Failure to function adequately suggests that individuals are not able to cope with everyday life and the behaviours they exhibit prevent them from being able to work or conducting satisfying relationships, for example. Rosenhan and Seligman (1989) suggested range of characteristics such as suffering, maladaptiveness, vividness and unconventionality, unpredictability and loss of control, irrationality and incomprehensibility, observer discomfort and violation of moral/social standards. The advantage of this concept is that it acknowledges the subjective experience of the person but most people fail to function adequately at some point in their lives, for example bereavement where if they were to act normally, they would be deemed as abnormal. Some behaviour is seen to be maladaptive, harmful or threatening, such as adrenaline sports, smoking, drinking etc. yet people are not classed as abnormal if they partake in these activities.
The deviation from ideal mental health begins with the idea of what is normal first. Jahoda (1958) suggested that the features necessary for living a full and happy life were self acceptance, autonomy, environmental competence, potential for growth and development, accurate perception of reality and positive interpersonal relations. This is a positive approach to looking at abnormality; however, this is an idealistic list and would generally be unattainable by most people therefore making the concept insignificant.
To achieve classification, the different disorders are diagnosed according to symptoms and should be based on factual information. The DSM IV explains a person’s psychological condition using five different criteria, axes, they are then assessed on each of the axes. Axis I describes clinical disorders such as anxiety disorders, mood disorders and other psychotic disorders. Personality disorders are listed under Axis II. Both Axis I and II can be included together in diagnosis. Axis III, IV and V are not required for diagnosis but they do help to show an understanding of the individuals situation. They include general medical conditions such as injury and poisoning, psychosocial and environmental problems such as educational problems or even being eccentric. The purpose of Axis V is to assess the extent, global assessment of functioning, at which the disorder diminishes the persons quality of life. This then enables the development of treatment for specific disorders. To be included in the DSM IV there must be elements of distress, disability, pain, risk of death or loss of freedom. The individual must also exhibit behavioural, psychological or biological dysfunction. As the DSM IV has been mainly influenced by psychiatrists, the system tends to be more consistent with the medical perspective; therefore diagnosing a psychological disorder only describes the symptoms and not the origins. As classification becomes more complex, more patients are being diagnosed with more than one disorder (Kessler et. al. 1994).
No classification scheme is flawless and no two people with the same diagnosis will behave in the same way. This is illustrated by a study by Rosenhan (1973) whereby eight ‘pseudo patients’ were sent to different psychiatric hospitals where they claimed they could hear voices saying ‘thud’ hollow’ and ‘empty’. All were admitted with the majority being diagnosed with schizophrenia. Shortly after admission they stopped claiming that they could hear voices and all were eventually discharged after varying lengths of stay, with the diagnosis of ‘schizophrenia in remission’. The diagnoses seemed to bias the staff at the hospitals, for example, one of the pseudo patients was writing notes which were construed as ‘patient engages in writing behaviour’. The study showed that mistakes can be made with opinions and that diagnoses vary greatly.
The danger comes that when people are labelled with a disorder, they will then show the characteristics of that label. Further support for this argument can be taken from Szasz (1962) who argued that organic mental illness should be classed as physical illness in which mental illness arises.
Psychiatrists also use different types of models to aid their diagnosis. The Behavioural model suggests that abnormal behaviours are learned, such as phobias. These experiences are learned either through classical conditioning, (for example being stung by a bee) or social learning, seeing somebody else reacting fearfully in a situation. Once the anxiety is associated, it is then carried on through operant conditioning. The person learns that being near the cause of the phobia then creates anxiety which reinforces a negative reaction. This can then lead to maladaptive behaviour. This can be treated through behavioural therapy by relearning how to deal with the anxiety and turning the experience into a positive outcome. Wolpe (1958) described the therapy Systematic desensitisation as where the patient learns firstly deep muscle relaxation, then they construct a series of increasingly threatening situations and finally the patient then imagines each scenario while deeply relaxed. If at any point the patient anxious, the image is stopped and relaxation as regained.
The Cognitive model suggests that it is the way an individual thinks about a situation that is maladaptive. This could be through early experiences causing negative schemata or an organic brain defect that then affect thought processing. This can be cured through therapies such as rational-emotional therapy and cognitive restructuring therapy thereby restructuring patients thought and enabling them to change their perception of themselves and their environment. These therapies are quick and becoming increasingly popular however, this model would not be ideal for those with thought problems such as schizophrenia.
The Biological model is based on result of an underlying biochemical or physiological dysfunction which could cause the abnormality of the physical structure of the brain, a differing level of brain chemicals or an over or under sensitivity of the brain to some of its own chemicals and therefore should be treated in the same way as a physical illness. Chua and McKenna (1995) wrote that the brains of patients with schizophrenia were smaller and had larger ventricles than the brains of normal individuals thus showing that some mental disorders are know to have specific biological causes and can be treated by prescribing drugs. However, this model is thought to be too simplistic and putting emphasis on biological foundation may mean that other factors are overlooked.
The Psychodynamic model is based largely on Freud’s psychoanalytical theory. He suggested that mental illness is the result of psychological causes rather than physical ones arising from unconscious and repressed conflicts. This could be due to a traumatic experience in childhood (especially of a sexual nature) an abnormal relationship with parents or failure to move through psychosexual stages of development. This theory implies that recovery can only take place if the unconscious is made conscious and patients resolve their problems. This is done through psychoanalysis where a therapist asks a question and the patient is encouraged to talk so that the therapist can identify where the patients thoughts are repressed. The therapist then explains to the patient their thoughts and feelings. This was the first attempt to explain mental illness and is supported by comprehensive theory and practice. However, critics suggest that there is too much emphasis on childhood trauma and by looking too closely at early conflicts, present conflicts may be overlooked.
To conclude, defining a person or their behaviour as ‘abnormal’ can imply that they are undesirable and require to change to the ‘norm’, however using a definition to explain abnormality is unavoidable but necessary so that psychologists can distinguish between ‘normal’ and ‘abnormal’. The classification and diagnosis should be objective and produce the same results no matter which psychologist gives the diagnosis, but this is not always achievable, as demonstrated by the experiment conducted by Rosenhan (1973). Critics (Szasz, 1962, MacLeod 1998 and Farina, 1992) suggested that labelling could have a negative effect, such as former patients being discriminated against or becoming pigeon holed and thus leading them to ‘live’ their diagnosis. The classification of disorders although extensive, does not take into account the causes of abnormal behaviour, if the causes are unknown how can the disorder be treated correctly? Abnormal behaviour and mental illness are stigmatized in most cultures; therefore defining, classifying and diagnosing abnormality may always be complex task.
Word count 1647