PSYC A333F

Current Issues in Psychology

Lecture 8
Normality and abnormality
 The field of abnormal psychology assumes that a
distinction can be made between normality and
abnormality
 If you are asked to give examples of behaviour in
abnormal psychology, you would probably include
schizophrenia, anxiety, panic attacks, depression etc.
 But what do they all have in common that makes us
Introduction call them abnormalities?
 Does there have to be anything that links them?
 Can they all illustrate abnormality for different reasons?
 Do psychologists consider the meaning of normality
and abnormality, or do they just assume (for
example) schizophrenia is abnormal?
 Is it possible to define and diagnose abnormality in
an objective way, without allowing our values to bias
our judgments? 2
Criteria for defining psychological abnormality

3
 According to this criterion, the “average”
determines what is “normal”
 Behaviour is abnormal to the extent that it falls
outside the middle ranges
 What the majority of people do
The statistical  E.g. for “mental retardation, people with IQ score
infrequency <70 represent the lowest 2% of the population, and
are considered to be retarded (abnormally low)
criterion (or
deviation from
the average)

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But what about those whose scores are extremely
high?
According to the statistical criterion, they should be
thought of as abnormal too because their scores (the 2%
scoring >130) are as extreme as those scoring <75
They are usually described as “gifted”, a much more
positive label than “mentally retarded”
 Although the 2 groups are statistically equally abnormal
Also, how far from the population mean should a
person be in order to be considered abnormal?
Miller and Morley (1986) pointed out that any chosen cut-
off point is just arbitrary
 E.g. what is the significance of 70 or 75 as the boundary
between mental normality and retardation? 5
Another problem with this criterion is that most kinds
of abnormality that psychologists are interested in
cannot be measured in the way that intelligence can
The statistical criterion assumes that psychological
characteristics can be viewed as dimensional in general,
such that everyone’s score can be placed somewhere on
the same scale
 But can we use a score to represent hallucinations or sexual
fetishes?
 This in itself is a complex and controversial issue in relation to
the normality/abnormality debate

6
  From the perspective of the person, abnormality is the
subjective experience of intense distress or suffering
 While sometimes this may be the only indication that
something is wrong (and may not be obvious to others), it
may be a sufficient reason for the person to seek
professional help (“neurotic” disorder)
Abnormality as  “… people do not come to clinics because they feel that
they have met some abstract definition of abnormality. For
personal the most part they come because their feelings or
distress behaviour cause them distress.” (Miller & Morley, 1986)
 However, sometimes the converse may be true:
 Someone’s behaviour is obviously “mad” to others, while
he/she may be unaware of how others see him/her and may
experience no subjective distress
 This “lack of insight” is often taken to be a characteristic of
“psychotic” mental disorder
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  We have seen that a person seen by others as behaving
abnormally may be the last to recognise his/her own
problem
 So one can use other peoples’ distress to define abnormality
 This criterion also suggests that abnormality is
interpersonal, not simply intrapersonal
 Behaviour takes place between people in social situations
Abnormality as  From a ethical point of view, others’ distress may be
others’ distress both a “blessing” and a “curse”, e.g.:
1. Blessing for someone lacking insight into his/own self-
destructive behaviour
2. Curse for parents’ distress regarding a son’s homosexuality,
with which the child may feel perfectly comfortable
 While the former may be an empathic concern (the helper
wants to reduce the person’s distress), the latter is an egoistic
desire to reduce one’s own distress
 → So, whose distress is really the focus of an intervention? 8
Laing and anti-psychiatry
 An outspoken critic of conventional psychiatry during 1960s was
the Scottish psychiatrist R.D. Laing
 According to his “family interaction model” (1961), schizophrenia
can only be understood as something that occurs between people
but not something taking place inside a person
 To understand individuals, we must study not individuals but the
interactions between them
 The model was supported by Bateson et al. (1956) which showed that
schizophrenia arises within families that use “pathological” forms of
communication, particularly contradictory messages
 Liang’s (1967) conspiratorial model suggests that schizophrenia is
a label, a form of violence perpetrated by people against others
 People treat the schizophrenics as patients who are sick, “imprisoning”
them in a psychiatric hospital, which degraded and invalidated them as
human beings
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 According to Davison and Neale (2001), it
is abnormal to react to a situation in ways
that could not be predicted or reasonably
expected
E.g. anxiety disorders are diagnosed when
anxiety is “out of proportion to the situation”
Abnormality as
unexpected While it seem like a reasonable criterion,
behaviour but who is to say what is “in proportion”?
Is it just another form of the statistical
criterion, whereby “normality” is simply how
most people would be expected to respond?
And by this criterion, underreacting is just as
abnormal as overreacting
10
 → So, why only the latter is a problem?
The positive – and temporary – side of madness
Some experiences associated with “serious” forms of
madness (e.g. hearing voices, seeing visions) have been
used by people as the basis for creative artworks,
literature and even sciences
Perhaps the most famous example is the painting of Van
Gogh:
 “… If they can use this [madness] constructively as part of the
development of their life story, it may be distressing, but is still
of value. If people cannot make sense of, or otherwise learn
from, the experience, then it is deemed to be worthless…”
(Barker, 2003)
 Only when the experience is worthless and causes the person
discomfort and emotional pain, attempts will be made to
eliminate this “madness” 11
Another way of looking at the positive potential of
“madness” is to consider its duration and situation
Sometimes, our response may be extreme, but not
necessarily being “out of portion”
 If the situation is extreme (e.g. a soldier witnessing colleagues’
horrific injuries in a war), then an extreme reaction (e.g. PTSD)
is a reasonable reaction to such a situation
Some extreme reactions like PTSD tend to be long-
lasting, but some can be temporary
 These can best be described as a response to a crisis
 “Oscillates between the psychically normal and the psychiatric”
(Cullberg, 2006)
 Such temporary reactions are often acceptably reasonable given the
external circumstances
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 If we have generalised expectation about how
people are typically going to react to a
particular situation (normal behaviour), then a
person’s behaviour is predictable
Abnormality as  However, sometimes individual differences play a
highly much larger role in influencing behaviour, making
consistent/ it less predictable
inconsistent  Then, it is “normal” that any person’s behaviour is
partially predictable and partially unpredictable
behaviour
If we accept this argument, we can argue that it
is abnormal for a person to display either
extremely predictable or extremely
unpredictable behaviour
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 For someone acting so consistently that they seem to be unaffected
by the situation → very odd to other people
 Like a machine more than a person
 Equally, it is difficult to interact with someone who is very
unpredictable
 Since interpersonal interactions require us to make assumptions and have
expectation about their responses
 E.g. schizophrenics are often perceived as embodying this unpredictability
 In both case, the perceiver of the actor’s behaviour is making
judgment on the behaviour
 → Then, perhaps the term “consistency” should be applied equally to the
predictability of the actor’s behaviour and the predictability of the perceiver’s
judgment
 To understand behaviour, we must always take the actor and the situation
(including other people) into account
 (This may be related to the process of psychiatric diagnosis) 14
 When a behaviour prevents people from
achieving their goals, or does not contribute to
their well-being, or prevents them from
functioning as they wish (in their personal,
sexual, social, intellectual, and occupational
Abnormality as lives), it may be seen as abnormal, e.g.:
maladaptiveness  Substance-use disorders are define by how the
or disability abuse produces social and occupational disability
 Such as poor work performance and serious marital
arguments
 Phobias can be maladaptive or disabling
 Such as fear of flying might prevent someone from
taking a job (Davison & Neale, 2001)
15
According to this criterion, it is the consequence of
behaviour that lead us to judge the behaviour as
abnormal, rather than the behaviour itself
The behaviour may be very distressing for the person
 E.g. phobias are negative experiences that involve extreme
fear, regardless of any practical effects of the fear
→ The crucial issue is how people respond to the
experience of mental distress
 (Such as Van Gogh’s “madness” that he used constructively in
producing creative paintings)

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  So far, we have 6 criteria for defining abnormality:
1. Abnormality as statistical infrequency
 Involves comparison with other people
2. Abnormality as personal distress
 Involves consequences of the behaviour for self
3. Abnormality as others’ distress
 Involves the consequences of the behaviour for others
4. Abnormality as unexpected behaviour
An interim  Involves another kind of comparison with others’ behaviour
summing up 5. Abnormality as highly consistent/inconsistent behaviour
 Involving making comparisons between both the actor and others,
and between the actor and him/herself in different situations
6. Abnormality as maladaptiveness or disability
 Concerns the (disabling) consequences for the actor

 Among these, what is special about the 2nd criterion

(personal distress)?
 While the other criteria could be seen as having an external
17
focus, the personal distress criteria has an internal focus
While a simple definition of abnormality seems
impossible, the distinction between external and
internal focus is important
Discussions of abnormality often assume that certain
behaviours and experiences are abnormal in themselves,
without any reference to any external criterion
 Examples include schizophrenia, anxiety, panic attacks, and
depression as mentioned, but some — such as homosexuality
— may be more controversial when seen from this perspective

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The case of homosexuality: normal of abnormal?

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We may apply the criteria we discussed to the case of
homosexuality, to expose some of their limitations:
1. Abnormality as statistical infrequency
 It is likely that most people believe that lesbians and gay men
represent a very small minority of the population
 But even it turned out that majority of adults were homosexual,
most people would continue to believe it to be abnormal
 So, there is more to judging homosexuality to be abnormal
than “deviation from the average”
2. Abnormality as personal distress
 While some homosexuals experience conflict and distress
about their sexuality, there are many who feel being
homosexual as “right”
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 This, together with the fact that many homosexuals
experience distress because of society’s irrational fear,
intolerance or discrimination, suggests that “being
homosexual” is not distressing in itself
 (Unlike phobia, it is not an inherent feature of preferring people
of the same sex to experience distress)
 Indeed, likely that “being homosexual” to them is as pleasurable
as a heterosexual's attraction to someone of the opposite sex
3. Abnormality as other people’s distress
Assuming that homosexuals themselves do not typically
experience distress, why should other people do so “on
their behalf”?
 It is clearly false that homosexuals “don’t realise what they are
doing” (as in the case of drug addicts or self-destructive
behaviour), such that they need to be “saved” 21
4. Abnormality as unexpected behaviour
It does not make much sense to see homosexuality as an
overreaction to some event
→ What could such event be?
 For example, if it were discovered that homosexuals typically
have experienced some kind of trauma in early childhood, we
would not then call the outcome of homosexuality an
overreaction
 It would be seen as a “normal” reaction to that kind of trauma
 The idea of homosexuals as a group all reacting in the same way at
least suggests that homosexuality as a reaction to certain childhood
trauma is not a deviation

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While research may not have found evidence for traumatic
events as causing the development of homosexuality, Bieber
et al. (1962) claim to have found difference between male
homosexuals and heterosexuals
 The former are brought up by a “close-binding imitate mother”
and a father who display “detachment-hostility”
 This difference is referred to as a pathogenic (disease-producing) factor
 But we judge this to be pathological only if we have already judged
its outcome to be pathological
 In other words, only if we regard homosexuality to be abnormal will we
regard any difference between homosexuals and heterosexuals as
abnormal (Davison & Neale, 1994)
 → This is a circular argument which begs the question of normality and
abnormality
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5. Abnormality as highly consistent/inconsistent behaviour
 There is no reason to believe that homosexuals, compared to
heterosexuals, are any more or less consistent or predictable in
their overall behaviour
 So, this criterion does not help in explaining the reasons behind the belief
that homosexuality is abnormality
6. Abnormality as maladaptiveness or disability
 Unlike phobia, the negative consequences suffered by
homosexuals are not due to being homosexual, but stem from
society’s response to the homosexual
 It is the social attitudes towards homosexual that constitute the
maladaptiveness/disability of homosexuality, not the “handicapping”
nature of being gay
So, we are left still needing to know by what criteria
homosexuality is judged to be abnormal
 This bring us on to the “deviation from the norm” criterion 24
 “Norms” implies “oughtness”
 They convey expectations about behaviour, such as
what is right, proper, natural, desirable etc.
 These all convey value judgments, and are not
neutral, objective assessments of behaviour
Abnormality as Sometimes, it is very obvious what a norm is
deviation from and how a behaviour deviates from it
the norm  E.g. murder is a crime, and the law that makes it a
crime embodies the moral law — you should not
murder
 However, there is no law against being
schizophrenic or depressed, and it is not obvious
what moral law is being broken in these cases
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Up until 1960s in UK, homosexuality was illegal
 Embodied the early Christian condemnation of sex outside
marriage and for any purpose except reproduction, even as an
expression of love between husband and wife (Doyle, 1983)
In western culture, a sharp distinction is made between legal,
religious, and medical definitions of normality
 Disease, illness, and pathology (bodily and psychological) are dealt
with by the medical profession
 Mental disorder has become medicalised
 Religion and illness are in separate “cultural compartments”
However, many situations of human distress that are
conceptualised as “illness” in the west are seen in religious or
philosophical terms in Indian culture
 E.g. harmony between the person and his/her group is stressed as
indicating health 26
 In African culture, the concept of health is more social than biological:
 “In the mind of the African, there is a more unitary concept of psychosomatic
interrelationship, that is, an apparent reciprocity between mind and matter.
Health is not an isolated phenomenon but part of the entire magico-religious
fabric; it is more than the absence of disease. Since disease is viewed as one
of the most important social sanctions, peaceful living with neighbours,
abstention from adultery, keeping the laws of gods and men, are essentials in
order to protect oneself and one’s family from disease.” (Lambo, 1964)
 → The spiritual and physical worlds are not separate entities; mind and body
do not exist separately
 No distinction is made between “bodily illness” and “mental illness”

 So, thinking about and treating psychological abnormality from a

medical perspective is itself a cultural phenomenon
 This leads to another major criterion for defining abnormality — “abnormality
as mental illness or mental disorder”
27
 A 9th criterion emerges from the study of
personality
 Psychologists tend to see personality as composed
of a collection of traits, relatively stable tendencies
inherent within the person, which define his/her
Abnormality as “typical” ways of behaving, thinking and feeling
an  These dimensions of traits apply to everyone, allowing
exaggeration people to be compared with each other, but people can
also be regarded as unique, in displaying different
of normality profiles across these various dimensions
 (Nomothetic-idiographic approaches)
 The trait/dimensional approach assumes continuity
in the feature of personality
 People are more or less extrovert or sociable, being
ranged at various points along a continuum
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Claridge and Davis (2003) believe this approach is tailor-
made for helping us understand psychological disorders:
 “The clinically abnormal can easily be visualized as, in some
regard, an extension of the normal, defining the extremes of the
dimensions that describe personality.”
 In other words, there is only a quantitative difference between
“normal” people and those diagnosed with mental disorders
 “We’re all a little bit mad” or “some of us are madder than others”
 Eysenck was very critical of the psychiatric construction of
psychological abnormality as discrete disease entities
 He argued strongly for the essentially biological roots of mental disorder
 Eysenck (1960) argued that the biology of mental illness was an extension
of the biology of personality dimensions that predispose to illness
29
Are we all a little bit schizophrenic?
Ochert (1998) describes research by Steel into
schizophrenia-like personality traits (“schizotypy”)
 He regards the symptoms of schizophrenia as a “severe
manifestation of personality traits that exist within the normal
population”
Everyone has some degree of schizotypy, as assessed by
the Oxford-Liverpool Inventory of Feelings and
Experiences (O-LIFE)
 High “schizotypes” are normal people who answer questions in
much the same way as schizophrenics (and are more vulnerable
to schizophrenia), e.g.:
 They have difficulty weeding out irrelevant information like
schizophrenics
 They have tendency to be less affected by expectation built up from
past events 30
However, the picture is not quite as simple as Steel
puts it
Claridge and Davis (2003) point out that people with
mental disorders are not merely individuals occupying one
end of some normal personality dimensions
 E.g. someone with agoraphobia would certainly score high on a
rating scale, but by the time such person has been formally
diagnosed as agoraphobic, he/she will have developed new,
pathological behaviours
 (Such as refusal to leave home or expressing irrational fears they
previously did not have)
 So, “they are now more than just people of very anxious personality;
so new facts are needed to explain the transition from extreme trait
anxiety to symptomatic anxiety”
31
The preferred approach amongst psychiatrists is the categorical
approach, which forms the basis of attempts to classify mental
disorders, such as DSM and ICD
 But authors of DSM admit that it falls short of the standards of the
strictly categorical model used in physical medicine
 They defend it largely on practical grounds (e.g. easy communication between
clinicians), but the scientific value is much more doubtful
Claridge and Davis also draw a distinction between psychological
and neurological diseases (e.g. Alzheimer’s and Huntington’s)
 Both categories appear in DSM and ICD, but there are important
differences in the 2 types of disorder:
1. Neurological disorders result from some pathological process (already
known, or can assume to be discovered in future)
 They are like other physical diseases, and just happen to affect the brain, often producing
progressive deterioration in mental functioning
2. In psychological disorders, the biology is much more continuous with the
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biology of health
According to McGhee (2001), discussion of mental disorders
often focuses on absences, while actual diagnostic categories
for specific disorders focus on the presence of symptoms
 For example, the mentally ill are often described as not following
society’s behavioural norms, not functioning effectively etc.
 But diagnosis is made in terms of present, identifiable symptoms (e.g.
hearing voices, anxiety, anger outbursts)
 But as stated by McGhee (2001):
 “… according to psychologists, the mentally ill do not seem to have
anything in common with one another, apart from the fact that they are
different from some notional standard of normal functioning. If this is the
case, then we should treat very sceptically any general claims about the
‘mentally ill’.”
 While the primary goal of DSM-5 is to shift towards a dimensional
classification, this shift will neither be fundamental nor significant
(Widiger, 2012)
 In the end, DSM-5 will remain a categorical diagnostic system 33
  In relation to auditory-verbal hallucinations, some
researchers attempted to directly measure “source
monitoring”
 (The capacity to distinguish between self-generated
thoughts and externally-presented stimuli)
Psychiatric  Patients with delusions appear to perform normally on
symptoms as conventional measures of reasoning
 Delusional thinking is linked to the tendency to “jump to
psychological conclusions” when reasoning about probabilities:
processes that  They request less information before reaching a decision compared
with non-delusional controls
go wrong  Deficit in theory of mind skills have also been implicated in
delusions (Gross, 2010, 2012)

 Once we can adequately explain all symptoms of

psychosis, will there be no “schizophrenia” left behind
that requires explanation? (Bentall, 2003)
 Then with the same logic, do mental disorder exist? 34
The objective nature of mental disorders: do they
exist?

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At the heart of the “abnormality as mental illness” criterion
is the medical model
 Central to the model is the classification and diagnosis of mental
disorders, treatment of psychiatric patients, and the use of other
medical terminology and practices (Maher, 1966)
All systems of classification (particularly DSM and ICD) stem
from the work of Kraepelin (1913) who published the first
textbook of psychiatry
 He proposed that certain groups of symptoms often occur
together and merit the designation of “disease” or “syndrome”
 And he also described the diagnostic indictors associated with each
syndrome
 His classification helped to establish the organic nature of mental
disorder, which is an integral feature of the medical model
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The overriding question is:
 Are psychopathology and related terms (e.g. mental
disorder/illness) scientific terms that can be defined objectively,
or are they social constructions that are defined largely by
societal and cultural values (Gergen, 1985)?
The definition of mental disorder in DSM-5 refer to a
“psychobiological dysfunction” to recognize that mental
disorders ultimately reflect a dysfunction of the brain (Stein
et al., 2010)
 → It has a strong focus on biological processes and emphasis on
neural circuits
 But while “… It might be impossible to construct a diagnostic
manual that is truly theoretically neutral… this is not a
compelling reason for abandoning the effort, particularly if the
manual is to be used for research attempting to determine the
37
validity of alternative theoretical perspectives.” (Widiger, 2012)
According to Kupfer et al. (2002), both
epidemiological and clinical studies have shown
extremely high rates of comorbidities among
disorders
This undermines the hypothesis that the syndromes
represent distinct aetiologies
→ Mental disorder categories overlap to a large degree,
while DSM assumes that each disorder has a specific and
distinct cause
Also, lack of treatment specificity is common,
putting the validity of the categorical system into
question
38
Single diagnostic categories are hardly likely to
justify the complexity of most mental disorders
According to Rutter (2003), mental disorders appear to
be the result of complex interaction of different
biological vulnerabilities and dispositions of many
significant environmental, psychosocial events that
exert progressive effects on the person over time
 Symptoms and pathologies of mental disorders appear to be
highly responsive to a wide variety of neurobiological,
interpersonal, cognitive, and other variables that form a
person’s psychopathology profile

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 The limitations of all the criteria we
discussed lead to one conclusion:
→ There is no objective definition of
abnormality that is free of subjectivity,
value, bias, culture etc.
Psychopathology Psychiatric diagnoses are potent social
as a social categorisations
construction
We need to understand the process by which
people try to conceive and define
psychopathology, what they are trying to
achieve by doing this, and how these
conceptions are continually debated and
revised (Maddux et al., 2012)
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Social constructionism
 Involves “elucidating the process by which people come to
describe, explain, or otherwise account for the world in which
they live” (Gergen, 1985)
 → From this perspective, concepts such as psychopathology and
mental disorder “are products of a particular historical and cultural
understanding rather than… universal and immutable categories of
human experience” (Bohan, 1996)
 Universal definitions of concepts do not exist because they depend
primarily on who does the defining (and reflecting their own interests
and values)
 For this reason, mental disorders and DSM categories were not
discovered, but invented (Raskin & Lewandowski, 2000)
 They are social artefacts that serve the same sociocultural goals like
other conceptions (e.g. race, gender, social class) to maintain the power
of certain people, and maintain social order as defined by those people
(Rosenblum & Travis, 1996) 41
However,
“The social constructionist perspective does not deny
that human beings experience behavioural and
emotional difficulties — sometimes very serious ones. It
insists, however, that such experiences are not evidence
for the existence of entities called ‘mental disorders’ that
can then be invoked as causes of those… difficulties. The
belief in the existence of these entities is the product of
the all too human tendency to socially construct
categories in an attempt to make sense of a confusing
world.” (Maddux et al., 2012)

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Social constructionism versus essentialism
One way of thinking about the validity of psychiatric
diagnosis is to ask whether mental disorders possess an
underlying “essence” (an underlying nature shared by
the members of a category)
 Proponents of the medical/disease model maintain that each
disorder is universal and has a biologically-based causation,
with discrete boundaries
 i.e. each disorder is distinct and separate from all the others (Ahn et
al., 2006)
 → They are natural categories that exist as categories whether or
not humans know about them

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An alternative view states that the categories,
assumptions and measurements that people use to
classify the world are not found in nature, but are
human-made (→ consistent with social
constructionism)
Distinction between categories (e.g. mental disorders)
and the meaning attached to them are products of social
negotiation
 There is no reason to expect any categorisation scheme (e.g.
DSM) will be used everywhere and stay the same forever, nor
we can assume that later editions come closer to “the truth”
than earlier ones (Hacking, 1994)
 E.g. revisions to DSM since first publication showed increase
in number of categories:
 16 (DSM-I in 1952) to 340 (DSM-IV in 1994) 44
New categorisation scheme in DSM-III reflected the re-
medicalisation of psychiatry in 1970s: (Magnusson &
Maracek, 2012)
 Moving to the biomedical view as the “official approach”
 It was not the result of new scientific discoveries, but rather reflected
the dramatic changes in external, economic, political and social
environment of medicine (Horwitz, 2002)
 To “reinvent” psychiatry to resemble biomedicine for its future
 The collection of the troubling experiences of individuals became
characterised as “diseases”
 Making it necessary to devise specific indicators to diagnose them
 E.g. checklists of symptoms to define mental disorders; removing all
psychodynamic assumptions about causes of disorders to “make it
objective”
 The language of mental health professions also changed into
biomedical terms
 E.g. mental health, illness, disease, patient, symptom, diagnosis 45
 When someone with cystitis suffers hair
loss, there is factual evidence that each
condition has a distinct causation, and
they also look very different
Some
But in psychiatry, “comorbid disorders can
problems with often seem suspiciously similar, as though
the diagnosis they share some common cause or
of mental underlying mechanism” (Claridge & Davis,
disorders 2003)
So, comorbidity refers to having more than
one disorder
 E.g. eating disorders and substance-use
disorder often occur together
46
The distinction between illness and health is an issue
related to physical disease, but it takes on even
greater force in psychological disorders
“In physical diseases the primary fault lies in just one
part of the organism and the evidence for its failure or
deficiency is usually fairly objective. Psychological
disorders, on the other hand, are defined more in terms
of the person’s whole behavioural and mental
functioning…”
→ This means that psychological abnormality can
sometimes be quite arbitrary, and may depend on the
changing social criteria regarding what is healthy and
unhealthy
 So, the idea of “disease process” in physical illness is less
47
helpful than in the case of psychological disorders
Similarly, Boyle (2007) argues that psychiatric diagnosis is
based on assumptions which became acceptable during late
19th centuries that:
 “… troublesome behaviour, emotions and psychological
experiences will form the same kinds of pattern, conform to the
same theoretical framework, as bodily complaints; that these
behaviour and emotions are outward symptoms of an underlying
internal dysfunction which, together with signs (objective,
measurable bodily antecedents), will cluster into syndromes…”
However:
 “… our body parts… don’t have language or emotions, form
beliefs, make relationships, create symbols, search for meaning,
or plan the future. Small wonder that a theoretical framework
developed for understanding bodily problems has proved so
inappropriate for the task of understanding psychological
experience and behaviour…” (Boyle, 2007) 48
Boyle (2007) also criticises psychiatric diagnosis in
terms of the way it distorts research
For example, diagnosis directs research efforts to the
“ill” individual whose brain or psyche is assumed to be
the fundamental cause of their disorder
 “… Yet there is strong evidence that emotional distress and
behavioural problems, even the most bizarre, are
understandable responses to our ways of actively trying to
manage adverse circumstances and relationships… The
theoretical and practical implications of this evidence are
often minimised by, for example, presenting adverse
environments and relationships largely as consequences of
‘having a mental disorder’ rather than as antecedents of a
range of meaningful and purposive – if problematical –
responses to adversity…” 49
In other words, the person, rather than his/her life
circumstances, is “blamed” for the disorder in the
diagnosis approach
As Harper er al. (2007) point out, researchers have
found strong association between ethnicity, gender,
social class, sexual abuse and many forms of distress
This suggests:
 “… the brain-body is an open system that cannot be
comprehensively understood outside of its social context.
Psychiatric diagnoses ignore such research in favour of the
individualization of distress, forcing it into categories of
dubious validity, and then implicitly associating it with
underlying biomedical pathologies”
50
  Gross, R. (2014). Themes, issues and debates in psychology
(4th ed.). Hodder Education. (Chapter 8)

References

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