Disorders of the Mind
David Rosenhan, in 1973 conducted an interesting experiment in 12 mental hospitals. He sent in 8 pseudopatients who upon admission stated that they heard voices. After admission they stopped saying they heard voices. The outcome of Rosenhan's experiment was that the professionals in the mental hospitals didn't detect the fake patients and in some cases placed a diagnosis of schizophrenia on some of the patients. Besides the fact that none of the pseudopatients were found out by the staff [patients suspected the fakes] his experiment did call to question the issue of labeling and diagnosing.
What is abnormal?
This question of what is abnormal is a complex and compound question. The word itself indicates it means 'not normal'. So one must consider what is normal and what level of deviation is acceptable.
David Holmes suggests that behavior that causes subjective distress of the individual, behavior that is psychologically or socially disabling, and behavior that deviates from social norms is considered abnormal.
Carlson, Butcher, and Mineka suggested that abnormal behavior as being deviant from cultural norms and maladaptive for the individual.
Terry Pettijohn defines abnormal behavior as:
· Contributes to the maladaptiveness in the individual
· Is considered deviant by the culture
· Leads to personal psychological distress
You will note the above definitions acknowledge "what is culturally normal. So an issue in psychology is diagnosing abnormal behavior within the context of the culture.
The early beliefs about mental illness held by the Greeks and Romans revolved around a person being out of favor with the gods. It was thought that evil spirits possessed the person. An early form of psycho-surgery called trepanning used to drain out the evil spirits. [evidence of trepanning has also been found in prehistoric societies as well] This procedure consisted of using a sharpened stone a hole was made in the back of the head. This hole allowed the evil spirits to leave the body. Many times, after the evil spirit left, the person died. During the Middle Ages it was believed that a mentally ill person was in league with the devil. The use of torture was an accepted form of treatment that would result in confession of sins or death. Individuals that displayed behavior that was considered abnormal, and was such the community did not want them around, were often placed in prisons and asylums. The conditions of the asylms were often very inhumane. It wasn't until a French physician, Philippe Pinel, became the director of an asylum in Paris ordered the 50 patients unchained, clothed, and fed that treatment began to get more humane.
Models of Abnormal Behavior
Biological Model: is the concept that behavior is caused by biological factors. Thus when behavior is abnormal it is caused by biochemical imbalance. Medical means are used to correct this problem such as medication or surgery. This can also be referred to as the Medical Model.
Psychoanalytic Model: approaches abnormal behavior from the psychodynamic theoretical base that there are issues with anxiety and conflicts which are too immense for the defense mechanisms. Abnormal behavior is the symptom of internal issues. Treatment is focused on the curing of the sources of anxiety and conflicts.
Cognitive Model: approaches abnormal behavior as non- effective thinking and problem solving. The treatment approach is to help the person understand his/her problems and learn effective ways of problem solving.
Behavioral Model: Consider abnormal behavior the result of learned social maladjustment. This results in learned inappropriate role expectations and behaviors. Treatment is focused on learning new behavior and unlearning behaviors that are maladaptive.
Sociocultural Model: cultural and social variables influence and define behavior and what is considered abnormal. Also, one must look at what forces in the society and culture cause or creates deviance.
Legal Model: Society sets up laws, regulations and standards of conduct. Violation of these is not acceptable therefore 'deviance or abnormal'.
Statistical Model: Abnormal behavior is considered deviation from the statistical norm.
Classification of Abnormal Behavior
The American Psychiatric Association in 1952 developed a standard that is used to determine and diagnose abnormal behavior. This is called the Diagnostic Statistical manual of Mental Disorders or DSM. Currently, the latest addition is called the DSM-IV [4th revision] . The World Health Organization standard is called the International Statistical Classification of Diseases and Related Health Problems or ICD-10 [10th revision] Both the DSM and ICD are coordinated with each other.
The DSM-4 classifies the individual on five axis or dimensions.
Axis I - Primary Clinical diagnosis which concerns the major problem and symptoms
Axis II --long-term personality characteristics or developmental problems
Axis III - any medical problems that might be relevant to the disorder
Axis IV - environmental and psychosocial problems
Axis V - global assessment is made on how the person is functioning
The DSM uses a number code that is associated with agreed upon disorders. An example would be 300.14 -Associative Identity Disorder.
Although there is disagreement on how DSM describes disorders, or includes or not includes certain disorders, it does present us with a standard to operate from. The DSM and ICD are continually being reviewed and when there is significant change then a revised addition comes out.
The DSM covers or identifies over 200 classifications of abnormal conduct these classifications are further categorized into major categories.
Acute Stress Disorder
Brief Psychotic Disorder