How Useful is the Concept of Abnormality?
There are many examples in history which show us that up to the late seventeenth century people the world over predominantly considered the 'Abnormal' or 'Mentally Ill' to be suffering from some kind of supernatural force. It was not uncommon that in popular thinking, external influences such as the Devil or spirits would be held responsible for strange and uncontrollable behaviour in people and animals, a train of thought termed 'Demonology' having its roots in religious thinking (Davison/Neale, p8).
The concept of abnormality changes with knowledge and the prevailing social attitudes, therefore it is difficult to define an individuals' mental state or behaviour as abnormal. The term Abnormal is defined in the 1985 edition of The Penguin Dictionary of Psychology as "Any departure from the norm or the normal". It also defines Normal as "Conforming to that which is characteristic and representative of a group; not deviating markedly from the average or the typical.". Legally, normality is largely defined as the ability to distinguish between right & wrong, and to control their own behaviour (Roediger et al., p533).
The basis of the modern approach to classification and diagnosis of mental illness was instigated with a book published by Emil Kraepelin (1883). Therein he described sets of symptoms, or syndromes, which indicate the presence of an abnormality in an individual. The need to describe what is normal has led more recently to classifications of unacceptable behaviour, such as the British Mental Health Act (1959), DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, 1987) and the ICD-10 (International Classification of Diseases, 1987). Eysenck (1960) suggested a formula for diagnosis involving the measurement of the extent of neuroticism, introversion and psychotism in an individual. Statistical analysis of the results of these three tests reveal how 'abnormal' the subject is. Classification systems like these form a structured definition of 'deviant' behaviour so diagnosis can be made more consistent.
They have however led to a bias in the way of looking at abnormality, using the Medical Model as a basis which brings with it its own variety of terms such as Illness or Disease. Abnormal behaviour can often be just inconvenient or unusual for others, and it can be hard to define behavioural patterns as an illness. Since it is hard, if not impossible to measure mental states, and symptoms are not always consistent, it has been suggested that mental 'illness' should not be described as a disease (Milton & Wahler, 1969).
One criticism against classification is Labelling Theory, which describes the effect on the patient of using classification systems in diagnosis. It is claimed that the "very use of diagnostic labels has a profoundly negative effect..." on the very behaviour of the patient. It is also noted that there is a negative effect on the behaviour of those people around them resulting in the labelled person being treated as 'sick' (Roediger et al., p536). If being called mentally ill, or being classified as abnormal changes the behaviour of a patient or others, diagnosis will surely be that much harder. If this is extended to a patient suffering from real symptoms, it does raise issues of morality; how do we justify imposing this on them?
Another argument against any classification of mental 'disorder' is based on the continued unreliability of diagnosis. In a famous study by Rosenhan ('On Being Sane In Insane Places', 1973), twelve 'normal' people were successfully admitted into separate psychiatric hospitals via misdiagnosis of schitzophenia, even though they were previously described as psychiatrically normal (Gross, p955).
Compounding this is the question of how to measure the extent of a 'symptom'. There are suggestions that behaviour could be looked at as a continuum from 'normal' to 'abnormal', a parallel with the colours of the rainbow. This has obvious implications in diagnosis; where do you draw the line between the two extremes? In addition, one might also ask how to measure Normality. Statistical analysis of 'norm groups' consisting of groups of psychiactriclly normal individuals can give a measure of what average, or 'normal', behaviour could or should be. However, norm groups are usually substantially smaller than the ideal in a lot of research. To gain a truly accurate picture of what average behaviour is, one would need research involving tens of thousands of subjects.
The moves to study abnormality, and the progress which has been made towards a better understanding of its causes have also led to developments in special needs education and therapy. Analysis of abnormal human behaviour can throw light on 'normal' behaviour and vice versa, however there has been very little research on healthy behaviour and well-being.
It seems clear that there must be some form of universal language with which we can communicate mental states and problems to each other accurately and without misunderstanding. The need to diagnose problems implies the need for some form of labelling and grouping of symptoms. The labels used to describe abnormal mental behaviour up to now have often had negative overtones. A labelling system which is both impartial and accurate must surely be of utmost importance. However, there is always the possibility that any labelling of mental disorders will develop a negative tone due many peoples fear, or lack of understanding, of these conditions and their implications for an individual. It could therefore be that the problems associated with labelling someone are surpassed by the problem of how we act towards that person?
Davison, G., Neale, J, Abnormal Psychology 3rd Ed., (John Wiley & Sons, Inc.), 1982
Roediger, H, Rushton, J, Capaldi, E and Paris, S, Psychology 2nd Ed., (Little, Brown & Co.), 1986
Gross, R, Psychology, The Science Of Mind & Behaviour 2nd Ed., (Hodder & Stoughton), 1993
The Penguin Dictionary of Psychology, (Penguin Books), 1985
Gregory, R (Ed.), The Oxford Companion To The Mind, (Oxford University Press), 1987
Copyright © 1998, Adam King
Categories: General Topics