Concepts and diagnosis in abnormal psychology
This page is designed to give the information to cover three overlapping learning outcomes from the specification:
Concepts and diagnosis
• Examine the concepts of normality and abnormality.
• Discuss validity and reliability of diagnosis.
• Discuss cultural and ethical considerations in diagnosis (for example, cultural variation, stigmatization).
Concepts and diagnosis
• Examine the concepts of normality and abnormality.
• Discuss validity and reliability of diagnosis.
• Discuss cultural and ethical considerations in diagnosis (for example, cultural variation, stigmatization).
Assignment 1 - what is 'abnormal'?Look at the picture of One Direction on the right. All of them are admitting to some unusual behaviour... but which would you diagnose as 'abnormal'?
For each band member, decide if the behaviour is abnormal or not. Write a brief justification (3-4 lines for each person) of your views. |
Remember... the command term asks you to 'examine' so you need to be aware of the assumptions and interrelationships of abnormality. What are the assumptions of our everyday ideas about normality and abnormality?
Definitions of abnormality
There are 4 different methods of defining abnormality which you need to know. Different definitions may be more effective for different situations. Listen to this podcast, then read the descriptions below...
Deviation from statistical normsThis definition asks one simple question:
How unusual is the behaviour being displayed? If it is statistically unusual, then it is classed as abnormal. For this reason, the explanation is sometimes known as 'statistical infrequency'. Using a normal distribution (see above), we can identify people who are a long way from the mean. However, an obvious problem here is that this doesn't take into account whether the behaviour is desirable or not (e.g. is a high IQ 'abnormal'?) For example, twins with very high IQs in Bouchard et al's (1990) Minnesota Twin Study would be classed as abnormal, in the same way as those with very low IQs. Is this a sensible strategy? H.M. would be another good example of a statistically very unusual case. |
Violating social normsSocieties and cultures all have a number of unwritten rules of behaviour which most people follow. These are called social norms.
For example: If someone does not say thank you if you do them a favour, you might feel that this violates a social norm of being polite. In extreme cases, violating social norms could allow a diagnosis of abnormality. However, social norms may change over time and between cultures and areas (or even families). Who is to say which set of norms we use as our baseline? You could perhaps argue that the case of Genie illustrates this, as through extreme deprivation she never learned the appropriate social norms. (Though of course, given the severity of her condition, she undoubtedly fulfils the other definitions as well). |
Deviation from ideal mental healthRather than look at what is 'abnormal', we could start by deciding what is 'normal' and then find people who do not display 'normal' characteristics. Defining normality is, of course, just as hard as defining abnormality, but psychologists will often include:
However, do normal people exhibit all of these all the time? I certainly don't! Also, these definitions of normality are very ethnocentric. Caspi et al (2003) could be used as an example of where a genetic marker was found which illustrated a tendency to deviate from ideal mental health more easily than some other people.
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Failure to function adequatelyMost people who ask for psychological help are suffering from distress. Rosenhan and Seligman (1989) suggested that this could be used to help define abnormality. People failing to function may display:
Bremner et al's (2003) study into PTSD clearly illustrates these failure to function characteristics in the symptoms displayed by the victims of abuse studied. |
Linking these different definitions of abnormality to what we've studied in Paper 1...
In the descriptions above are links to some studies which we've already covered, which help to illustrate either advantages or disadvantages with the different definitions of abnormality. Can you think of any more?
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Assignment 3 - Definitions factsheet
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Further evidence on 'normality' and 'abnormality'The three essays here all overlap hugely (see right). It is not something that can be learned in separate boxes.
For example:
This means that you should not attempt to practise any of the essays covered on this page until you have read and understood ALL of it, in detail. Evidence from all of the sections can be used for each question, providing you shape what you're writing to the specific question being asked. |
Assignment 4 - 22 mark questionExamine concepts of normality and abnormality (22)
Remember that the sections should overlap, so you should only write this essay after having read all of the page. You can use information from the whole page to help you explore your answer. See to the right for help in addressing the 'examine' command term. |
What ARE the 'assumptions' of ideas of normality and abnormality?It is not immediately obvious what the 'assumptions' here might be. However, I think that the idea that 'there are clear differences between the normal and the abnormal... and these differences can be reliably identified' might be a commonly held assumption. 'Abnormal psychology conditions are universal' might perhaps be another. The interrelationships analysed can be the relationship of the three factors above.
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Discuss the validity and reliability of diagnosis
General introduction to problems with defining abnormality
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General introduction to problems with diagnosing mental illness
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How do we diagnose mental illness? Introducing the DSM
The APA (American Psychiatric Association) describes the DSM as:
the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders. It also provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions. This Education Portal video also gives you a good introduction to the DSM. As you learn about it, try to relate this to ideas of reliability and validity. Why would it be a good idea to have a "common language" for people to use when diagnosing mental illness? What benefits should this bring? Can you foresee any drawbacks? Evaluating the DSM
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DSM-V - Volume number 5Since it was first released in 1952, the DSM have been periodically updated to reflect changing scientific and social understanding of mental illness. Sometimes these changes can seem shocking in hindsight (homosexuality was included as a mental illness of 'sexual deviance' in the first two volumes, before being removed in the 1970s)
There are numerous small updates to each edition, but there have been 5 major reorganisations of the manual, the most recent of which came out in 2013.
The DSM is a controversial document, however. Its categorisation of mental illness is often seen as being more reflective of political or social prejudices than of any true biological categories of illness. There have also been accusations of DSM members being influenced by drug companies (in whose interest it is to have as many conditions as possible listed, so that they can see more drugs for the all! 'Binge eating' and 'hoarding disorder' are two new diagnoses, for example). All this has lead to some people losing faith with the DSM altogether. The National Institute of Mental Health in America (a very influential research body) announced in 2013 that it would not use the DSM-V guidelines in its research. This was interpreted by some as a 'death blow' to the DSM, though others disagree. |
On being sane in insane places - Rosenhan, D.L. (1973)
Rosenhan's famous study is the classic demonstration of how psychiatric diagnoses can be biased and unreliable (though precisely how successfully Rosenhan demonstrated this is still up for debate, as we shall see).
There is a full page on the Rosenhan study on the AS Level section of the site, with a large amount of relevant information on there. The key info, however, is below: The original study can be read here.
The Holah site has a nice summary and evaluation of the study here. You should also listen to this Claudia Hammond 'Mind Changers' podcast for the BBC. Then... Test your knowledge: |
Now relate this back to the question!! How can we use Rosenhan's study to help us answer the questions in this section?
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Assignment 5 - reviewing evidence and theories on the reliability and validity of diagnosis
Read the above document which contains more information about the problems introduced above. THIS IS GREAT EVIDENCE AND ANALYSIS FOR USE IN AN ESSAY.
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Assignment 6 - 22 mark essay questionDiscuss validity and reliability of diagnosis (22)
Use the information above, and in the document to the left, to help you. Remember that the sections should overlap, so you can use issues with the definition of abnormality here too. For example, the fact that we have no clear definition of normality and abnormality makes it very hard to decide what is a valid diagnosis! |
Discuss cultural and ethical considerations in diagnosis
Again, there is huge overlap here with what we have look at already, and we have already looked at some evidence which could be used in an essay on this topic.
Assignment 7This link has some very interesting and useful information on cultural and ethical considerations. Make a summary of the key points for your notes. This page on emic and etic concepts (something you should already be familiar with from SLoA) may also be useful.
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What does the question want?The use of the word 'and' in the title is important here. It suggests that, as well as a 22 mark question, you could also be asked about just one of either cultural OR ethical considerations, for example in an 8 mark SAQ.
E.g. Explain factors related to ethical considerations in the diagnosis of abnormality (8) |
Cultural relativism and mental illness
We've already seen the idea of labelling above, but this can be analysed in some more detail here.
At it's heart, Labelling Theory suggests that all mental illnesses are culturally realtive, in other words they are specific to the culture that they occur in and merely reflect the characterisitcs of that culture, rather than reflecting any 'truth' about the condition of the sufferer. Key points below:
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RD Laing, a humanistic psychiatrist, developed Szasz’s idea still further by arguing that schizophrenia could be reinterpreted as a rational response to the patient’s surroundings and circumstances! In other words it is society that is mad, not the patient. 'Schizophrenic behaviour' is as rational response as any to a society that it itself insane.
Culture-bound mental illnesses
There are many instances where mental illnesses seem to appear only in certain cultures. These are termed 'culture-bound' illnesses. They may have characteristics which are similar to some more commonly diagnosed conditions, but they also have unique features which are specific to their cultural context. In order to link usefully to the upcoming sections on anxiety and depression, one culture-bound anxiety disorder and one depressive disorder are described below.
KoroKoro is a disorder mainly associated with Chinese and South-East Asian regions, involving the intense fear that one's genitals will retract inside the body causing death!
The DSM-V lists Koro in its 'Glossary of Culture-Bound Syndromes of Appendix I', and it has been suggested that the disorder can be categorised as a "specific, culture-imposed nosophobia" (nosophobia is the fear of contracting a disease). Ng (1969) reported on an outbreak of Koro in Singapore in 1967, and numerous other 'outbreaks' have also been reported. Similar symptoms have been reported for individuals in other countries (e.g. UK and US, Berrios et al, 1984), but these are almost always individuals with unusual sexual histories, not the mass hysteria outbreaks seen in SE Asia. Assignment 7 - Analysing culture-bound syndromesWhat does the existence of culture-bound syndromes tell us about abnormality, and our explanations and diagnosis of it?
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Brain FagBrain fag was first reported from Nigeria, specifically in school and university students.
There are a number of symptoms, which cover areas similar to other affective disorders such as major depression... Ola et al (2009) found that reported symptoms of brain fag could be linked to classical diagnoses of either anxiety or depression
Brain fag may therefore be comparable to the diagnosis of 'neurasthenia' (weak nerves) in China, rather than depression. |
Triangulation and making links... emic and etic approach
You've got lots of useful research to illustrate the emic and etic approaches to psychological research, and to be able to discuss the strengths and weaknesses of these... WHY NOT USE THEM HERE?
E.g. The DSM takes an etic approach to diagnosis of mental illness. This is perhaps a necessary step as it allows us to make comparisons between different cultures and ensures a reliability in the criteria being used for diagnosis... HOWEVER this of course brings with it accusations of ethnocentric bias and validity issues due to the inconsistent application of the diagnostic criteria.
You could expand discussions like this in more detail, using what you have studied on emic and etic approaches.
E.g. The DSM takes an etic approach to diagnosis of mental illness. This is perhaps a necessary step as it allows us to make comparisons between different cultures and ensures a reliability in the criteria being used for diagnosis... HOWEVER this of course brings with it accusations of ethnocentric bias and validity issues due to the inconsistent application of the diagnostic criteria.
You could expand discussions like this in more detail, using what you have studied on emic and etic approaches.
RevisionThe InThinking site has a free page on concepts of normality, as well as an essay mind map. Use these and the notes on this page to plan an essay answer which you then wrote under timed conditions.
Try to think how you would change this answer if the command term was changed. |
Extension |