Normal or Abnormal
As you learned about past methods, did you think that some of the practices were cruel and somewhat barbaric?
From the vantage point of today they may have appeared to be forms of torture but you need to keep in mind that the diagnostic tools of today were not available to people then, and they did the best they could with what they had.
Also, the lines between normal and abnormal behavior are not definite. It is difficult, possibly impossible, to define a specific set of behaviors that everyone will agree on to define abnormality.
There have been four attempts to distinguish behavior as normal or abnormal.
Four attempts to distinguish behavior as normal or abnormal:
- The first attempt was to define abnormal as a departure from a statistically calculated norm or what the majority of people do and do not do. The problem with this definition is that there are many people that do not follow the "norm" but that does not mean that they are abnormal. Many artistic people are not typical of the majority of people but that does not mean that they are abnormal.
- A second attempt was to look at personal emotional discomfort that was caused by the behavior. Depression and anxiety cause great emotional distress but not all abnormal behaviors have emotional distress for the person. An example is mania where the manic person is euphoric and filled with energy and grandiose ideas.
- The third attempt was to look at departures from socially unacceptable behaviors. What might be considered abnormal for one culture may be normal for another. An example of this is that many Native Americans believe in the importance of dreams and use dream catchers which may be considered abnormal in other cultures.
- The last attempt was to look at the degree of maladaptive behavior and how harmful it is to the person or others. The problem with this is that many people who show maladaptive behavior are not mentally ill, as in some criminals.
The practical approach today sees abnormality as including those patterns of thought, behavior and emotional reaction that significantly impair a person's functioning within their culture. This approach takes in all of the definitions above.
Classification
Psychologists believe that it is important to classify the disorders. It is important to classify the disorders so that they can be diagnosed correctly and that there can be some universal agreement on diagnosing disorders.
The classification system that is used in psychology is a book called the Diagnostic and Statistical Manual of Mental Disorders, 4th edition TR, usually shortened to the DSM-4TR. It is published by the American Psychological Association and it is a widely used diagnostic classification system. It provides a set of criteria for psychologists to make assessments and it also predicts the future course of each illness and suggests appropriate treatments.
The DSM has had a number of revisions in its history. The first DSM had about 100 diagnoses to the DSM-V that has about 400.
Can you think of reasons for the increased numbers in entries?
The DSM-IV uses five major dimensions or axes, to describe a person's mental functioning. Each axis reflects a different aspect of a patient's case.
Axis I is used to describe clinical syndromes.
Disorders are grouped into different categories.
These categories range from disorders that are usually first evident in infancy, childhood, or adolescence and include adjustment disorders, anxiety disorders, substance-use disorders, and schizophrenia to name a few.
Axis II is used to describe developmental disorders and long-standing personality disorders or maladaptive traits such as compulsiveness, over-dependency, or aggressiveness.
It is also used to describe language disorders, reading or writing difficulties, mental retardation, autism, and speech problems.
It is possible for an individual to have a disorder on both Axis I and Axis II. The use of both Axes I and II permits multiple diagnoses and allows the clinician flexibility.
Axis III is used to describe physical disorders or general medical conditions that can influence or worsen Axes I or II disorders.
Axis IV is a measurement of the current level of stress at which the person is functioning. The rating of stressors (such as death of a spouse or loss of a job) is based on what the person has experienced within the past year.
Axis V is a Global assessment of functioning and is used to describe or rate the overall level of adaptive functioning present. Adaptive functioning refers to three major areas: social relations, (family and friends), occupational functioning, (work, student, and homemaker), and the person's use of leisure time.
Although this five part diagnosis may be extremely helpful to researchers trying to discover connections among psychological disorders and other factors such as stress and physical illness, there have been criticisms of its use.
One criticism of the use of the DSM is the possibility of over diagnosing.
For example, ADHD (attention deficit-hyperactivity disorder) has become the fastest growing disorder in America. Because of the criteria listed for it, it can easily be applied to children, especially boys that would have been looked at as just "typical boys" in the past.
The second criticism of the use of the DSM is that it applies a label. People are being recognized as the label and not the person. For example, Harry is schizophrenic, rather than used to mean the individual is suffering from a particular disorder.
Labels may follow people and there are stereotypes and stigmas that exist in society concerning the mentally ill.
 |