DEFINING “ABNORMALITY” OR CONSTRUCTING PSYCHOPATHOLOGY?:

LECTURE OUTLINE

• Some warnings about “abnormality”

• Difficulties defining abnormality

• Thomas Szasz (1960) – the myth of mental illness

• Rosenhan (1973) – on being sane in insane places

• Myths and misconceptions

• Various ways of defining abnormality

SOME WARNINGS

• Clinician’s bias – look for abnormality and you will find it

• Tendency to focus on problems and ignore the whole person and her/his strengths

• Fundamental attribution error – tendency to downplay the importance of the environment as contributing to problems – are people “abnormal” or doing the best they can to cope in stressful circumstances?

SOME WARNINGS

• Words can hurt – “crazy”, “wacko”, “psycho” are inappropriate

• All this can lead us to turn the individual into one of “those people,” uncovering societal prejudices towards people with mental health problems that we may have internalized

SOME WARNINGS

• So, focus on the person first, the problem second; and look at the person in context

• Use “people first” language – person’s proper name or more generally, e.g., “person experiencing depression”; avoid language like “a schizophrenic”

SOME WARNINGS

• Pay attention to how mental illness is portrayed in the media

• Use STOP criteria to think about stigma – Stereotype, Trivialize, Offend, Patronize

• Recognize the potential for recovery

• Think critically, be a skeptic, question current views!

DIFFICULTIES DEFINING ABNORMALITY

• What is considered to be “abnormal” is a value judgment, assumption that normality is clearly defined. But what is normality?

• Some warning signs for normality – serious, nice, always right, boring, obedient, gullible (Janet Foner, Support Coalition Survivor and Psychiatric Survivor) – please note this is a joke!

DIFFICULTIES DEFINING ABNORMALITY

• Values depend on social context, and values and social context are variable

• Are individuals abnormal or are social conditions stressful?

• Defining abnormality is a social act

THE MYTH OF MENTAL ILLNESS

• Psychiatrist Thomas Szasz argued that mental illness does not exist, but rather problems in living

• No known lesions, defects, or diseases of the nervous system underlie any mental illness

• “symptoms” of mental illness are not linked to anatomical context, but to social context

THE MYTH OF MENTAL ILLNESS

• Deviation from social norms is judged by mental health professionals

• Whose agent is the mental health professional? (the person, relatives, organization, the state)

• Psychiatry is different than other branches of medicine, more tied to problems of ethics and values

ROSENHAN (1973) – ON BEING SANE IN INSANE PLACES

• 8 “pseudo” patients sought admission to hospitals

• voices – “empty”, “hollow”, “thud”

• no simulation of symptoms after admission

• all except 1 admitted with diagnosis of schizophrenia, discharged with “schizophrenia in remission”

ROSENHAN (1973) – ON BEING SANE IN INSANE PLACES

• this is an example of the clinician’s bias

• detection

• “stickiness” of diagnostic labels - stigma

• experiences of hospitalization

• powerlessness and depersonalization

MYTHS AND MISCONCEPTIONS

• People with mental illness are strange and different

• People with mental illness should be treated differently

• Mental illnesses are inherited

• Mental illnesses are incurable

• Mental illnesses are caused by the stresses of modern life

MYTHS AND MISCONCEPTIONS

• Mental illness and genius go hand in hand

• Mental illnesses is caused by personal weakness and can be overcome through will power

• People with mental illness are irrational and dangerous

• People with mental illness need to be hospitalized

MYTHS AND MISCONCEPTIONS

• People with mental illness are poor

• People with mental illness are less intelligent than others

• All homeless people are mentally ill

• Mental illness is a single, rare disorder

SUMMARY

• Abnormality and mental illness are problematic concepts because of values and social context

• Remember that mental illness is not something absolute and unchangeable, but a concept that is constructed in a social context