Want to know how to tell whether someone’s dealing with a mental issue? That’s what psychologists are all about. But it’s far harder than you might suspect.
In essence, the study of mental disorders or ‘psychopathology’, is the study of “abnormality”. But what makes something ‘abnormal’? The term is extremely vague and comes with no objective definition for psychologists. In fact, psychologists and psychiatrists have a very hard time figuring out just what typifies a mental disorder or ‘abnormal’ behaviour. If it’s hard to figure out for them what about the general public? Statistics say just over half of (or as much as two in three) people will meet clinical criteria for a mental health disorder. About 25% within the last year. And that’s likely an underestimate, as all surveys are. That means, more than likely, that’s you. So this kind of a big deal. To help you understand how psychologists determine what is ‘abnormal’, today I’m going to break down the four major ‘rules’ or models they use to figure it out.
You might be thinking, ‘well isn’t abnormality just something that people think is weird?’ If so, kudos ’cause you’re kind of right. Psychologists often use the ‘Cultural/Social model‘ to determine abnormality. Basically, if certain types of behaviour break the implicit rules of a society; that is, if the stuff you’re doing is seen as ‘strange’ or ‘inappropriate’ by most people then we can use this to diagnose someone. Unfortunately, there are some pretty obvious problems. Firstly, it’s super subjective, so how does one measure it? I know plenty of people who act weird but where do we draw the line? How much weirdness is abnormal? Secondly, social norms vary wildly across time and culture. What’s abnormal for me or you might not be abnormal the next country over, or fifty years ago, or more pressingly, fifty years from now. It might be a disorder today, but in twenty years it might not be the cultural norm! Finally, this particular model is highly pejorative; by definition it highlights one’s isolation from the community.
So maybe we look at something that can’t pejorative. The ‘Statistical model‘ simply looks at behaviours that are statistically rare. Lets say only 5% of people are doing something, we might say that’s sufficiently rare enough to classify as ‘abnormal’. And that doesn’t stigmatise either, it’s simply the way things are. It’s also really easy to measure because it’s so objective. But, we mentioned before that things aren’t always so rare – one in five people is not a small proportion at all. And where do we determine the cut off for these things? Who gets to decide that 5% of people is sufficiently rare? More to the point though is that rarity doesn’t always indicate mental illness. Having 50 close friends is pretty rare, but does that really indicate ‘abnormality’?
Ok, what about if they are a danger to themselves or others? We know that common illnesses like depression and anxiety can lead to suicide. Less common illnesses like schizophrenia can occasionally result in violence too. So perhaps we look at the ‘Danger model‘. If you pose a risk to yourself or others, then you can be considered ‘abnormal’ under this rule. And it can be really good, it has an inherent protective value. Instantly, treatment can be organised to reduce that risk of harm. However. it can swing the other way too. Since it’s kind of hard to define who is at risk (how many times have you said ‘I’m going to kill that person’?), it can be really easy to abuse. How many political prisoners all over the world do you think get incarcerated for reasons like this?
Alright, so maybe we can just ask the person what they think. Instead of looking at all these external facets of mental illness, Psychologists can just ask the client how they feel. This is called the ‘Distress model‘. Basically, if the behaviour is personally distressing or interfering significantly with the persons life, it can be seen as ‘abnormal’. This is really nice and easy to measure because it’s self defined. It’s well known that different people have different tolerance to stress and different coping mechanisms. Unfortunately, there is such a thing as a hypochondriac. We’ve got to be careful we don’t convince ourselves that a momentary distress is a mental disorder.
I feel like you probably know where I’m going with this. It’s impossible to just look at one facet of someone’s mental health or presentation and decide whether that person is ‘abnormal’. It’s got to be a considered approach evaluating each of these four areas to determine what’s going on. And in fact, many psychologists will simply decide that despite two or three models fitting something, it still isn’t ‘abnormal’. It’s just a bit odd. Fortunately, two diagnostic tools, the ICD-11 and the DSM-IV have been developed to help psychologists make their decision.
Use what you know now to treat mental illness with a bit of respect. Mental Health Professionals don’t mess around when it comes to diagnosing and treating disorders and the like. If someone you know has been diagnosed then understanding where that came from can help you understand a little bit of what they are going though. They might feel socially isolated, statistically strange, at risk of hurting themselves or even just having a really hard time.
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