The study of abnormal psychology (also sometimes called psychopathology) often captivates many students, because it is one of the most interesting and provocative topics in psychology. Descriptions of the wide variety of mental disorders and related symptoms can include combinations of bizarre and illogical actions, thoughts, and feelings that may look somewhat like a comic tragedy to the outside observer. However, this may be due in part to the descriptions and perceptions of the cases chosen for presentation to begin with. Various forms of media often portray people with mental disorders in an entertaining yet unrealistic and overly dramatic manner, further reinforcing stereotypes and misconceptions about mental illness. Yet for people suffering with mental illness, without diagnosis and treatment, theirs can be a world of loneliness, fear, alienation, and marginalization.
There are several key questions for students to answer as they work toward mastering the content of abnormal psychology. How do psychologists define and diagnose something as being abnormal? Who are key historical figures, and how have views of mental health and illness changed over the years? How do psychologists use science to better assess and understand mental disorders? What are the primary theoretical perspectives and treatment options? We explore these questions in the following sections.
What is Abnormal Psychology? Definitions of Abnormal
Defining what is abnormal depends on how one first defines what is normal. This may sound simple and obvious, but it is not always so easy to remember that these are dynamic and relative terms. What people consider normal behavior depends on the time, place, and those involved. For example, most people believe that physical aggression against another person is generally unacceptable, but certain forms of aggression under certain circumstances (e.g., a great hit in a football game) may in fact be encouraged and celebrated. Psychologists therefore face a unique challenge when trying to define abnormality, because normality is a complex moving target directly influenced by evolving social values.dysfunctional, and maladaptive (among others). These synonyms can help describe key features or dimensions that psychologists and other professionals may use to help identify abnormality. Each dimension represents a unique perspective and offers specific advantages when trying to describe and define normal vs. abnormal. However, each perspective also has specific limitations, and attempting to use any one of them in isolation as the sole determinant of what is abnormal leaves you with an incomplete and oversimplified view of abnormal behavior.
Perhaps the simplest definition of what is abnormal involves deviation from what a group considers correct or acceptable. Each group develops a set of rules and expectations, or norms, for behavior under a variety of circumstances. A norm may be explicit (e.g., written laws) or implicit, but group membership and acceptance is largely determined by adherence to the norm. Deviation from the norm is often discouraged because it threatens group integrity and cohesion, and repeated norm violations may result in negative consequences for the deviant individual. Obviously, groups can vary in size and construction (e.g., your immediate family versus all people in the United States in your age group), and the degree of influence their norms have on your own behavior will depend in part on how much you value being a member of that group and how influential your own behavior is within the group (i.e., it is a feedback loop—your behavior is influenced by the norm while also helping to define the norm). The advantage of this approach is that it necessarily includes norms that are current and relevant to the group in question. The obvious limitation of this viewpoint is that any behavior that is new or different and runs counter to a group’s preexisting norms will be labeled and treated as deviant, a term that carries a strong negative connotation. The negative connotation and resulting stigmatization associated with being labeled deviant may in fact be one of the potential consequences designed to prevent a person from drifting too far away from the values and beliefs of the group. This may sound very stifling and overly rigid to some people. In Western cultures, such as the United States in particular, maintaining balance between group affiliation and individual identity is important because of the value Americans place on individualism and freedom of choice. Another important limitation is the consideration that even the most pervasive norms are not stable or static; what is generally acceptable today (e.g., hairstyles, fashions, tattoos, and body piercing) may be laughably deviant in the future.
If psychologists define what is normal by quantifying what is average or typical of a group, then abnormal is anything unusual, or that which lies outside an accepted range. Psychologists often use a cutoff of two standard deviations above or below the mean to define something as being highly unusual or rare (i.e., statistically significant), as this represents the extreme scores (upper and lower 2.5 percent approximately) of a normal frequency distribution. By comparing an individual’s score to the average score of an entire sample, psychologists can make probabilistic statements about the likelihood of obtaining a specific score randomly or by chance alone, versus obtaining that same score because the individual most likely is truly and statistically different from the sample. This approach has the advantage of being quantified and more objective than other perspectives, and thus applicable in the use of statistical procedures and scientific interpretations of data. However, this approach has the disadvantage of labeling anything that is statistically extreme as abnormal, even if it is a desirable trait (e.g., a very high IQ). Additionally, any cutoff used is an arbitrary one that may be influenced by sample size or the shape of the frequency distribution, and there is lots of gray area between what is easily defined as average and what is obviously atypical in the statistical sense. This issue is made even more apparent when one considers the relative lack of precision and measurement error that psychologists often have to take into account when trying to assess traits and behaviors that may be considered indicators of mental disorder.
If psychologists use measures of daily functioning (occupational success, academic performance, social/ interpersonal interaction, aspects of self-care, etc.) to define what is normal, then they would define as abnormal or dysfunctional anything that prevents maximal or ideal functioning. This approach has the advantage of using behaviors that are typically observable and measurable (e.g., salary, GPA, number of close friends, cholesterol levels, etc.), and is flexible enough to account for different developmental stages and individual differences. This flexibility, however, is also the primary disadvantage of this perspective because maximal functioning is a concept that depends on numerous other factors: age, cultural expectations, personal values, and so on. Getting an average grade on an important exam may be perfectly acceptable to a struggling student simply trying to pass a course, yet thoroughly unacceptable to another student on academic scholarship who wants to pursue a graduate degree. The issue then becomes one of deciding which expert determines what ideal functioning looks like for any given person. This is not impossible to do, but it does require sound clinical judgment combined with a high level of skill and experience to gather and assess relevant data.
Because normality differs from person to person, it might be necessary to use a perspective that pays very close attention to individual levels of distress. Assessing personal distress or unhappiness as a means of defining what is abnormal includes measuring the frequency, intensity, and duration of symptoms that are cognitive, emotional, physical, or some combination of the three. Whereas using dysfunction includes elements of interpersonal functioning as already mentioned, using distress could be thought of as a way of determining intrapersonal functioning. Individual levels of pain, anxiety, anguish, and so forth are important indicators of abnormality regardless of social norms, statistical rarity, or daily functioning. Self-reports of the severity, origin, and meaning of symptoms are an important source of information, and can be a powerful component of a therapeutic relationship. In fact, the goal of therapy may often include work on defining what being happy means and helping a person find ways to move closer to that ideal state. Relying on personal distress as the defining feature of abnormality obviously assumes that personal distress exists in the first place, an assumption that may very well be fallacious, particularly in cases of acute psychosis or severe personality disorders. Additionally, people are often motivated toward productive goals by their anxieties and insecurities, thus one could question if an equal but opposite state of perfect happiness exists, and whether it is even possible or beneficial to eliminate all sources of personal distress. This may be an important philosophical or existential issue, but in reality it represents an artificial and oversimplified dichotomy. When levels of distress paralyze, debilitate, and otherwise prevent individuals from feeling like themselves on a daily basis, even modest relief can be a welcome change of pace and a more achievable goal, thus rendering the issue of achieving total happiness and eliminating all sources of stress a moot point.
Finally, if the synonym “maladaptive” is used as the primary reference point, then anything that causes harm or increases the risk of harm to self or others serves as an indicator of abnormality. Physical injuries, suicide attempts, substance abuse, indiscriminant sexual behavior, and extreme sensation seeking could all be easily seen as maladaptive behaviors, because they all represent a high level of severity and risk. The problem is that even though this elevated level of harm and risk is easy to spot when it occurs, it does not occur in every case of what professionals consider abnormal, and in fact may be the least prevalent of all indicators of abnormality. This obviously limits the utility of this criterion to define what is and is not normal.
It should be apparent by now that, as stated previously, no single element can be used in isolation to achieve a definition of abnormality that is sufficient. By combining several of these factors into a working definition of abnormality, psychologists can take advantage of the strengths of each perspective while avoiding or minimizing the inherent individual disadvantages. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000), specifically incorporates several of these dimensions into each set of diagnostic criteria for various disorders and syndromes. However, even this approach is relative and dynamic, and will always depend on the culture and timing surrounding what is defined as normal.
Just as there are multiple dimensions used to define what is abnormal, there are multiple theoretical models in use today to help describe and predict abnormal behavior as well as dictate treatment methods and techniques. In order to fully understand these models and put them in proper perspective, a brief review of the history of abnormal psychology is in order.