Abnormality may be defined as behavior that causes distress, loss of freedom, physical or emotional pain, and increased risk of death or injury to self or something that causes a disability of some sort. Abnormal behaviour is however difficult to diagnose because it is, to a large extent, based on the symptoms people exhibit. Psychiatrists and psychologists use a standardized system called a diagnostic manual to help them but this system isn’t without faults. Since there is no clear definition of normality or abnormality – and symptoms of the same psychological disorders may vary not only between individuals but also between social and cultural groups, it is clear that a psychiatric diagnosis may be biased or even wrong. Definitions of normality and abnormality can also change over time. Another way to define abnormality is to consider when behavior violates social norms or makes others anxious. This definition is also problematic.
Cultural diversity affects how people view social norms: what is seen as normal in one culture maybe seen as abnormal in another. Rosenhan and Seligman (1984) suggested that there are seven criteria that could be used to decide whether a person or behaviour is normal or not. These criteria include suffering, maladaptiveness, irrationality, unpredictability, vividness and unconventionality, observer discomfort and violation of moral or ideal standards. These criteria demonstrate a fine line between defining abnormality in ways that focus distress to the individual and defining it in terms of what is or is not acceptable to society. Vividness and unconventionality represents a social judgment because it deals with what is seen as social convention or not. The danger of social judgments is that they often fail to consider how people live their lives. There is an increasing awareness of how psychiatric diagnosis of ethnic minorities has been misapplied because doctors do not understand the cultural norms of the groups people come from.
Jahoda’s mental health model of normality suggests criteria for what might constitute normal psychological health (in contrast to abnormal psychological health). Deviation from these criteria would mean that the health of an individual is “abnormal”. The criteria includes absence of mental illness, realistic self perception and contact with reality, a strong sense of identity and positive self esteem, autonomy and independence, ability to maintain healthy interpersonal relationships, ability to cope with stressful situations and capacity for personal growth and self actualization. However, majority of people would be categorized as “abnormal” if the criteria were applied to them. It is somewhat easy to establish criteria for what constitutes “physical health” but it is impossible to establish and agree on what constitutes “psychological health”.
These criteria were criticized by Szasz. According to him, psychological normality and abnormality are culturally defined concepts which are not based on objective criteria. Furthermore, the criteria in the model are culturally biased value judgments i.e, they reflect an idealized rather than realistic perception of what it means to be normal in a Western culture. Michael Foucalt argued that the idea of “madness” being an illness to be treated by medical professionals was an idea that developed in order to “silence” and control people who did not live up to the standards of reason that were introduced in the enlightenment. Szasz, Foucalt and Rosenhan wanted a definition of mental illnesss that was objective and value free.
This means that they wanted it to be a scientific fact whether someone has a mental illness. In addition to that, they didn’t want a psychiatrist’s or a society’s view on what is good or desirable affecting whether someone is diagnosed as mentally ill. The technique of looking at science to establish what is normal and abnormal is known as naturalism. The desire to have a naturalistic definition of mental illness is a part of the medical model of medical illness. The mental illness criterion (the medical model) sees psychological disorders (abnormality) as psychopathology. This literally means illness in the psyche. This criterion is linked to psychiatry, which is a branch of medicine. Patients with psychological problems are seen as “ill” in the same way as those who suffer from physiological illnesses.
Diagnosis of mental illness is based on the clinicians observations, the patient’s self-reports, a clinical interview and diagnostic manuals. Kendell (1975) was one of those who wanted a naturalistic account of mental illness. He wanted a scientific distinction between normality and abnormality. Kendell argued that illness in general (both physical and mental) should be understood as any condition reduces fitness. According to the evolutionary theory, fitness refers to an organism’s ability to pass his genes on to the next generation. So an illness is a condition that reduces longevity or fertility. Kendell found that people with schizophrenia have fewer offspring than people who do not suffer from it. Major depressive disorder is also known to decrease life expectancy, partly due to its association with suicide. However, this could be partly to do with stigma (i.e., mark of infamy or disgrace) associated with mental illness and other social factors. Also, homosexuality clearly reduces fertility, but it’s not considered as an illness whatsoever. After Kendell, Wakefield (1992) attempted to provide a definition of mental illness that took into account natural facts and social forces.
There are two parts to Wakefield’s analysis which must both be present for a condition to be considered an illness (mental or physical) ; dysfunction (a mechanism not functioning as it was designed to by evolution) and harm (result of dysfunction). Depression would be a good example of mental illness in terms of Wakefield’s analysis as it’s a dysfunction of a sadness mechanism which is harmful because it stops us being able to live a normal life. Sadness might normally have the function of eliciting sympathy and help from others or of including someone to think about what caused things to go wrong, or of encouraging me to give up on projects that are failing. However, the existence of mechanisms such as sadness mechanisms is provisional. We do not know for sure that the brain is divided up into these ways.
Evolutionary psychology is very difficult, in most cases it is we just don’t know whether a condition involves a failure in a naturally designed mechanism. In some mental illnesses, such as schizophrenia, it is unclear what single mechanisms could be malfunctioning – there seems to be all sorts of problem. In addition to that, some mental illnesses such as ADHD, may not involve malfunctions at all, it is thought that ADHD only developed because human evolved in an environment much different to ours where it wasn’t unhealthy to be hyperactive, inattentive and highly demanding of attention. According to Derek Bolton (2008), there are no clear boundaries between mental health and illness, between normality and abnormality. Instead, mental illnesses should be understood as the conditions that psychiatrists treat: they are conditions that involve distress and disability, that carry a risk of adverse outcomes, that are attributable to some state of the mind and that can be treated using the available sciences of mind and brain.
This approach lies between naturalism and the sociological critiques which argue that mental illness doesn’t really exist and is something that only arises as a label when certain social forces come together. It recognizes that the problems are real and need to be treated. However, if we rely on science to tell us what mental illness is, the conditions are classified as mental illnesses and which are not are highly questionable. For example, we could have another homosexuality problem where something is classified as a mental illness that should just be seen as an alternative way of being. Furthermore, some of these problems may arise partly from social forces, but this is the business of politicians and other people concerned with the way that society affects people.
The influence of social factors on categorization also raises possible cross-cultural issues: members of other cultural groups might express themselves and understand the world according to different social norms, but this might be misunderstood by psychiatrists and they might be labeled as mentally ill. For example in many cultures it is completely normal to have vivid religious experiences that seem very abnormal to us. Although there are failures in Bolton’s approach towards naturalism, his approach seems to be the best option for approaching mental illness. Changing social attitudes and social organization are not jobs of psychiatrists – their job is treating people who are distressed or disabled due to some condition of their mind.