Concept of normality and abnormality
Normality and abnormality are two important concepts used to define behavior and psychological disorders in people. Normality is defined as the common occurrence or common behavior expressed by an individual. Its definition may vary according to different social context and normal. Normality is referred as the good signs of behavior in an individual whereas abnormality is regarded as the bad part of human behavior. On the other hand, abnormality is regarded as undesirable behavior or psychological disorder in an individual (Bassett and Baker 2015). Although diagnostic manual of mental disorders has clearly defines different types of mental disorder, however there is lack of clear definition on normality and abnormality. This is mainly because psychological disorder varies between individual and different socio-cultural groups. Currently, abnormality is measured and identified in an individual by the criteria of violating social norms, statistical infrequency and being harmful to others (Sue et al. 2015).
There are two main systems for the classification of mental disorders used by health care professionals. These include:
- ICD 10 (The International Classification of Disease): This standard diagnostic classification is published by WHO and covers 10 main groups of mental disorders. These includes symptomatic mental disorder, mental and behavioral disorders due to psychoactive substance, schizophrenia, mood disorders, neurotic disorder, behavioral disorder, personality disorder, mental retardation, psychological development related disorder and emotional disorders in childhood and adolescence. ICD-10 provides both clinical description as well as diagnostic guidelines to health care professionals (WHO | ICD-10 classification of mental and behavioral disorders 2017).
- DSM-IV (Diagnostic and Statistical Manual of Mental Disorder): The DSM-IV manual is published by the American Psychiatric Association and it classified and defines all types of mental disorders found in both adults and children. By the use of DSM-IV manual, health care professional can use multidimensional approach to diagnose mental illness. The advantage of this manual is that it allows health care professionals to provide a comprehensive diagnosis of mental illness defined by considering all factors that contribute to illness (Proctor, Kopa and Hoffmann 2014). They mainly assess the following five dimensions to confirm the type of mental illness in patient:
Axis I: It is the top level in the multi-axial system of diagnosis which gives idea about acute symptoms that can be treated. For example, major depressive episode, schizophrenia and panic attack are most familiar symptoms.
Axis II: This dimension helps in the assessment of developmental and personality disorders. Some example of developmental disorders includes autism and one example of personality disorders include paranoid and borderline personality disorder. These are life long mental problem that starts from childhood. Diagnosis of such disorder is also associated with social stigma as it such patients face challenges in adapting to demands of the society (Tyrer et al. 2015).
Axis III: This dimension focus on assessment of physical conditions that can help in determining the cause of disorder mentioned in axis I and II.
Axis IV: It comprises the component of psychosocial stressors that significantly has an impact on diagnosis and prognosis of mental illness. Review of life event records helps health care professional to identify psychosocial stressors resulting in medical illness in patient.
Axis V: This is the final level where the health care professional examines level of functioning in patients at present time and compares it with previous year (Proctor, Kopa and Hoffmann 2014).
1.Biological (medical):In the field of mental health care, the medical model of mental illness supports diagnosing and identifying disease by the process of observation,, description and assessment by means of diagnostic test and symptom observation. Hence, in case of psychopathology, the main assumption of biomedical model is that physical structure and level of functioning of the brain is also a cause of mental disorder. The modern classification system of DSM and ICD is found useful in determining the physical cause of mental illness. The biological approach to abnormality also believes that behavioral dysfunction is caused by changes in physical factors such neurotransmitter levels or changes in hormones.
There are certain strength and weakness of biological model. For instance, the involvement of biological factors like neurotransmitters and hormones in psychological disturbance has been established in research. Sperner-Unterweger, Kohl and Fuchs (2014) gave evidence about the interaction between neurotransmitters and immune changes in depression. The study gave the evidence that impaired metabolism of catecholamines and neurotransmitters plays a role in the pathogenesis of depression and mood disorder. Another strength of this model is that it helps to address experience of social stigma in patients as they tend to accept that psychological disorder is caused by biological factor and not dependent on patient’s personal capability. The biomedical model has favored implementation of drug therapies for mentally ill patients thus providing quick relief from adverse symptoms. The criticism that has emerged for this model is that it focuses a lot on nature instead of nurture for cause of illness. Another limitation is that it does not take into account individual difference in people that might contribute to illness.
Main systems for classification of mental disorders
Behaviorist model:The main concept of behaviorist model is that normal or abnormal behavior is learned from the environment and different interactions with environment. Hence, environmental factor is found to play a key role in diagnosis of mental disorder. According to behaviorism approach, people can learn new behavior either through classical or operant conditioning. Classical conditioning is the process of acquiring good or bad behavior by means of environmental stimulus and operant conditioning is the process of learning through reward and punishment (Horowitz 2014). The main strength of this model for mental health professionals is that it can help them to understand changes in behavior due to environmental factors. However, the model has been criticized because of its reductionist approach. The model is too simplistic and it has ignored the role of unconscious mind of behavior. Hence, mental illness cannot be assessed by just focusing on externally observed behavior. Biological and psychological factor might also be a cause of mental illness (Mohr et al. 2013). Therefore, the model is found ineffective due to its one-dimensional approach and little focus on internal influences such as thoughts and feelings on abnormal behavior.
Psychoanalytical model:The psychoanalytical model in psychology been given by Sigmund Freud who gave the idea that people can be cured by exploring and changing their unconscious thoughts and motivation. Hence, in short terms, it can be said that this model assumes that all psychological disorders or mental illness are rooted in the unconscious mind. Therefore, certain issues or trauma during people’s development might contribute to abnormal behavior in people. Due to the focus on exploring the unconscious mind, this model has found wide clinical application to assist patients with depression and anxiety disorders to modify their thought pattern (Stolorow, Brandchaft and Atwood 2014). This model has resulted in the emergence of problem-based therapies such as cognitive and behavioral therapies that focused on identifying maladaptive thought pattern in client and working with client to develop healthy thought pattern. The only challenges that has been found in applying this model is that it is a time-consuming process resulting and results in ethical issues during the therapy.
While considering treatment according to medical model, drug treatment or treatment by means of antipsychotic is widely implemented for mentally ill patients. For instance, the research gave insight regarding the effectiveness of antipsychotics in the treatment of depressive disorder. The advantage of these drugs was that it helped in active resolution of problems in people with severe depressive symptoms (Leucht et al. 2013). However, the issue that has been identified in using antipsychotic for mental disorder is that they have serious side-effects creating more complications in patient. Due to this limitation, evidence has pointed out to the option of combining other medications in treatment to minimize complications in patient. Efficacy and tolerability of drug is also a problem in patient (Spielmans et al. 2013).
Behavioral therapy is one example of treatments gives to mentally ill patients according to the behaviorism model. The main aim of behavioral therapy is to identify and modify maladaptive behavior in clients and it functions on the assumption that as all behaviors are learnt, treatment can also help to modify unhealthy behavior. Behavioral therapy has been found useful in treating patients with depression, anxiety disorder and anger issues. Cognitive behavioral therapy is also a part of behavioral therapy and although the process has been found useful in reducing symptoms, however treatment dropout rate has been high (Hans and Hiller 2013). Hence, there is a need to solve these issues to maximize the effect of the therapy.
Psychodynamic therapy is an example of treatment options under psychodynamic approach. The therapy is designed in a way to explore emotions and feelings of people. The main purpose is to identify any trauma or unresolved issues that has contributed to maladaptive behavior and thought pattern in patients. The advantage of psychodynamic therapy is that it supports open-ended exploration of patient’s feeling. It may help patient to improve their social, personal and work functioning in life and help them to better cope with mental problems (Driessen et al. 2013).
References
Bassett, A.M. and Baker, C., 2015. Normal or Abnormal?‘Normative Uncertainty’in Psychiatric Practice. Journal of Medical Humanities, 36(2), pp.89-111.
Driessen, E., Van, H.L., Don, F.J., Peen, J., Kool, S., Westra, D., Hendriksen, M., Schoevers, R.A., Cuijpers, P., Twisk, J.W. and Dekker, J.J., 2013. The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. American Journal of Psychiatry, 170(9), pp.1041-1050.
Hans, E. and Hiller, W., 2013. Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression: a meta-analysis of nonrandomized effectiveness studies, DOI: 10.1037/a0031080
Horowitz, F.D., 2014. Exploring developmental theories: Toward a structural/behavioral model of development. Psychology Press.
Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F., Samara, M., Barbui, C., Engel, R.R., Geddes, J.R. and Kissling, W., 2013. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet, 382(9896), pp.951-962.
Mohr, D.C., Burns, M.N., Schueller, S.M., Clarke, G. and Klinkman, M., 2013. Behavioral intervention technologies: evidence review and recommendations for future research in mental health. General hospital psychiatry, 35(4), pp.332-338.
Proctor, S.L., Kopak, A.M. and Hoffmann, N.G., 2014. Cocaine use disorder prevalence: From current DSM-IV to proposed DSM-5 diagnostic criteria with both a two and three severity level classification system. Psychology of Addictive Behaviors, 28(2), p.563.
Sperner-Unterweger, B., Kohl, C. and Fuchs, D., 2014. Immune changes and neurotransmitters: possible interactions in depression?. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 48, pp.268-276.
Spielmans, G.I., Berman, M.I., Linardatos, E., Rosenlicht, N.Z., Perry, A. and Tsai, A.C., 2013. Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLoS medicine, 10(3), p.e1001403.
Stolorow, R.D., Brandchaft, B. and Atwood, G.E., 2014. Psychoanalytic treatment: An intersubjective approach. Routledge.
Sue, D., Sue, D.W., Sue, S. and Sue, D.M., 2015. Understanding abnormal behavior. Cengage Learning.
Tyrer, P., Reed, G.M. and Crawford, M.J., 2015. Classification, assessment, prevalence, and effect of personality disorder. The Lancet, 385(9969), pp.717-726.
WHO | ICD-10 classification of mental and behavioural disorders. (2017). Who.int. Retrieved 30 November 2017, from https://www.who.int/substance_abuse/terminology/icd_10/en/
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