normal, daily functioning. Many times loved ones will crudely tell them to “get over it”, as a display of tough love, in an attempt to wake the person up from their semi-trance like, depressed state. In Egypt, on the other hand, many will show empathy and compassion by gathering together, share their stories of how they coped and how much they miss their own dead loved ones, and will often hysterically cry together to show they can relate to a person’s loss, as well as to seek interpersonal comfort and a sort of “healing together” ritual.

Those who oppose the concept of cultural relativism will indicate that it sets a dangerous precedent to allow cultural norms to establish what is considered “normal” or “abnormal” behavior. Psychiatrist Thomas Szasz noted in 1971 that is was a common practice throughout history for societies to purposefully justify their need to silence or control individuals and groups by labeling them as “abnormal”. Hitler used this label to classify Jews and therefore create a justification for the Holocaust. Those who were vocally political dissidents, activists and anti government were branded “abnormal” by the government of the Soviet Union and were involuntarily admitted to mental institutions, where they would be in confinement for long periods of time, as being released from a mental institution is usually at the behest of the assessing doctor, who might have been working for the establishment that put these people there in the first place and was tasked with making sure they stay confined inside the mental institution.

In the United States during the period when slavery was legal and an active practice, those slaves who tried to escape were diagnosed with an ailment back then referred to as “drapetomania”, or in layman’s terms what would be deemed a sickness that was characterized by the desire to be free or obtain their freedom. Back then this served as a justification for these slaves to be re-captured and therefore returned to their masters, according to Thomas Szasz. In 1851, Dr. Samuel Cartwright, a known physician at the time, published an essay for the prestigious New Orleans Medical and Surgical Journal with the title “Report On The Diseases and Peculiarities of the Negro Race” in which his argument was:

“The reason or underlying cause for what entices the Negro to run away from serving his master, is a disease of the mind in much the same way as other types of mental alienation, but is also much more curable, as a general rule. With the advantages afforded by proper medical advice,
that would have to be followed strictly, can prevent this problematic illness from occurring.”

Cartwright additionally described the disease as “dyaesthesia Aethiopis” or “the refusal to work for one’s master”. In order to cure the “disease”, the following treatment was prescribed by Cartwright:

“The liver, skin and kidneys should be stimulated with activity, and be made to work and aid in decarbonising the blood. The best way to stimulate the skin, firstly, have the patient washed thoroughly with warm water and soap, then to anoint him with oil, and then to proceed slapping the oil with a broad leather strap, and then to put the patient to hard physical labor in the open air and sunshine, so his lungs may expand, things such as chopping wood, splitting rails or sawing with a cross-cut or whip saw.”

Cartwright argued that whipping slaves and then forcing them to work would in turn help “revitalize” their lungs and bring them back to their senses, accordingly. We would want to believe that Cartwright’s views were representative of a single individual or even a small portion of the medical field, but unfortunately the fact remains this essay was published for a prestigious and well known medical association.

In modern society, expectations regarding gender roles also influence what is considered “normal” or “abnormal” behavior by society. Those men who display sadness or anxiety, those who choose to stay at home to raise their children instead of working themselves and their wives work for them, that are not in congruence with the general idea of the male gender role are said to exhibit abnormal behavioral traits. As it pertains to female gender roles, those women that are too aggressive, masculine, those who refuse to have children, or are in violation of what is considered to be the cultural norm for the female gender role are said to exhibit abnormal behavioral traits, accordingly.

On the flip side, when men are aggressive and women are chronically anxious or sad, these traits tend to be considered normal,

as they do not violate the general cultural perception of their respective gender roles according to the expectations imposed by society on these gender roles.

The perspective of those who are in favor of cultural relativism creates many problems regarding the association of abnormality due to the various behaviors exhibited that do not fall within the spectrum of “normal” within a given culture. Luckily, most mental health professionals nowadays do not base their diagnoses or assessment of a patient, situation or behavior solely on cultural norms, as they recognize the dangers of this type of association. Despite this, even those who refuse to diagnose behaviors based on cultural relativism must recognize and be aware of the fact that culture and gender still do heavily influence how certain behaviors can be classified as abnormal, and how they are in turn treated. For one, culture and gender have an effect on the expression of various symptoms: Those who lose touch with reality and believe themselves to have come in possession of divine powers, such as believing they are the reincarnation of Jesus or Mohammed, in the end plays down to their religious background.

On the other hand, gender and culture also plays a role in whether or not some people are willing to admit to exhibiting various types of behaviors. People from Eskimo and Tahitian backgrounds will be hesitant to admit that they are angry due to cultural norms that teach strongly against the expression and display of anger. On the other end of the spectrum, the Kaluli people of New Zealand as well as the Yanomamo of Brazil tend to value displays of anger, and therefore have developed complex and elaborate rituals regarding the expression of anger.

Additionally, culture and gender can play a role in determining the acceptable treatment in regards to a behavior that is considered abnormal. While some are willing to accept pharmaceutical treatments for mental illness, others are more willing to undergo psychotherapy instead.