What is abnormal

To describe someone as abnormal depends on the circumstances. What is abnormal in one culture or at one time might not be abnormal in the next culture or a few years later. One way of looking at abnormality is statistically. This equates the abnormal with the rare. At first sight this might seem reasonable. In Western culture, the two types of reaction described at the start of this chapter are relatively rare. Fortunately, either for themselves or for those around them, not many people suffer from paranoia or from borderline personality disorder. But, there again, even fewer people win a Nobel Prize or run a 4-minute mile. This is even more abnormal, but such achievements do not have anything negative about them.

Another way of defining abnormality is very pragmatic - it is whatever is labelled abnormal by the majority of people within a culture - a social definition. This means, for example, that killing someone is abnormal; but not in times of war. To take another example, to decide not to seek medical treatment for a serious condition is abnormal. However, it is not abnormal among, say, Christian Scientists or members of similar religious groups. Even paranoia might be seen as normal among a group of spies.

A further problem with terming something as abnormal and then classifying it in some way, for example, as schizophrenia, can lead to self-fulfilling prophecies. If someone is classified with a label that is within the abnormal range, then this creates expectations among those around them about how they will behave and leads not only to the greater likelihood of such behaviour but also puts them at enormous disadvantages in life. Such classification and labelling typify current Western views of abnormality.

Abnormality is also defined as whatever is maladaptive for the individual or for those around the individual. If you are so anxious that you are unable to leave the house, this is clearly maladaptive for you. If you are consistently inconsistent in the way that you deal with others, then this is clearly maladap-tive for them. Again, however, what is maladaptive for the individual or for society changes from time to time and place to place. Linked to this way of looking at abnormality is seeing it as whatever causes personal distress to the individual. Many people who are classified with one of the 'mental' disorders are certainly distressed emotionally. However, if someone close to you dies or if you lose your job or if someone writes off your uninsured car, you are likely to be personally distressed, but this is unlikely to be seen as abnormal.

In our society, all of these ways of looking at what is abnormal tend to be used together in order to decide whether or not someone's behaviour is abnormal or if they are suffering from a mental disorder. Much of the remainder of this chapter will be spent describing some of the main disorders as they are classified in our society. It is important to bear in mind several points, however, when reading these or any similar descriptions of such disorders.

1 They are very much restricted to Western culture at this time in its history.

2 They are rarely seen in as clear-cut a fashion as they inevitably seem to be when they are described.

3 To label someone with a particular mental disorder might be convenient but such a label explains nothing and might in itself put the person at a serious disadvantage in life.

4 The major classification system of abnormality used in the Western world comes from the American Psychiatric Association (1994) - it is the Diagnostic and Statistical Manual (in its fourth iteration) (DSM-IV). Whether there are sufficient similarities between American society and European society, let alone antipodean society or Eastern society, as to make the DSM-IV equally applicable to all is arguable.

There are various axes to the DSM-IV, but the most significant of these are Axis I and Axis II, referring to clinical disorders and personality disorders. A list of such disorders follows, but only some of the more common (and more interesting) will be described in this chapter.

Axis I disorders: disorders of infancy, childhood or adolescence; cognitive disorders such as dementia and amnesia; substance-related disorders; psychotic disorders such as schizophrenia; mood disorders; anxiety disorders; somatoform disorders (that is, disorders about the body); factitious disorders (in which symptoms are feigned or consciously produced); dissociative disorders (temporary alterations to consciousness); sexual disorders; eating disorders; sleep disorders; impulse control disorders (such as compulsive stealing or lying); adjustment disorders.

Axis II disorders, describing various types of personality dysfunction: antisocial; avoidant; borderline; dependent; histrionic; narcissistic; obsessive-compulsive; paranoid; schizoid; schizotypal.

A final point to be made by way of introduction concerns the links between physical and mental disorders. In the everyday world this is a common enough distinction. But there are problems with it. For example, although something like chicken pox is clearly centred in the body (the spots are obvious), where is a disordered personality centred? Again, the only possible answer to this is 'in the body'. What else is there? This might, then, mean restricting 'mental' disorders to anything that goes wrong that involves the brain. There again, however, there is a problem. It can be argued, and, indeed, is argued, that any disorder, disease or even accident has a mental (or, perhaps, it is better to say, psychological) aspect. This might be before, during or after the illness or the accident. For example, not all broken legs occur merely by accident; some personality types might be more prone to such 'accidents'. Also, it is obvious that there are psychological effects of having a bodily illness or being laid up following an accident, and equally obvious that it takes some time to 'come right' afterwards.

Perhaps, then, it is a matter of the balance between the physical and the psychological (even though the psychological must be physically based, as well). This balance can vary from time to time and person to person within one disorder. For example, a stomach ulcer might have its main cause in the food eaten or it might have its main cause in living a stressful life. Whatever the balance of causes, it remains a stomach ulcer. So, to say to someone 'It's just psychological' or 'It's all in your mind' is nonsense.

These points apart, the brief descriptions of 'mental disorders' or behavioural 'abnormalities' that follow are more psychological than physical, although they must have a physical substrate - they are, after all, occurring in the human body. However, to say that they must have a physical underpinning does mean that they have a physical cause - the cause might well lie in the environment, in thought processes, in emotional or motivational processes, and so on. Of course, all such processes are also grounded in the physical. Other than the spiritual, there is no choice.

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