Abnormal Psychology: Theories, Issues, Diagnosis
Abnormal psychology: Definitions of abnormality
What is abnormal psychology? The concept of abnormal psychology implies a controversial question: what is normalcy? On the face of it, abnormality can be defined in a fairly narrow fashion, namely as a deviation from the statistical ‘norm.’ A good example of this is intelligence, namely that intelligence, as graphed upon a bell curve, suggests that most individuals have a certain range of IQ, as measured upon a test, while only a handful of abnormal individuals are extremely gifted or extremely intellectually challenged (Gilles-Thomas 1989, Lecture 1). Alcoholism could also be defined as such, namely by an individual’s consumption of drinks per day, if it vastly exceeds the statistical norm of the population. Few psychological concepts, however, can be as easily defined in a numerical, statistical fashion as IQ or substance abuse, and even these instances are quite controversial.
Other definitions of abnormality reflect what is considered the social norm, such as juvenile delinquency. The problem with this definition of abnormality is that notions of social deviancy can be quite subjective. Homosexuality, for example, was once defined as socially ‘deviant’ in the DSM (Diagnostic and Statistical Manual of Mental Disorders) although it is no longer defined as such. Maladaptivity to the social environment and the pursuit of personal goals is another common criteria for abnormality: “Maladaptive to one’s self – inability to reach goals, to adapt to the demands of lifeâ€¦maladaptive to society – interferes, disrupts social group functioning” (Gilles-Thomas 1989, Lecture 1). Of course, it could be argued that a socially withdrawn individual and thus maladaptive might be ‘happy’ with his or her lack of social functioning, and not a threat to society. The behavior might still ‘seem’ abnormal, and meet the criteria of avoidant personality disorder, even if the individual did not wish to be clinically treated for the condition. This calls for another possible definition of abnormality, that of distress to the individual manifesting the behavior. “Personal distress: Put simply, if the person is content with his/her life, then s/he is of no concern to the mental health field. if, on the other hand, the person is distressed (depressed, anxious, etc.), then those behaviors and thoughts that the person is unhappy about are abnormal behaviors and thoughts” (Gilles-Thomas 1989, Lecture 1).
And yet even here the boundaries of the definition are imperfect: someone with a relatively stable life may feel profoundly abnormal because they do not live up to a social ideal (such as marrying someone approved of by their community, having a high salary, having children, being heterosexual) yet someone with an apparent psychological illness like a drug addiction or bulimia may feel as if he or she ‘has things under control’ because of the nature of the denial that is part of the symptoms of the addiction. Additionally, abnormality encompasses biological factors, such as the twin studies which suggest a strong, inherited component for schizophrenia, or even the physical deterioration that causes psychological conditions in the case of patients that have suffered a stroke or have dementia.
Theories of abnormality
Most modern theories of abnormal psychology acknowledge the complexity of defining normalcy and abnormality, and the multifactoral nature of mental illness. Each conceptualization of abnormality reflects a theoretical school’s tendency to emphasize one component of mental illnesses over others. “These theories can be divided into four main groups or schools: (1) biophysical, (2) intrapsychic, (3) existential, and (4) behavioral,” and as a result of their definitional emphasis prescribe different treatments (Abnormal psychology, 2009, a2zpsychology). For example, “biophysical theories emphasize the importance of underlying physical causes of psychological disturbances. Such disturbances include two main groups: (1) those related to a medical condition, such as a disease or injury, and (2) those related to the use of a drug or medication. In these disorders, the condition, drug, or medication is believed to cause mental problems by affecting the brain or other parts of the nervous system. Biophysical theorists think such factors also underlie mental disturbances whose causes have not yet been identified. They believe many disturbances result from inherited physical defects” (Abnormal psychology, 2009, a2zpsychology).
In the 19th century, before Freud, this biological model was the preferred mode of diagnosing and treating individuals suffering psychological distress — dousing the insane in cold water, sterilizing the mentally ‘defective,’ and other types of treatments now considered barbaric were used to treat the insane. However, today, as more has been revealed about the brain’s affect upon producing consciousness, biological theories against rose to prominence. The increased sophistication of psychological drugs also means that electric shock or surgery on the brain or other parts of the nervous system is less common, and biophysical therapists can treat individuals with mental disorders with drug treatments, or with more finely calibrated versions of surgeries and other treatments.
In contrast, “intrapsychic theories focus on the emotional basis of abnormal behavior. Intrapsychic theorists believe that conflicts in early childhood cause people to worry or have other unpleasant feelings throughout life” and this results in abnormal behaviors (Abnormal psychology, 2009, a2zpsychology). Sigmund Freud, for example, believed that abnormal behavior such as hysteria was produced by unresolved childhood trauma. Or certain personality types, such as anal-retentive ‘type’ (including miserly individuals or people with obsessive-compulsive disorders) were merely replaying past childhood trauma about toilet training, or other issues. Freud applied his intrapsychic theory of deviance to both neurotic (such as phobic) individuals as well as those who were openly delusional. “Psychologists use the term neurotic to describe people who sometimes behave abnormally but can usually cope with everyday problems. Individuals who lose track of reality are called psychotic. Some psychotics believe in very unrealistic ideas called delusions. They may also think perceptions such as ‘hearing voices’ or ‘seeing visions,’ called hallucinations, are real” (Abnormal psychology, 2009, a2zpsychology). Freud’s technique of psychoanalysis was designed to elicit subconscious associations about past traumas and conflicts, bring them to light and thus resolve them. Traditional psychoanalysis tends to eschew drugs: “During psychoanalysis, the patient talks to the therapist, who is called an analyst. In one technique, called free association, the patient talks to the analyst about whatever thoughts, images, or feelings come to mind” (Abnormal psychology, 2009, a2zpsychology).
Challenges to both psychoanalysis and medical models of the brain grew increasingly popular in the 20th century. One school of thought, encompassing humanistic and Gestalt therapies, is commonly known as the existential theory of abnormal behavior. It stresses the importance of current experiences and the person’s view of himself or herself in the world. “Existential therapists try to help patients gain insight into their feelings, accept responsibility for their lives, and fulfill their potential” (Abnormal psychology, 2009, a2zpsychology). Existential theories of abnormality, such as that of the school of Karl Rogers, stress the radical freedom of the human condition, and the ability of people to make positive changes in their lives, by changing their minds. Existential theories tend to emphasize normal human development, and may even normalize apparently abnormal conditions — finding comfortable, individualized peace and stasis with the rest of the world is more important than conforming to a particular definition of normalcy.
Unlike psychoanalysis, existential psychology involves a far more direct approach — the therapist does not face away from the client, as in free association, rather the client and the therapist engage in a kind of conversation, although the client still tends to speak more than the therapist, as the therapist may restate or probe what the client says. Psychotropic drugs are also not emphasized in existential psychology. Existential psychology may also incorporate philosophy, mythology, literature, or other disciplines to enable the individual to find him or herself.
The most recent school of abnormal psychology to gain currency in the psychological community is that of behaviorism or cognitive-behavioral psychology. Behavioral theories emphasize the effects of learning on behavior. The emphasis is not on past trauma, as in psychoanalysis, but on physically manifested negative behaviors that must be changed. This type of therapy can be used for obsessive-compulsive disorder (OCD), eating disorders, drug addiction, attention deficit hyperactivity disorder (ADHD) and many other psychological illnesses that manifest themselves as negative coping mechanisms. “Behaviorists use a learning process called conditioning to change abnormal behavior. In this process, behaviorists treat disturbed people by teaching them acceptable behavior patterns and reinforcing desired behavior by rewards” (Abnormal psychology, 2009, a2zpsychology). Cognitive behaviorists challenge unproductive ways of thinking: such as “I always do stupid things,” by demanding specificity in setting concrete goals. Change the mind, change the behavior, and change the behavior, and change the patient’s attitude through new methods of habituation. Behaviorism is also more open to incorporating drugs as part of the therapy, as it addresses both external as well as internal forms of behavior.
To deal with the complexities of diagnosing abnormal psychology and the many ways of treating abnormal psychological conditions, the American Psychological Association has developed a guide known as the Diagnostic and Statistical Manual of Mental Disorders, which has undergone many revisions over its history, spanning back to the 1950s. The DSM explicitly “strives to be atheoretical, using merely observationally referent terms. The hope with this is to make the manual as acceptable as possible to professionals with different theoretical orientations (Gilles-Thomas 1989, Lecture 2). Specific criteria and systematic descriptions are offered as guidance for making diagnoses. “Essential features, associated features, prevalence rates, sex ratios, family patterns, and differential diagnoses are listed” and it is noted when “alternative or additional diagnosesâ€¦should be considered,” such as the possibility that a manic episode could mask itself as schizophrenia (Gilles-Thomas 1989, Lecture 2). This might occur if the clinician was unacquainted with the patient and the patient’s past history of depression, for example, and/or mood disorders in the patient’s family.
Also key to the efficacy of the DSM in approaching the ideologically and theoretically charged world of abnormal psychology is its multiaxial system. The multiaxial system “allows for a more holistic and comprehensive account of an individual” and his or her psyche (Gilles-Thomas 1989, Lecture 2). An individual, for example, can be both manic depressive and a substance abuser, or a person with an eating disorder can have borderline personality disorder and other medical conditions that exacerbate the major clinical disorder he or she suffers. The patient is assessed not as abnormal or normal, but upon “several different axes or dimensions, each focusing on a different type of information” as follows:
Axis I: Clinical Syndromes
Axis II: Developmental disorders and Personality disorders
Axis III: Physical disorders and conditions
Axis IV: Severity of psychosocial stressors
Axis V: Global assessment of functioning (Gilles-Thomas 1989, Lecture 2).
Axis I and II comprise the entire classification of mental disorders, plus ‘V codes’ (codes which indicate conditions not attributable to a mental disorder but that are a focus of attention or treatment. E.g.: Academic, interpersonal or occupational problem I, II and III)” and all of the five components “together constitute the official, completeâ€¦diagnostic assessment” for the client (Gilles-Thomas 1989, Lecture 2).
Axis I involves clinical syndromes, what are often thought of as major psychological disorders, such as major depression or schizophrenia — disorders that can overtake a person’s entire life and call for immediate intervention. Axis II or developmental and personality disorders are also extremely serious, although often entail less direct, immediate intervention, unless a person also has an Axis I condition. Axis II types of disorders are “pervasive, long standing disorders, typically beginning in childhood or adolescence,” and are not necessarily mental disorders so much as they are abnormalities or deviations from the norm, including “mental retardation or borderline personality disorder,” although, of course, “a person can have a diagnosis on both Axis I and II (Gilles-Thomas 1989, Lecture 2). Both Axis I and II disorders require intensive treatment, but treatment of different types — one may be more direct and immediate (such as drug therapy to bring an individual ‘down’ from a manic phase) while the other may be more supportive in nature, such as cognitive behavioral therapy to manage borderline personality disorder.
Axis III comprises “Physical disorders/conditions: Current physical complaints that may be relevant to understanding or managing the case. E.g.: Neurologic disorders or diabetes.” A person with binge eating disorder may have additional complications, for example, because of his or her diabetes. A stroke, Alzheimer’s disease, birth trauma, and other disorders may be connected to the mental conditions suffered by the individual. Additionally, the mental illness itself can cause physical distress for the client, such as the complications of alcoholism, eating disorders, or the lack of self-care manifest in someone with schizophrenia.
Axis IV measures the “severity of psychosocial stressors: Overall severity of life stress for the past year” (Gilles-Thomas 1989, Lecture 2). Axis IV recognizes that certain types of stressors can exacerbate preexisting conditions and even cause abnormal behaviors to manifest themselves in individuals without full Axis I or Axis II diagnoses. Stressors can be marital, financial, legal, developmental (like going away to college or having a baby), job-related, physical, interpersonal or relate to major personal and even national disasters such as Hurricane Katrina or 9/11. “These stressors are rated on a six point scale, ranging from ‘None’ to ‘Catastrophic’ and are used to contextualize the overall assessment of the individual’s state of mental health. For example, a person with borderline personality disorder and alcoholism may suffer even more complications relating to his or her disorder during a time of family crisis — or even if the nation is going to war, simply by ‘picking up’ on these external stressors within the larger social environment (Gilles-Thomas 1989, Lecture 2). .
The final Axis V assessment is a so-called holistic of “Global Assessment of Functioning: This allows the clinician to give his/her judgment of the person’s psychological, social and occupational functioning for two time periods: 1. Current: reflects need for treatment 2. Past Year-highest level of functioningâ€¦Each is rated on a 90 point scale, ranging from 1 (Suicidal acts, recurrent violence, etc.) to 90 (Absent or minimal symptoms)” (Gilles-Thomas 1989, Lecture 2).
The multiaxial system thus encompasses biological and social elements into a multifaceted, holistic definition of functioning and abnormality. Features of physically observable behaviors as well as attitudes and organic conditions are built into the DSM. This allows for a more comprehensive portrait of individual functioning and also enables theorists of most of the major schools of psychology to create a diagnosis they find suitable for the client.
Abnormal psychology. (2009). a2psychology. Retrieved September 23, 2009 at http://www.a2zpsychology.com/articles/abnormal.htm
Gilles-Thomas, David L. (1989). Definitions. Abnormal psychology: Lecture 1. University of Buffalo. Retrieved September 23, 2009 at http://ccvillage.buffalo.edu/Abpsy/lecture1.html
Gilles-Thomas, David L. (1989). Classifications. Abnormal psychology: Lecture 2. University
of Buffalo. Retrieved September 23, 2009 at http://ccvillage.buffalo.edu/Abpsy/lecture2.html
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