1. Examine the concepts of normality and abnormality
Mental health model of normality (Jahoda, 1958)
The model 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”:
· he 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 (e. g. capacity to love)
· ability to cope with stressful situations
· capacity for personal growth and self-actualization.
Evaluation of the mental health model of normality
· The majority of people would be categorized as “abnormal” if the criteria were applied to them. It is relatively easy to establish criteria for what constitutes “physical health” but it is impossible to establish and agree on what constitutes“ psychological health”.
· According to Szasz (1962) psychological normality and abnormality are culturally defined concepts, which are not based on objective criteria.
· Taylor and Brown (1988) argue that the view that a psychologically healthy person is one that maintains close contact with reality is not in line with research findings.
· Generally people have “positive illusions” about themselves and they rate themselves more positively than others (Lewinsohn et al. 1980).
· The criteria in the model are culturally biased value judgements, i.e. they reflect an idealized rather than realistic perception of what it means to be human in a Western culture.
The mental illness criterion (the medical model)
· The mental illness criterion sees psychological disorders (abnormality) as psychopathology. Pathology means “illness” so it is literally “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 clinician’s observations, the patient’s self-reports, a clinical interview and diagnostic manuals (classification systems) that classify symptoms of specific disorders to help doctors find a correct diagnosis.
Evaluation of the mental illness criterion
· Proponents of the mental illness criterion argue that it is an advantage to be diagnosed as “sick” because it shows that people are not responsible for their acts.
· Although the origin of some mental disorders (e.g. Alzheimer’s disease) can be linked to physiological changes in the brain, most psychological disorders cannot.
· Critics of the mental health illness criterion argue that there is a stigma (i.e. a mark of infamy or disgrace) associated with mental illness.
· Szasz (1962) argues that it is not possible to identify the biological correlates of mental illness. Therefore, psychological disorders should rather be seen as “problems of living”.
Abnormality as statistical deviation from the norm
- Deviance in this criterion is related to the statistical average. The definition implies that statistically common behavior can be classified as “normal”. Behavior that is deviant from the norm is consequently “abnormal”. In the normal distribution curve most behavior falls in the middle.
- An intelligence quotient of 150 deviates from the norm of 100. It is statistically rare but it is considered desirable to have high intelligence. Mental retardation is also rare but this is considered undesirable.
- Obesity is becoming increasingly statistically “normal” but obesity is considered to be undesirable.
What may be considered abnormal behavior can differ from one culture to another so it is impossible to establish universal standards for statistical abnormality. The model of statistical deviation from the norm always relates to a specific culture.
Abnormality as deviation from social norms
- Social norms constitute informal or formal rules of how individuals are expected to behave. Deviant behaviour is behavior that is considered undesirable or anti-social by the majority of people in a given society. Individuals who break rules of conduct or do not behave like the majority are defined as “abnormal” according to this criterion.
- Social, cultural and historical factors may play a role in what is seen as ‘normal’ or ‘abnormal’ within a certain society. For example, homosexuality was seen as abnormal in Britain around 1900 where the famous writer Oscar Wilde was imprisoned for homosexuality. Homosexuality was classified as abnormal (sexual deviation) in the American Diagnostic and Statistical Manual DSM-II (1968). In later revisions of the manual homosexuality in itself was not seen as abnormal – only feeling distressed about it.
Evaluation of the deviation from social norms criterion
- This criterion is not objective or stable since it is related to socially based definitions that change across time and culture. Because the norm is based on morals and attitudes, it is vulnerable to abuse. For example, political dissidents could be considered “abnormal” and sent to hospitals for treatment as occurred in the former Soviet Union.
- Using this criterion could lead to discrimination against minorities including people who suffer from psychological disorders.
- Psychological disorders may be defined and diagnosed in different ways across cultures and what seems to be a psychological disorder in one culture may not be seen in the same way in another culture. The American classification system DSM includes disorders called “culture-bound syndromes”. This indicates that it is impossible to set universal standards for classifying a behavior as abnormal.