This reluctance to talk to a professional about a psychological disorder is linked to culture, not only gender. Some ethnic groups think that mentally ill (or abnormal) people are cursed. In China, Rack (1982) found that mental illness carries and undesirable stigma, and therefore only the people who are indisputably psychotic and out of contact with reality are diagnosed.
Similarly although occurrence of depression in Western cultures is high, in Asian cultures it is unexpectedly low. Rack (1982) saw that actually the frequency rates of depression are roughly equal; however Asians believe that doctors are only to be approached regarding physical illness, not mental illness. Due to the fact that Asian people live, and therefore are in much closer contact, with extended family than traditional Western people, there is a greater social support network. Asian people are able to tackle issues within the home, rather than resorting to professional help. Therefore the statistical infrequency will not be a true image of psychological disorder frequency; however it will represent the likeliness of a person to seek help in a certain culture instead.
The use of statistical infrequency as a definition of abnormality is effective when measuring a certain characteristic, however is not applicable to all behaviours. There is a wide scope for error in diagnoses as a ‘black or white’ approach is given- if a person is within a certain percentage they are normal, if not they are abnormal- this cannot be representative of an illness such as depression which has a range of severities. It has been shown through studies that the occurrence of mental illness is not necessarily ‘infrequent’ either, so statistical infrequency may not be the right definition to adopt. Differences between cultures- the way they view abnormality as socially acceptable or not- and differences between genders- reluctance to seek professional help- contributes to the overall inaccuracies in statistical infrequency. This is not showing an accurate sample of the population; only those who are assessed. Statistical infrequency is also more representative of the number of people willing to seek help, rather than the prevalence of psychological abnormality.
The second of the four definitions is deviation from social norms. This definition is reliant on the set of behaviours and moral standards of a certain culture. These rules can either be part of the law (e.g. not stealing, not vandalising) or can be implicit and conventional of a certain culture (e.g. in Britain not choosing to sit next to a stranger on an otherwise empty bus, not greeting people by kissing both cheeks). If a person goes out of the boundaries of these social norms by violating them (either the implicit or explicit rules) they are deemed to be abnormal according to deviation from social norms. An example of such deviation may be relevant to a person suffering with schizophrenia- they may display inappropriate emotions, such as laughing after receiving bad news.
This definition is useful for everyday recognition of psychological abnormality- when a person drastically deviates from expectations and their own idiosyncrasies friends or family are able to see that there is an underlying problem. However, encouragement may then be needed in order to ensure the person asks for the appropriate psychological help.
Although this definition is good as it can easily be used to identify problems within a certain culture, if the same social norms were applied to a separate culture it may appear that everyone was abnormal. Social norms vary drastically between cultures- in Britain people respect personal space and avoid placing themselves too close to others, however in Italy there is no such implicit rule about how close you stand or sit next to a person. If an Italian were to visit Britain they may think it unusual how close proximity is avoided by strangers. To the Italian most British people would be deviating from the Italian social norms.
This makes diagnosis difficult using this definition. The person must be judged by someone of the same culture and of the same understanding of social norms. The severity of the deviation must be judged as well. Some people may display idiosyncrasies that are unusual to others, except themselves and their friends.
Deviation from social norms is used a social control in some countries, not as a true understanding of ill mental health. Cohen (1988) found that in Japan those who were unwilling to conform to bettering the industry were sent to ‘loony-bins’. The ‘loony-bins’ were known to be brutal, dirty and overcrowded. This provided a threat to the people, and so more chose to conform even if they did not support the ideal of industrial success.
Russia used deviation from social norms in a similar way in order to remove political rebels from the community. These people were deemed to be abnormal as they did not support the correct political party and conform to the Russian political and social structures. They were classed as insane and were sent to asylums to be detained, so that they could no longer interfere with the running of the country and could not influence others to rebel also.
In every culture, although there are a set of social norms, deviation from these are not necessarily indications of psychological abnormality. Some people may deviate but merely be classed as having a slight eccentric character (they won’t cause harm to themselves or others, this is simply an idiosyncrasy) whilst others will display an actual pathological abnormality. This suggests that only certain types of abnormal behaviour can actually be regarded as showing a psychological illness.
Similarly the way in which a person acts may be considered abnormal due to its deviation from social norms, but when in a separate context the behaviour can be explained. A person choosing to lie on the pavement of a busy street may seem to be acting abnormally, however this view is changed as we learn that the person was studying how likely the local community are to help a person in trouble. What originally appeared to be a deviation from social norms is no longer classed as abnormal.
As with differences in culture when applying deviation from social norms as a definition of psychological abnormality, difference in time period will also affect people’s opinions and views. Social norms change over time, so for older generations a certain behaviour may be categorised as abnormal, but for the younger generation of today it may be an everyday occurrence. An example of this is how previously it was frowned upon and unusual to be a single mother, however today the number of single mothers in the UK is constantly rising. Single mothers today would not be classed as abnormal.
Due to this, the person making the judgement may be biased. If they are of an older generation, they may see a behaviour to be abnormal or strange, yet to someone from a younger generation it is acceptable. Therefore the classification of a person as abnormal is purely reliant on the opinion of the judge.
The difference between abnormality and criminality is often confused. Although criminality is deviation from social norms (the offender is not abiding by the explicit rules of the law) it does not necessarily indicate the presence of a psychological disorder. A person claiming more benefits than they are entitled to is being fraudulent and is committing a criminal offence- however they would not often be deemed psychologically abnormal; their offence is understandable as they wished to gain as much money as they could from the government. A person who has committed a series of rape attacks would be deemed psychologically abnormal as their desire to rape women is an extreme deviation from social norms and causes a great amount of suffering to the victim- something that ‘normal’ people would not often wish to do and carry out.
It is considered that a rapist or murderer’s personality is displaying abnormality, not only their behaviour. If only the behaviour (not the character) was abnormal there is a suggestion that anyone would be capable of such an act. This is opposed by the fact that other people are either incapable of committing such a crime or are in control of themselves and so choose not to commit such a crime.
There seems to be a key difference between those who would murder someone and those who wouldn’t, which must be caused by personality differences. Most people have the capacity to pick up a knife and stab someone to death, however not everyone does- only those with a severe disturbance or psychological problem, other people have the ability to control themselves and prevent such a frenzy.
Deviation from social norms can be used to monitor the behaviour of people in the same culture and in a known context by an independent judge. If the same judge were to enter a different culture or unknown context the reliability of their diagnosis of abnormality would be significantly less reliable. As most people are biased in someway; whether it be age group, culture or otherwise, it is difficult to find someone who can be a truly independent judge and can make an unaffected decision.
It may be possible to determine whether a friend or family member starts experiencing psychological problems, as there will be a deviation from their normal behaviour; however it is more difficult to make a similar decision based on the behaviour of someone who isn’t known as well.
Deviation from social norms is so dependent on culture and other factors that this definition of psychological abnormality is severely limited. However it does have its strengths in some particular circumstances.
The third definition is deviation from ideal mental health. This was originally suggested by Jahoda in 1958, and was unique at the time as it did not focus on what it was to be abnormal but instead what it was to be normal. Six criteria were identified as indication ideal mental health, and it was suggested that anyone who could not show these qualities was likely to be suffering, or to suffer in the future, from a psychological disorder. These six criteria are outlined below:
- Positive attitudes towards the self- To understand themselves as a person, so that they can accept their limitations and possibilities; to have realistic view of themselves. The person has a positive, healthy attitude towards himself in the areas of self-confidence, self-respect, self-reliance and self-acceptance; they are able to live with themselves as the person they are. The person will like themselves as they are, and understand, as well as accept, what they truly are.
- Self-Actualization of one’s potential- (as proposed by Maslow- 1968) the understanding that every person has an individual potential that they should strive to fulfil. If a person is prevented from fulfilling this potential (either internally or externally) they may suffer from ill mental health.
- Resistance to stress- a person of good mental health ought to be able to cope under stressful situations. If a person is vulnerable to stress and anxiety their chances of experiencing a psychological abnormality at some point in their life is increased.
- Personal autonomy- the ability to rely on inner resources and remain stable despite hard knocks, deprivations and frustrations. An autonomous person will not be dependant on other people; they will be able to make decisions that are right for themselves and are not just to satisfy others.
- Accurate perception of reality- a person can see himself and the world in realistic terms, so they are not overly optimistic or pessimistic. Their vision of reality is not distorted, and so their behaviours are considered to be in keeping with others around them.
- Adapting to the environment- being able in all areas of life such as work, relationships and leisure activities. The person is able to be flexible, not overly rigid, and is easily able to adapt/change.
Deviation from ideal mental health allows psychologists to focus on the positive aspects of a person’s functioning. This outlines how a person with good mental health ought to act and think, and any deviation from these six criteria suggests psychological abnormality. This makes abnormality easier to diagnose to a certain extent as there is a standardised set of criteria that must be met in order to be normal- the judgement is not based so much on an individual’s opinion as seen with the deviation from social norms definition.
However, there is some degree of opinion involved, as a professional must determine whether or not a person fulfils the criteria. In one psychiatrist’s view there may be no deviation, but in another’s deviation may be significantly prominent. So although the standardisation is good, the diagnosis of ‘abnormal’ or ‘normal’ will still be affected by “who’s making the decision?”.
The major limitation of this definition is the difficulty in reaching self-actualisation. There are very few people who can honestly say that they have met their full potential. Fulfilment of potential may be influenced not only by oneself but by others around them; certain circumstances may be restrictive yet unavoidable. Due to this, the majority of the population would be classed as psychologically abnormal according to this definition. However, this is not true- a person can be happy and lead a well balanced life with good mental health but still never fulfil their true potential. This is not a failure on their part, and they do not require self-actualisation in order to live in a psychologically ‘normal’ way.
Personal differences affect the way people work with stress. According to Jahoda a person ought to be resistant to stress- they ought to be unaffected and have the ability to employ coping strategies. However, not everyone has a negative response to stress. Some people may be unable to cope and will develop a mental illness after a long period of stress, whilst others will thrive under the pressures of stress. It has been seen that certain people show improved performance when working under stressful conditions; they are able to work more efficiently and effectively. So although they are not employing coping strategies, and they are letting themselves be affect by the stress, the result is positive and not negative. According to Jahoda this would be showing a high level of self-actualization and positive self-attitudes; the person is able to understand their possibilities and how they work best and are using this knowledge in order to achieve their full potential. By resisting stress they will be deviation from the 1st and 2nd criteria, but will be complying with the 3rd criterion. By accepting stress they will be complying with the 1st and 2nd criteria, but will be deviating from the 3rd criterion. In some cases the criteria is contradictory, and so this definition is not always entirely effective.
Once again, this definition is affected by the cultural issues and other biases present. Although in Western societies self-fulfilment and individuality are seen as desirable ideals, in other countries and cultures they are not. In Asian cultures it is customary for the family to plan a child’s future, including arranged marriages and career paths. If the child were to grow up and decide to follow his own ambitions he would be deviating from social norms and would be conflicting with his culture. However, by complying he would be deviating from Jahoda’s definition of ideal mental health.
Personal autonomy in the Western world is regarded highly, however in other cultures and in many circumstances a person would be expected to put the needs of others first. There is often seen to be a duty to others in the family (because of authority and respect, or the status of men and women within the culture) and so it is not possible to always put oneself first.
The historical bias present conflicts with the perception of reality over time, whilst the cultural bias conflicts with the current perception of reality. Many years ago the Earth was considered to be the centre of the universe- any thoughts otherwise would be ridiculed and the person considered abnormal. However over time and through advances in science we now know that the Earth revolves around the sun- sticking with the originally proposed theory would class one as abnormal, no longer the opposite way round.
Cultural differences relating to life after death may affect the current perception of reality a person may have. In Western culture, someone who was hearing voices or talking to a dead relative would be seen as abnormal and would be thought to have a psychological disorder. In other cultures it is normal to continually talk to those who have passed on, as they remain with the family in spirit.
Deviation from ideal mental health acts as a good definition in its method of standardising what it is to be normal. However it is still subject to the same biases and cultural relativism as the previous two definitions (statistical infrequency and deviation from social norms).
It has been shown that it is difficult to achieve the six criteria suggested to indicate ideal mental health, and so many people ought to be psychologically abnormal- but through other assessments psychologists know this not to be true. The six criteria also show a certain degree of conflict with each other in certain circumstances; this suggests that the definition is not always accurate or reliable.
Like with deviation from social norms, the aspect of the person judging and their opinion will affect whether an individual ought to be classified as abnormal or normal. There will be variation between the views of different judges questioned, and it is up to the discretion of this judge as to the diagnosis.
The fourth definition is failure to function adequately. Individuals known to have a psychological disorder will often display symptoms in the form of dysfunction. These may be through inability to work or socialise, not maintaining good hygiene, or difficulty with communication. As this is amongst those suffering from psychological abnormality the behaviours can be used to assist with a diagnosis of others.
The Global Assessment of Functioning Scale (GAF) is used in assessments by psychologists in order to determine whether a person has a mental illness/abnormality. A poor score on the GAF combined with poor scores from other psychological and physical measures can be an indication of a psychological disorder.
With other definitions of abnormality, deviating from perceived norms may not always mean a person needs psychological help- as long as they continue to function well and are not affecting themselves or others negatively. However, with a failure to function adequately, as the name suggests, the person himself is being affected by the problem as they are unable to continue with their every day life. This strongly suggests a psychological problem, and if a mental disorder is not diagnosed there is still the need for professional help.
Failure to function adequately can be used to measure the extent of an individual’s problems and the possibility that they may require appropriate help, however as Comer (2000) said, dysfunction alone is not an indication of psychological abnormality. Some people will chose to deprive themselves of necessary items, such as food, in order to protest against something they believe to be unjust- this is not a psychological abnormality, although they are failing to function adequately according to the GAF. This shows how some low scoring assessments may simply be circumstantial. The behaviour must be seen to affect the person over a long period of time and significantly restrict their life in order for them to be classed as abnormal.
There are some exceptions present under this definition of abnormality. Once again, it may be circumstantial that a person is acting in a dysfunctional way. Under a period of intense stress, such as searching for a new job or taking exams, an individual may become highly anxious and behave inadequately. This would be regarded as normal however; as they are simply reacting to stress- it would be unusual for a person in this situation to be calm.
Other people, such as sociopaths, will appear to be extremely aggressive towards others but will not be suffering personally, nor experiencing stress, or functioning inadequately. However, their amoral attitudes would be considered abnormal and could be representative of a psychological disorder.
The cultural issues facing failure to function adequately are such that some groups of people may appear to be dysfunctional, but this is just an indication of high levels of stress and inability to cope, not the presence of a mental disorder.
It was suggested by Sashidharan (1995) that racism and prejudice may negatively impact psychological wellbeing. This would be shown in the ethnic groups that have immigrated to Western countries. The way in which they are affected is not due to their cultural background, but rather the way in which they are treated in the country they have immigrated to- where they are subjected to financial problems, poor housing, and difficult working conditions.
Failure to function adequately works well as a definition of psychological abnormality as the scale is specifically standardised- there is little room for the affect of a person’s opinion on the diagnosis. There are limitation though as the GAF cannot be used alone to determine abnormality (it must be used in conjunction with other tests), cultural situations may affect the results and may lead to generalisations that certain groups are more likely to suffer from a psychological disorder than others due to culture rather than living conditions, and in some circumstances dysfunction is expected- such as during high levels of stress. Alone this definition cannot show who should be classed as abnormal and who should not.
In all four of the definitions cultural relativism has featured as a limitation. This is because each definition has some cultural specificity and cannot easily be transferred to different cultures without adaptations being required. There is no clear definition of abnormality that can be applied to the whole world, as in each culture there are different social norms and expectations, as well as different laws and perceptions of adequate functioning.
Due to this it is seen as inappropriate for a diagnosis of an individual to be made by someone of a separate culture, as the cultural relativism will impair their judgement.
Within cultures there are other variations, due to subcultures. African-Caribbean immigrants in the UK will conform to the wider society norms; however aspects of their culture will be continued. For this reason the African-Caribbean immigrants are 2-7 times more likely to be diagnosed with schizophrenia that a British person, as discovered by Cochrane (1977). This may be due to their differences in communications, or their religious beliefs.
Cultural changes may also affect a diagnosis- as times change, so do social norms. In the UK, women who were unmarried and pregnant used to be sent to mental asylums as they were seen to be abnormal and the situation was socially unacceptable. Today this is very different; single mothers are accepted in society and are seen as normal by most generations.
Similarly with homosexuality; this was illegal in the UK until 1967, and was considered to be a mental disorder in the USA until 1973. Once again, cultural changes mean that homosexuality is now generally accepted and is no longer illegal, although some people still hold old values or religious beliefs and refuse to tolerate this.
The definitions of abnormality offered by psychologists are subject to many biases and constrictions due to circumstances, especially being affected by cultural relativism. Each has its strengths and is applicable within separate cultures; however the limitations are also vast. Due to cultural differences not one single definition can be applied world-wide, and this is unlikely to ever be possible whilst maintaining a high level of reliability.
It is important to understand the differences between cultures and the limitations of each definition so that psychologists are able to make well-informed and accurate diagnoses.
The four definitions offered show much conflict between each other, due to the way in which abnormality is measured. An individual may appear to be normal according to one definition, but abnormal in another. Because of this psychologists must look at the whole picture- the circumstances, the person’s personality, the culture, their ability to function appropriately, as well as other factors- in order to make an accurate and reliable decision of a diagnosis. A combination of aspects of each definition may be useful in doing this.
