Diagnosis of mental illness is linked to the identification of behaviour that is considered “abnormal.”  Although one might believe that depression and anxiety have always been around, definitions of mental illnesses change over time as the definition of abnormal behaviour changes. Some ways of determining whether a behaviour is abnormal are a deviation from social norms, deviation from optimal health standards, level of dysfunction or the use of a “symptoms approach” which identifies specific behaviours which may be linked to specific disorders.

Introduction and focus on the question: a brief mapping of the planned essay.

One reason why behaviours may be listed as abnormal is that they violate social norms. This is when a behaviour is considered unacceptable by a local community, yet an individual engages in that behaviour.  One problem of this approach is that attitudes towards behaviours change over time. Homosexuality was considered abnormal until 1974 when the DSM decided to remove it from the guide. When social norms determine mental illness, this can oppress minorities or minority opinions.  In the Soviet Union, people who disagreed with the communist system were considered “mentally ill.”

Knowledge and understanding shown of the use of social norms to determine abnormality.

And yet social norms can also be helpful.  Bolton carried out a study in Rwanda to learn how the local community could identify depression in their community after the genocide. They were able to identify which behaviours were considered “abnormal” by identifying the social norm for coping.  Those that did not fit that norm, were considered to be depressed.  

Jahoda proposed that abnormal behaviour be identified by using an “optimal health” checklist.  Jahoda proposed a list of behaviours that she believed reflected good mental health, and those that did not meet those standards would be labelled as “abnormal.”  These behaviours included a sense of independence, healthy interpersonal relationships and a good self-esteem. Although this may appear to be a good list, it could also be said to reflect the individualistic culture that Jahoda represents. Independence and “self-direction” are characteristics of individualistic cultures and may not reflect normal behaviour in collectivistic cultures. The list is also problematic because our behaviours are on a continuum of mental health.  It is difficult to measure whether someone has “healthy” relationships or “good self-esteem.” This means that determining normality is less than objective.

Use of theory to support answer: Jahoda's Optimal Health criteria.

Evaluation of the technique.

Another approach looks at an individual’s level of distress or dysfunction.  Distress is one’s level of negative stress; dysfunction is one’s inability to carry out day-to-day tasks and to maintain relationships. However, this is also problematic. Distress is subjective and is difficult to measure. Psychiatrists must rely on self-reports which means that they rely on the perception of the client. In addition, some distress is normal – for example, the grief we experience when we lose someone we love. Dysfunction is also problematic.  Some “abnormal” behaviours are highly productive and allow people to function in society quite well. Psychopaths can be CEOs and people living with bipolar disorder can be artists and comedians.  Dysfunction alone cannot define abnormal behaviour.  

Evaluation of terms "distress" and "dysfunction" with regard to abnormality.

A final method is to use a list of symptoms – for examples, the DSM – to identify a behaviour as “abnormal.” This can also be problematic.  Rosenhan carried out a study to see what would happen if confederates went to a hospital and told a doctor that they were hearing voices in their heads saying, “One, two, three, thud.” Rosenhan found that in almost all cases, the confederate was diagnosed as having schizophrenia and was admitted for care, even though they did not have the disorder.  However, they had identified a symptom – auditory hallucinations – which at the time was considered a symptom that indicated schizophrenia.

This study shows us the difficulty of using a symptom-based approach.  When a person goes to a hospital and asks for help, the doctor assumes that there is something truly wrong and that it is her job to diagnose.  This is called the “sick role bias.”  It is often not the case that “no diagnosis” would be given, but hearing the symptoms, the doctor will attempt to match it with prior knowledge and/or the DSM. It is true that the original study is quite old and used the DSM III.  Today there have been several improvements in the guide and it is unlikely that a doctor would diagnose an individual based on a single symptom.  Today there is also a better understanding of the role of family history and aversive childhood experiences in making a diagnosis.

Defining what is abnormal and using this to determine the level of one’s mental health is the focus of abnormal psychology.  Yet, it is clear that there is no unanimous consensus on how to define these terms. As social norms change as a result of globalization and diagnostic manuals are updated to reflect modern medical understandings, understanding of what is considered abnormal continues to evolve.

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Clarity and organization: the argument is well reasoned, discussing a range of strategies and relevant research.