Wednesday, 26 March 2014

What Is Abnormal Behavior?

Is This Normal?
If I turned up at your place like this, would you
 think that was normal?
Source: author photo
How Do We Define Abnormality?
The study of 'abnormal behaviors' is officially termed either 'abnormal psychology' or, more commonly these days, 'clinical psychology'.
This discipline is the study of the origins, presentations and potential treatments of a range of behaviors that are considered abnormal. Clearly, when we talk about abnormal behavior in the clinical sense, we are going beyond mere eccentricity or a particularly extreme personality trait that does no harm. We are looking at disordered thoughts, habits or impulses and drives that cause harm or potential harm or suffering to the individual expressing the behavior and/or those around them.
It is commonly accepted that a range of symptomatic behaviors can have their origins in a diverse range of causes which include cognitive, genetic, neurological and environmental factors - or any combination of these.
In practical terms, clinical psychologists - who deal on a daily basis with the challenges presented by patients with abnormal behaviors - are concerned with the assessment, diagnosis of, and care planning for, these psycho-social problems.
The treatments may be for disorders such as acute anxiety, mood disorders, addictive or compulsive disorders or more complex psycho-neurological presentations such as schizophrenia and psychosis.
So, how do clinical psychologists actually define what is normal and what is abnormal behavior? It is no easy task and by its very nature, there can always be gray areas around the edges of any diagnosis. It is for this reason that an overriding influence and reference point in any diagnostic procedure must always be the well being of the patient.
 The Odd One Out
Very often, whether a person is abnormal or not is simply to do with whether
 they 'fit in' with the cultural norms.
Source: Mark Garrett CC-BY-SA 2.0 via Wikimedia Commons.
What Is Abnormal Behavior? The Adaptation Model
The most common and effective model for the assessment and diagnosis of abnormal behavior that is used today is the adaptation model - which sees behaviors as being more or less adapted or maladaptive to the promotion of the patient's well-being.
This functional model is useful as to take a literal view would mean to include very tall people or extremely smart people into the diagnostic spectrum, as 'abnormal' simply means any departure from the norm, from the average.
In real terms and for the study and practice of clinical psychology the question is not so much is the behavior normal or not as whether it is adaptive or maladaptive to the patient's well-being or the well-being of those around her/him. If the behavior in questions causes distress, social problems or potential harm to the sufferer and those around them then it will most likely be considered as abnormal.
What most people on the street would intuitively recognize as 'madness', the clinical psychologist - using a range of analytical tools that can be used to define various forms of psychopathology - can identify as illness.
Am I normal?
Am I normal? How will you decide?
Source: author photo
The Gray Matter - A Gray Area
On the one hand clinical psychologists can to some extent deal with neuropsychology and in many cases an endogenous cause can be identified - and sometimes rectified - which may have a base in a chemical or structural brain or hormonal disorder. However, for the most most, the practical clinical psychologist is actually having to deal not so much with the 'gray matter' as the very much more 'gray area' of cultural, social and interpersonal relationships.
Everybody would like to achieve a hard and fast definition of what is and what is not normal. However, the reality is that many of these concepts are formed and defined by cultural, historical and social principles. They can change from place to place and time to time.
The impact of this fact can clearly be seen in the nature of certain gender-related behavioral disorders. For example, women are much more likely overall to suffer from conditions such as bulimia or anorexia than men. Although these are not disorders that are rooted in female biology as men can and do also suffer from them. Men, on the other hand, are more likely to develop substance addictions such as alcoholism or illegal drug use.
Curiously, according to the latest figures, people who are economically disadvantaged are more likely to be given the diagnosis of schizophrenia than wealthy people. A friend of mine who is a practising clinician once said to me when we were discussing these things, "Just give all the schizophrenics $50,000 per annum and you will transform them overnight from very troubled individuals to happy eccentrics." I don't suppose that he meant that literally, but the point he was making was very clear to me.
Is this normal?
The Pope. Dressing up in medieval clothes and believing you are god's 
representative on earth could qualify you as deluded and abnormal
 - unless hundreds of thousands of others believe it, too!
Source: Rob & Lisa Meehan from Eckfeld, Germany CC-BY-SA 2.0
via Wikimedia Commons
The Cultural Context of Abnormal Behavior
In earlier times, before the advent of the modern scientific method and all the many benefits that it has brought to our understanding and well-being, many experiences and behaviors that we would now consider to be treatable disorders, were managed within society by being included in the mythology and rituals of the primitive people.
A Muslim Imam. Dressing up in medieval clothes and believing yourself 
able to proclaim the thoughts of god could be
 considered deluded, abnormal behavior - 
unless hundreds of thousands of others believe it, too!
Source: Abou Anmar CC-BY-SA 2.0 via Wikimedia Commons
Various forms of schizophrenia and psychosis were often interpreted as magical, visionary experiences or being possessed by demons and spirits. Unfortunately these primitive beliefs and associated practices are still all too common in churches, mosques and temples all over the world. Many people in need of real care continue to suffer horribly because of the perpetuation of these erroneous beliefs.
Throughout most of history, the various behaviors that give rise to the perception of madness have been regarded as either inspired by the devil or as simple forms of ill-intent. In other words, madness was regarded as badness. The treatment for these poor folk has been everything from terrifying 'excorcisms' to physical restraint, beatings and abuse.
A Hindu Guru. Undressing, painting your face and claiming to be living on
 another plane of existence could be considered deluded, abnormal behavior,
 unless hundreds of thousands of others believe it, too!
Source: Licensed under the GFDL by the author;
 Released under the GNU Free Documentation License.
The humane treatment of people with mental health problems only really began in the late 19th Century with the advent of modern medicine and a rational interpretation of behavior, made possible by the naturalistic world-view popularized and given authority in the publication of Charles Darwin's 'On the Origin of Species by Means of Natural Selection'.
So How DO We Define Abnormal Behavior?
These days in clinical circles, while there remains a degree of ambiguity (which is probably helpful in the context) diagnosis of abnormal behavior generally takes into account four fundamental criteria. These are: distress, deviance, dysfunction and danger. Otherwise known as 'the four Ds'.
The reason why we can make a clinical distinction between certain harmless forms of abnormal behavior and those which we would more usefully consider to be psychopathological is that, those which are defined as the latter generally cause pain, discomfort, suffering or danger. You can be as odd as you like if you are happy and cause no harm to anyone else. You will only find yourself in the consulting room if your behavior brings you suffering or puts others in danger.
So, we see by this definition, that the principles of adaptation are often at work in determining if an individual will experience suffering and be considered 'abnormal' or not. For example, if a man or woman chooses to dress up in medeival style clothes and talk to imaginary sky people, believing against all the evidence that the world is only 6000 years old, that gay people should be killed and that the entire universe was created just for him to be in, we would think that he was at best psychotic. But, if he's not on his own but joined in a common delusion by many thousands of others, then he is considered to be a 'normal' follower of one of the world's best known religions. That is to say, the cultural context in which he lives makes his otherwise bizarre behavior adaptive and normal. In another context, there would be no question about his insanity.
Likewise, take a rationalist evolutionary biologist and put him in discussion with a church full of pentecostalists and it is likely he that will be considered to be in league with a malign supernatural entity known as the Devil. At best he will be considered to have been thoroughly duped by science and deluded into atheism.
So, whether we are 'normal' or not, if it is to be interpreted literally, does seem to depend on how well we are adapted culturally to our environment.
It is for this reason that we tend to use the 'four Ds' so that we are dealing with definitions based on patient well-being, rather than on any judgement of the relative 'truth' of the beliefs underlying a given behavior. In this way, a clinical psychologist can offer help to anyone who is unhappy, be they a Christian, a Muslim, a Hindu or an atheist.
Is this abnormal?
Professor Richard Dawkins. Dressing in conventional clothing 
and giving a lecture on evolutionary biology at Oxford University
 may seem like perfectly reasonable, normal behavior - 
unless your audience is religious...
Source: Steve Jurvetson  CC-BY-2.0 via Wikimedia Commons

Experts and Everyman: who should decide what abnormal behavior is?
The difficulties that we face when attempting a definition of the problem of 'normal' versus 'abnormal' behavior should now be abundantly clear. But who should actually be determining these things?
For example, there is no doubt that a healthy person in an otherwise disturbed society, would be perceived as abnormal. There have been historically and still are all over America and indeed the world, profoundly intolerant societies or sub-cultures who are all too quick to condemn those individuals who do not easily conform to their narrow views and regulations. These divisions - primarly seen in religious, political and cultural or national groupings, are the source and foundation of a huge amount of suffering in the world.
So leaving the definition to 'everyman' doesn't seem to offer us the best solution if we want to uphold our primary principle of promoting the well-being of the individual within the group.
But let's face it, even the experts cannot always agree on a diagnosis. To be fair, this problem is addressed in part in the clinical dimension by the fact that a diagnosis of psychopathology must always be made by a multi-disciplinary team of practitioners, rather than a single, all-powerful clinician.
The other option is self-diagnosis. To some extent that does work. Many people begin the pathway towards the effective treatment they need because they present themselves on account of their suffering and unhappiness. However, it would be a mistake to imagine that we are all sufficiently cognizant and self-aware to be able to effectively rely on self-diagnosis.
Take two examples.
There is the psychotic individual who is convinced, say, that he is a messenger from god. Let's say that he is out of a socially acceptable religious context. This person might cause - as many cult leaders do - great suffering and even death to others (think of the famous 'suicide cults' of the 90s or the continuing accusations of abuse that are levelled against the 'guru' Sai Baba) yet at the same time there is little chance that he will see himself as being in any way 'abnormal'.
On the other hand, there is a study that showed that students of psychology often begin to self-diagnose, as their knowledge-base increases, as having various forms of the mental illnesses about which they are studying. This is because we all have a rather grander notion of our own uniqueness than the facts can actually support. So we tend to see ourselves as being party to a multitude of secret thoughts and behaviors that, once brought out into the open, are in fact, perfectly common. But because the students, in their ignorance, believed these things to be their own special experiences, when they found them described in detail in text books that listed thousands of possible signs of psychological illness, they were over-ready to diagnose.
Are YOU normal? How should I know?
Are You normal? How do you know? How can you be so sure?
Source: author photo
Conclusions
I think that if we want to answer the question about what is abnormal behavior, then we must first determine whether or not we are talking about eccentricity (abnormal behavior that does not bring suffering) or psychopathology (abnormal behavior that causes suffering).
These decisions should be made collectively, as they are in modern western medicine, by multi-disciplinary teams of professionally trained clinicians and social workers. The decisions of these teams should be based on the principle of identifying and alleviating suffering in the patient, not on cultural or interpersonal judgements about the 'truth' of a person's underlying beliefs.
An acceptance of the the ambiguity of diagnostic processess is essential in going forward and a contunuing effort to improve the science behind the procedures and the treatments avaiable to suffering individuals - coupled with an ever more tolerant, accepting and open society - will lead to the general diminishment of the problems associated with 'abnormal behavior'.
This IS normal...
...if you are a children's entertainer at work. In other contexts it might not go down so well...
Source: Attribution: Rick Dikeman at the English language Wikipedia.