Name : Varsha Chandrashekar
Roll Number:1114332
Class: PSEco
(SOURCE: GOOGLE IMAGES)
Roll Number:1114332
Class: PSEco
Abnormal Psychology
What is
abnormality?
Abnormal Psychology isn’t that
uncommon as we think it is. Though it is generally thought that it only
existing with in a certain section of the society, it actually also exists much
closer in one’s home. Issues such as eating disorders like bulimia, anorexia or
substance abuse fall under the criteria of abnormal psychology. Now before we
dwell into the detailed area of this topic, it is necessary to first understand
what is abnormality? To put it in simple terms, abnormality is anything that
deviates from normal norms of the society or environment in which it is
ratified. One example out the million case studies can be given for a clearer
understanding.
Case Study/Example:
Monica is a young, intelligent
girl in her teens who is a star student in her school. Her personal life is
just as good with her family and peers. If you were to meet her, you would
think she had minimal amount of problems in her life. But Monica has been
having an eating disorder since 13 years of age. She has been following a ‘diet’
since the beginning of her teenage life due to fear of losing her ‘perfect
shape’. She ate very little food during the day and at night she would stuff
herself with unhealthy foodstuffs in order to fill her stomach only to vomit it
out the next hour. She frequently misses morning classes due to weakness and
lack of energy in the body. However, she denies any sort of problem related to
food and her body and calls herself as ‘thin’ compared to the rest of the
girls. The previous week she decided to stop with the ‘diet’ and eat regular full
meals. However she found it next to impossible to stop and is now treading on a
dangerous path of getting rapidly thin which could prove fatal.
Now as you read this you may have
innumerable question in your mid. That is if people in Monica’s family have an
eating disorder too. Or since she is in her teens, is she really having an
eating disorder with a completely psychological explanation or is she just
trying to fit in her popular friends circle. Moreover to let in a few more
details, Monica’s family members such as her paternal aunt and maternal
grandmother had such a disorder too.
This is what we term as family aggression.
Although there is a change of name in this cases study for protection of
her identity, this is a real case and a real problem.
Given below is a graph depicting children
with abnormal disorders/behaviors among different age groups:
(SOURCE: GOOGLE IMAGES)
Role of a Psychologist and Clinician:
If one were
to understand mental disorders then it becomes obvious to learn to solicit
questions regarding such kind of behaviors in order to help patients and
families suffering from mental disorders. Without a doubt, posing questions is
an imperative part of a psychologist’s job. They are taught to ask questions
and conduct research. Psychologists not only have to raise questions but also
rely on scientific skills to gather information and present it in a logical and
lucid way. Arguably, treatment that was found a decade or even 5 years ago
would not be the best of ways to cure patients; hence psychologists have to
make use of the latest research to opt for the most effective treatment.
Meaning of Abnormal Behavior and
Elements:-
It would be
next to impossible to arrive at a perfect definition of abnormality or a
disorder. However there are certain elements of abnormality which make it clearer
to understand the field of study. We cannot say that one element is enough to
define abnormality as every element is dependent on the other and also if there
are greater similarities between the element and the person’s behavior; the
easier it is to diagnose the abnormality of the person. Given below are a set
of elements that assess the degree and criteria for abnormality:-
- Suffering: Psychological suffering
is indicative of abnormality. People in depression suffer psychologically
as well as people with anxiety disorders. But there are people who are
just frenzied or become agitated over thing like the net days exams. Although
that is suffering it is hardly labeled abnormal. Experts in this field state
that although suffering is considered as an element for abnormality, it is
not a sufficient or even highly necessary condition for abnormality.
- Maladaptiveness: This is a more
serious indicator of abnormality. This is because it interferes with our
relationships and enjoyment with family and peers and invades our well
being too. For example, Monica in the above case study would withdraw from
eating to the point where she is so frail that she needs to be hospitalized.
However not all disorders have the element of maladaptiveness. For
example, a contract killer would kill a person in return for a sum of money
which according to him is his wage. According to him, this behavior is not
abnormal because it is the way he makes his living. But on the other hand
we consider it abnormal because it goes against the norms set by the
society and hence is maladaptive for the society.
- Deviancy: Deviancy would lead us
to the meaning to being ‘away for normal’. But just statistically considering
unique or rather rare behavior to be abnormal would not help in defining
abnormality. People often make value judgments when defining abnormality. When
something is rare but desirable we consider it to be normal such as being
a computer genius. But if something is rare and undesirable such as being
dyslexic then it is likely to be considered as abnormal. Also if something
is common but undesirable it is less likely considered to be abnormal such
as being arrogant or selfish.
Thomas Edison who is the inventor of the
light bulb is a genius to reckon but this is not considered as abnormal..
- Violation of Standards of Society: Almost all cultures around the world have a set of rules and regulation. These are further framed as laws. Some societies set standards and norms which are to be followed by all individuals in the society. Any individual who breaks or refuses to follow the rules and norms are said to be abnormal. This also depends on the degree to which the laws are broken and also the commonalty of such violations. For example murder is considered as abnormal by any society but illegal parking is less likely to be considered abnormal in comparison.
- Social Discomfort: Violation of
any social rule would lead to people around feel a sense of discomfort and
uneasiness. For example when a stranger invades your personal space or
sits next to you even though there are free seats everywhere else, you
would feel uneasy and a sense of discomfort would start to build. It can
be said that unless you are a therapist working under such conditions, it
would seem greatly abnormal to you.
- Irrationality and Unpredictability: we as normal people expect others to behave I a certain code of conduct which is just as normal. However, even though being unconventional is a part and parcel of some individuals, it is inevitable that we would judge them after a certain point of time. For example a person who recites Martin Luther King’s speech during a ceremony, it would be considered as normal but if a person would say it out loud in the middle of the street lying flatly on the ground, it would be considered as abnormal. Also it is important to note that what is important is how we as people evaluate if others can control his or her behavior. Schizophrenic patients often have disordered speech which is considered to be irrational.
These are
the main criteria for considered a person to abnormal and deviate from what we
call normal behavior in the society.
Need for Classification of Mental
Disorders:-
There is a
dire need to classify information in almost all areas of study. This is due to
the fact that classifying information provides us with nomenclature which is a
naming system and it helps us to structure that information in a more organized
and helpful manner. It not
only helps us to structure information but also helps us learn more about the
disorder regarding its causes and most importantly how it would best be
treated. For example in the above case study, Monica’s eating disorder would
help us study what type of disorder it is and what would be the best treatment.
This is vital as it would distinguish the type of treatment that can be used on
the respective patients.
Finally classifying
information would help us ascertain the degree of problems the medical health
profession can tackle. It would also help in finding out which problem needs
reimbursement and the amount of imbursement.
Disadvantages of Classification:-
There are a
few disadvantages as well when we classify information. When we classify or
simplify information we acquire a loss of information as it is in a
short hand format. Any information which is in a short hand format will lead a
loss of information. For example, learning about the person’s disorder would
give us more information rather than just being told that he or she has ‘anorexia’.
Hence we are losing out personal details of the actual person who is suffering
from mental disorders by further simplifying the information.
When a
person is diagnosed with a certain type of mental disorder, there is a sense of
stigma
or fear that is automatically attached to him or her. For example,
people who are vocal about diseases like diabetes are likely to be more secretive
about a mental disorder as they have fear unwanted social and occupational
consequences. In the above case study Monica would prefer to be secretive
eating disorder and would rather change the topic to something else.
Along with
sigma, there is a sense of stereotyping that occurs among
people. Stereotypes are notions people have on others on the observation or
knowledge of one thing about them. For example stereotyping that people from Delhi are rude and people from South
India are very orthodox in nature. Hence, because we know about a
certain type of behavior that complements a certain type of mental disorder; we
tend to automatically presume that these are behaviors that attached any person
with a psychiatric diagnosis.
Along with
stigma and stereotyping there occurs a predicament of labeling. A person who is
diagnosed with a particular mental disorder and is grouped under a number of
symptoms, this diagnostic label is almost permanent in their minds even though
they have completely recovered. Also more importantly, person’s self-concept is
damaged when they are diagnosed with mental disorders such as autism, bulimia
etc. Language is essential when dealing with patients suffering from mental
disorders. It is crucial to know that diagnostic classification doesn’t classify
people but it classifies the disorders people have. It is now widely
recommended that doctors specify the disorder the patient is suffering from
rather than labeling them. For example it is preferred to say the “a person
with autism” rather than autistic giving a feeling that the person is more than
the diagnosis and not just the diagnosis.
The DSM 4 Definition of Mental Disorder:-
The American Psychiatric
association’s Diagnostic and Statistical Manual of Mental Disorder or popularly
known as ‘DSM’, is considered as the gold standard for measuring numerous
mental disorders. The DSM is presently in its 5th edition and was
first published in 1994 and was faintly improved in 2000. The 4th edition
of DSM defines mental disorders as the following:
·
“A clinically significant behavioral or
psychological syndrome or pattern.”
·
“Associated with distress or disability which
means impairment in one or more important areas of functioning.”
·
“Not simply a predictable and culturally
sanctioned response to a particular event such as death of a loved one.”
·
“Considered to reflect behavioral, psychological
or biological dysfunction in the individual.”
However, there are a few
debatable flaws in this definition proposed by DSM4. For instance, the cause of
mental disorders is not mention by the DSM. One can say that DSM has endeavored
to be ‘a theoretical’. Behaviors which are linked to culturally authorized
responses such as depression or sadness due to loss of a loved one is ruled out
by DSM. DSM also emphasizes that mental disorders are the product of dysfunction which is inherent in individuals
and not in groups. It has been argued upon that knotty or difficult behavior by
itself cannot be the dysfunction
because by saying so, it would be like saying that mental disorders are caused
due to mental disorders which is incorrect.
Definition by Jerome Wakefeild:-
After discovering this error in
the definition given by DSM, Wakefeild had put forward the idea of mental
disorder being a ‘harmful dysfunction’.
He further went on to categorize ‘harm’ in
terms of social norms and ‘dysfunction’ to
an underlying mechanism that is unsuccessful in performing in accordance to its
design. He defined mental disorders as follows:
- It is a condition that “causes significant distress or disability.”
- It “is not merely an expect-able response to a particular event.”
- It “is a manifestation of a mental dysfunction.”
Wakefeild’s approach to mental
disorders has a positive side to it. That is the role of social values in the
definition of mental disorders. In his notion of mental disorders, he has tried
to employ scientific theory. However, there is a range of philosophical and
logical problems associated with this approach as well. For instance,
evolutionary theory does not support an expedient list of what is and what is
not functional to us. Hence we are obviously left with no choice but to establish
these evaluations on social norms rather than scientific observations. Therefore
it can be said without a doubt that establishing a simple and clear-cut
definition on mental disorders is nearly impracticable.
Culture specific disorders:-
It is well known that the world
constitutes of innumerable cultures that are unique in nature and can collide
with one another’s beliefs and rituals which leads to one thinking that the
other culture has abnormal practices. This is mainly because what may seem to
be normative and customary in a certain culture may seem abnormal in the other.
Such culture specific disorders are decidedly culturally bound and are found in
specific parts of the world. For example, the Satere-Mawe tribes in Brazil
It can be in the form of behavior, norms, culture etc.
Culture specific disorders would generally not be considered as something
unusually new to the authors of DSM because they are a part of the culture
belief set. Moreover the yardstick for considering what is normal behavior for
a culture is set by the culture itself. When considered as a cross-cultural
concept, ‘normalcy’ is an almost hollow concept. For example, in South India it
is normal to celebrate a person’s death in some castes but this would be
considered as meaningless and horrifying in America
and even Britain
Culture and
Abnormality: The Affect
When one speaks about concepts such as normality and
abnormality, it is evident that one has to refer to culture to come to a
consensus. In a given culture, there are plenty beliefs and behaviors that are
customary and are a time-honored practice. For example, shaking the head in a
horizontal direction is considered a ‘no’ in most countries but in a country
like India India
Commonality of Mental
Disorders:-
An important aspect in this area
of study is to question how many people have diagnose-able and psychological disorders
and what kinds of people have them. This is imperative because it would help a
great deal in planning of mental health services. Aspects such as funding of
research or assistance imparted by community mental health centers have to be successfully
allocated and for doing so mental health planners need to have a lucid picture
of the nature and range of psychological problems with in an area, state or
country. For example, it would not be wise to have a treatment center filled
with specialists who treat Bulimia while at the same time offer a small amount
of treatment resources for people who have a medical condition of depression
which is a little more common.
Valuable inklings about the
causes of mental disorders can be attained by estimating the frequency of
mental disorders in different groups of people. For example, it is
statistically proven that women out number men with depression. This indicates that
in order to understand depression, it is important to consider the gender as a
factor. However this is not the case in other castes such as Jews which have
more number of males than females suffering from depression.
Incidence and Prevalence: Measuring Psychological Problems
We must understand the importance
of how psychological problems are counted before conversing about the degree of
mental disorders in a society. By doing so, we come across the term ‘Epidemiology’. The analysis of
distribution of diseases, disorders or even health related behaviors in a given
population is termed as epidemiology. Study of distribution of mental disorders
in particular is termed ‘Mental Health
Epidemiology’. It must be kept in mind that establishing the frequency of a
mental disorder is the fundamental element of an epidemiological study. The
following methods give an insight on how to determine the frequencies of mental
disorders.
1. Prevalence: it is usually denoted in percentages and is the number of active cases in a population throughout a given phase or time. When we say that it expressed in percentage, we mean to point out the percentage of population suffering from that disorder. Prevalence can further be categorized into the different types which are as follows:
1. Prevalence: it is usually denoted in percentages and is the number of active cases in a population throughout a given phase or time. When we say that it expressed in percentage, we mean to point out the percentage of population suffering from that disorder. Prevalence can further be categorized into the different types which are as follows:
·
Point Prevalence: we can explain this by
using an example. If one were to conduct a survey and calculate the number of
people suffering from Bi-Polar disease on January 1 next year, this would
present us with a point prevalence estimate of active cases of Bi-Polar
diseased people. However there is appoint to be remembered, that is, people who
are suffering from Bi-Polar during December but managed to recover by January 1
would not be a part of the point prevalence statistics. This condition holds
true for those whose Bi-Polar disease didn't begin until January 2nd.
Hence we can sum up a definition that in any instant in time, the anticipated
proportion of actual, active cases in a population is termed as ‘Point Prevalence’.
·
1-Year Prevalence: this is contradicting
to the point prevalence method as it takes into account anyone and everyone who
suffered from a mental disorder at any time during the given year. This would
obviously mean that we would end up with a higher result than the point
prevalence because it has covered a relatively longer time period. People who
have recuperated prior to point prevalence assessment and whose illness didn’t arise
until after the point prevalence survey was made would be included in this
method.
·
Lifetime Prevalence: if one wanted to identify
how many people have had a medical condition with reference to a mental
disorder at any point in their lives, then lifetime prevalence would be of use.
This type of estimate would be statistically higher than the two other
estimates mentioned above due to the reason that it envelops entire life spans
which incorporates both presently ill people and people who have recouped from
the disorder.
2.
Incidence: we can explain this estimate by using
an example. If one were to calculating a one-year incidence of Autism, then
individuals whose Autism began before the starting date , say January 1, would
not be taken into consideration even if they were unwell due to the simple
reason that theirs cannot be labeled as ‘new’ cases of Autism. Hence the number
of cases that transpire during a given period can be called ‘incidence’. This type of estimate would
be lower than prevalence as it does not include previously existing cases. But a
point to be noted is that people who have been keeping well but have developed
a disorder, like Autism, would be included in this estimate.
Points to be Remembered
- Thought it is said that there are high lifetime rates of mental disorders, there are exceptions that the time period of the disorder may be short-lived. For example, depression that may last for a few months after the death of a loved one.
- When a person is seriously impaired by a disorder, it is considered as different as compared to just meeting the diagnostic criteria for that disorder.
Comorbidity
Now let’s say an individual is diagnosed
with a disorder which may be mild, moderate or serious, is also diagnosed with two
or more other disorders then this can be termed as comorbidity. To put it in a
lucid manner, this phrase is used to depict the existence of two or more
disorders in the same individual. For example when a person is diagnosed with
excessive abuse of prescription drugs may also be diagnosed with depression and
severe anxiety. The condition in which comorbidity is likely to occur is when people
have mental disorders at a more serious level and if the condition is mild then
comorbidity is taken as an exceptional case.
Treatment
Treatment is the most important
aspect of a patients life and but treatment is not received by all people
diagnosed with psychological disorders. This happens mainly due to the fact
that people go into a state of denial where they refuse or deny any sort of
psychological problem within them. On the other hand, some may recover with the
course of time without then need of a professional and try to muddle through their
problems themselves. Family physicians often treat their patient and not a
mental health specialist.
‘Out-patient treatment’ is now widely followed which means that a
patient doesn’t necessarily have to be admitted in a hospital and stay there
overnight but instead book an appointment and visit the mental health facility
or practitioner. However, people who require intensive treatment are preferred
to opt for ‘hospitalization’ and ‘inpatient care’ that can be granted on
an outpatient basis. Statistically, there has been a decrease in the number of
people who have been admitted in mental institutions in the last 45 years
because of the fact that there has been rapid development in medicines which
keep under control even the most severe disorders. The trend of ‘deinstitutionalization’ which refers to
discontinuation of traditional hospitalization has been on the rise since the
past few decades. High costs play a contributing factor towards
deinstitutionalization as high costs reduce the patient’s stay in private
inpatient facilities. Hence patients are instead shifted psychiatric units of
general hospitals for those in need of inpatient care.
Team of Mental Health
In order to reach a particular
diagnosis and assessment there are a number of professional and
paraprofessional members involved in the entire process. They gather
information from different sources and which may include any person or thing
the patient has had contact with and then assimilate all the information and
finally come to a diagnosis and treatment. These members in the team include
professional like clinical psychologist, counseling psychologist, school
psychologist, psychiatrist, psychoanalyst, clinical social worker, psychiatric
nurse, occupational therapist and pastoral counselor. The paraprofessionals
include community mental health worker and alcohol or drug abuse counselor.
Conclusion
Thus this blog was made to put
forth an insight of the abnormal psychological world in a nut shell and provide
a birds eye-view on the subject which included examples, case studies whose
name have been changed for confidentiality and discretion
References
1.
Carson, Butcher, Mineka, Hooley (2007), Abnormal
Psychology, Thirteenth Edition
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