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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