Section Learning Objectives
- Define abnormal psychology, psychopathology, and psychological disorders.
- Explain the concept of dysfunction as it relates to mental illness.
- Explain the concept of distress as it relates to mental illness.
- Explain the concept of deviance as it relates to mental illness.
- Explain the concept of dangerousness as it relates to mental illness.
- Define culture and social norms.
- Know the cost of mental illness to society.
- Identify and describe the various types of mental health professionals.
1.1.1 Definition of Abnormal Psychology and Psychopathology
The term abnormal psychology refers to the scientific study of people who are atypical or unusual, with the intent to be able to reliably predict, explain, diagnose, identify the causes of, and treat maladaptive behavior. A more sensitive and less stigmatizing term that is used to refer to the scientific study of psychological disorders is psychopathology. These definitions beg the questions of, what is considered abnormal and what is a psychological or mental disorder?
1.1.2. Defining Psychological Disorders
It may be surprising to you, but the concept of mental or psychological disorders has proven very difficult to define and even the American Psychiatric Association (APA, 2013), in its publication, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5 for short), states that though “no definition can capture all aspects of all disorders in the range contained in the DSM-5” certain aspects are required. While the concept of mental or psychological disorders is difficult to define, and no definition will ever be perfect, it is recognized as an extremely important concept and therefore psychological disorders (aka mental disorders) have been defined as a psychological dysfunction which causes distress or impaired functioning and deviates from typical or expected behavior according to societal or cultural standards. This definition includes three components (3 Ds). Let’s break these down now:
- Dysfunction – includes “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (pg. 20). In other words, dysfunction refers to a breakdown in cognition, emotion, and/or behavior. For instance, an individual experiencing delusions that he is an omnipotent deity would have a breakdown in cognition because his thought processes are not consistent with reality. An individual who is unable to experience pleasure would have a breakdown in emotion. Finally, an individual who is unable to leave her home and attend work due to fear of having a panic attack would be exhibiting a breakdown in behavior. Abnormal behavior has the capacity to make our well-being difficult to obtain and can be assessed by looking at an individual’s current performance and comparing it to what is expected in general or how the person has performed in the past.
- Distress or Impairment – Distress can take the form of psychological or physical pain, or both concurrently. Simply put, distress refers to suffering. Alone though, distress is not sufficient enough to describe behavior as abnormal. Why is that? The loss of a loved one would cause even the most “normally” functioning individual pain and suffering. An athlete who experiences a career-ending injury would display distress as well. Suffering is part of life and cannot be avoided. And some people who display abnormal behavior are generally positive while doing so. Typically, if distress is absent then impairment must be present to deem behavior abnormal. Impairment refers to when the person experiences a disabling condition “in social, occupational, or other important activities” (pg. 20). In other words, impairment refers to when a person loses the capacity to function normally in daily life (e.g., can no longer maintain minimum standards of hygiene, pay bills, attend social functions, or go to work). Once again typically distress and/or impairment in functioning are required to consider behavior abnormal and to diagnose a psychological disorder.
- Deviance – A closer examination of the word abnormal shows that it indicates a move away from what is normal, typical, or average. Our culture – or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group – determines what is normal and so a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms. What is considered “normal” by society can change over time due to shifts in accepted values and expectations. For instance, just a few decades ago homosexuality was considered taboo in the U.S. and it was included as a mental disorder in the first edition of the DSM; but today, it is generally accepted. Likewise, PDAs, or public displays of affection, do not cause a second look by most people unlike the past when these outward expressions of love were restricted to the privacy of one’s own house or bedroom. In the U.S., crying is generally seen as a weakness for males but if the behavior occurs in the context of a tragedy such as the Vegas mass shooting on October 1, 2017, in which 58 people were killed and about 500 were wounded, then it is appropriate and understandable. Finally, consider that statistically deviant behavior is not necessarily negative. Genius is an example of behavior that is not the norm.
Though not part of the DSM 5’s conceptualization of what abnormal behavior is, many clinicians add a 4th D – dangerousness to this list. Dangerousness refers to when behavior represents a threat to the safety of the person or others. Individuals expressing suicidal intent, those experiencing acute paranoid ideation combined with aggressive impulses (e.g., wanting to harm people who are perceived as “being out to get them”), and many individuals with antisocial personality disorder may be considered dangerous. Mental health professionals (and many other professionals including researchers) have a duty to report to law enforcement when an individual expresses an intent to harm themselves or others. Nevertheless, individuals with depression, anxiety, and obsessive-compulsive disorder are typically no more a threat to others than individuals without these disorders. As such, it is important to note that having a mental disorder does not automatically deem one to be dangerous and most dangerous individuals are not mentally ill. Indeed, a review of the literature (Matthias & Angermeyer, 2002) found that only a small proportion of crimes are committed by individuals with severe mental disorders, that strangers are at a lower risk of being attacked by a person with a severe mental disorder than by someone who is mentally healthy, and that elevated risks to behave violently are limited to a small number of symptom constellations. Similarly, Hiday and Burns (2010) showed that dangerousness is more the exception than the rule.
1.1.3. What is the Cost of Mental Illness to Society?
This leads us to consider the cost of mental illness to society. The National Alliance on Mental Illness (NAMI) indicates that depression is the number one cause of disability across the world “and is a major contributor to the global burden of disease.” Serious mental illness costs the United States an estimated $193 billion in lost earnings each year. They also point out that suicide is the 10th leading cause of death in the U.S. and 90% of those who die from suicide have an underlying mental illness. In relation to children and teens, 37% of students with a mental disorder age 14 and older drop out of school which is the highest dropout rate of any disability group, and 70% of youth in state and local juvenile justice systems have at least one mental disorder. Source: https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers. In terms of worldwide impact, the World Economic Forum used 2010 data to estimate $2.5 trillion in global costs in 2010 and projected costs of $6 trillion by 2030. The costs for mental illness are greater than the combined costs of cancer, diabetes, and respiratory disorders (Whiteford et al., 2013). And finally, “The Social Security Administration reports that in 2012, 2.6 and 2.7 million people under age 65 with mental illness-related disability received SSI and SSDI payments, respectively, which represents 43 and 27 percent of the total number of people receiving such support, respectively” (Source: https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mental-health-awareness-month-by-the-numbers.shtml). So as you can see the cost of mental illness is quite staggering for the United States and other countries.
Check this out: Seven Facts about America’s Mental Health-Care System
In conclusion, though there is no one behavior that we can use to classify people as abnormal, most clinical practitioners agree that any behavior that strays from what is considered the norm or is unexpected within the confines of one’s culture, that causes dysfunction in cognition, emotion, and/or behavior, and that causes distress and/or impairment in functioning, is abnormal behavior. Armed with this understanding, let’s discuss what mental disorders are.
1.1.4. Types of Mental Health Professionals
There are many types of mental health professionals that people may seek out for assistance. They include:
Table 1: Types of Mental Health Professionals
Can they prescribe medications?
|Clinical Psychologist||Ph.D.||Trained to make diagnoses and can provide individual and group therapy||Only in select states|
|School Psychologist||Masters or Ph.D.||Trained to make diagnoses and can provide individual and group therapy but also works with school staff||No|
|Counseling Psychologist||Ph.D.||Deals with adjustment issues primarily and less with mental illness||No|
|Clinical Social Worker||M.S.W. or Ph.D.||Trained to make diagnoses and can provide individual and group therapy and is involved in advocacy and case management. Usually in hospital settings.||No|
|Psychiatrist||M.D.||Has specialized training in the diagnosis and treatment of mental disorders||Yes|
|Psychiatric Nurse Practitioner||M.R.N.||Has specialized training in the care and treatment of psychiatric patients||Yes|
|Occupational Therapist||M.S.||Has specialized training with individuals with physical or psychological conditions and helps them acquire needed resources||No|
|Drug Abuse and/or Alcohol Counselor||B.S. or higher||Trained in alcohol and drug abuse and can make diagnoses and can provide individual and group therapy||No|
|Child/Adolescent Psychiatrist||M.D. or Ph.D.||Specialized training in the diagnosis and treatment of mental illness in children||Yes|
|Marital and Family Therapist||Masters||Specialized training in marital and family therapy; Can make diagnoses and can provide individual and group therapy||No|
126.96.36.199. Prescription Rights for Psychologists
To reduce inappropriate and over-prescribing it has been proposed to allow appropriately trained psychologists the right to prescribe. Psychologists are more likely to choose between therapy and medications, and so can make the best choice for their patient. The right has already been granted in New Mexico, Louisiana, Guam, the military, the Indian Health Services, and the U.S. Public Health Services. Measures in other states “have been opposed by the American Medical Association and American Psychiatric Association over concerns that inadequate training of psychologists could jeopardize patient safety. Supporters of prescriptive authority for psychologists are quick to point out that there is no evidence to support these concerns (Smith, 2012).”
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