Concepts and Diagnoses
Discuss the concepts of normality and abnormality.
(Discuss: Offer a considered and balanced review that includes a range of arguments, factors or hypotheses. Opinions or conclusions should be presented clearly and supported by appropriate evidence) Defining Abnormality
* There are several characteristics that can be viewed as components of abnormal behaviour. * These cannot be used independently, as no one component sufficiently defines abnormality. Defining Abnormality in Terms of ‘Statistical Infrequency’ * Abnormality can be defined as deviation from the average, where statistically common behaviour is defined as ‘normal’ while statistically rare behaviour is ‘abnormal’. * Abnormal behaviour is considered to be infrequent.
* By definition, abnormality means ‘deviating from the norm or average’. * Perhaps the most obvious way to define abnormality is in terms of statistically infrequent characteristics or behaviours. * For example, if the average height of a given population of adults is 5’8”, we would probably describe someone who was 7’6” or 3’3” as being ‘abnormally’ tall or short respectively. * When people behave in ways the vast majority does not, or do not behave in ways in ways the vast majority does, we often label them abnormal. * Behavioural measures, such as intelligence and short-term memory, tend to be normally-distributed. * The distribution from a sample of people tends to fall within a bell-shaped curve. * Those that fall near the centre will constitute the majority, and their behaviour will be constructed as “normal”. * For example, anxiety can be assessed using Spielberger’s State-Trait Anxiety Inventory. The mean score for trait anxiety is 40 and people who achieve over 55 are seen as statistically rare as only 1 in 50 score that high. Therefore, those with high scores are seen as deviant from the greater majority of the population. * Statistical frequency is used to define mental retardation. * IQ is normally distributed amongst the population.
* Though a number of criteria are used to define mental retardation, low intelligence is the fundamental measure. * When someone’s IQ is below 70, the person is deemed to be mentally retarded. * Strengths:
* It is numerical based there are key boundaries less error in interpretation. * Limitations:
* It fails to take into account of the desirability of a behaviour or characteristic. * Some things that are statistically normal – such as obesity – are not desirable or healthy behaviours. * Some that are statistically rare – such as high IQ – are not dysfunctional. * There are people involved in a range of undesirable behaviours in all cultures: * “Americans [engage in various] socially undesirable behaviour patterns, from mild depression to child abuse, [and] if it were possible to add up all the numbers, it would become clear that as many as one out of every two people would fall into at least one of these categories” (Hassett & White, 1989). * These behaviour patterns, which characterise half the American population, would be normal in a statistical sense, but they are also regarded as mental disorders. * We cannot know just how far from the average a person must deviate before being considered abnormal. * If a population’s average height is 5’8”, a decision must be made about when a person becomes abnormally tall or short. * Such decisions are difficult both to make and justify.
* There are problems deciding how statistically rare (2 or 3 standard deviations?) behaviour has to be to be considered abnormal. * Some currently accepted mental disorders are probably not statistically rare enough to be defined as abnormal, eg. phobias. Defining Abnormality as a ‘Deviation from Social Norms’
* All societies have standards, or norms, for appropriate behaviours and beliefs (that is, expectations about how people...
Links: * Beck et al. (1962) found that agreement on diagnosis for 153 patients between two psychiatrists was only 54%.
* The US-UK Diagnostic Project (Cooper et al., 1972) confirmed this discrepancy and thus began paving the way for the development of internationally accepted criteria.
* Di Nardo et al. (1993) studied the reliability of DSM-III for anxiety disorders.
* Holmes (1994) found that as there is no absolute standard against which a diagnosis can be compared for most disorders, validity is much more difficult to assess, and there is no guarantee that a person has received a correct diagnosis.
* Heather (1976) found that there was only a 50% chance of correctly predicting treatment based on the diagnosis that they are given.
* Bannister et al. (1976) examined 1000 cases and found that there was no clear cut relationship between diagnosis and treatment.
* Lipton and Simon (1985):
* Randomly selected 131 patients in a hospital in New York and conducted various assessment procedures to arrive at a diagnosis for each person.
* Makay (1975):
* “The notion of illness implies a relatively discrete disease entity with associated signs and symptoms, which has a specific cause, a certain probability of recovery and its own treatments
* People react to ‘former mental patients’ more negatively than to people with the same symptoms who are not labelled (Farina, 1992).
* Scheff (1966) and Comer (1998) argued that one of the adverse effects of labels is the self-fulfilling prophecy – people may begin to act as they think they are expected to.
* Doherty (1975) pointed out that those who reject the mental illness label tend to improve quicker than those who accept it.
* In a study carried out by Langer and Abelson (1974), testing social perception, they showed a videotape of a younger man telling an older man about his job experience.
* Since their job is to diagnose abnormality, they may overreact and see abnormality wherever they look. This was clearly demonstrated by Rosenhan’s (1973) study.
* Kahneman and Tversky (1973) point out that this is not the case. There is no positive correlation between the number of assessment techniques used and the accuracy of an eventual diagnosis.
* Once the pseudo-patients in Rosenhan’s (1973) study were admitted to mental wards, it was very difficult for them to get out; one participant took 52 days to convince medical staff that he was well and the whole thing was an experiment.
* Authoritative Figure:
* Temerline (1970) found that clinically trained psychiatrists and clinical psychologist could be influenced in their diagnosis by hearing the opinion of a respected authority.
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