In this video I begin the unit on psychopathology by asking how we can define normality and abnormality. Which traits or behaviors should be considered abnormal and indicative of a psychological disorder? What role do societal views play in the determination of mental illness? I describe concepts of statistical abnormality, as well as Thomas Szasz’s view of mental illness as problems in living rather than diseases. Lastly I describe the medical model for diagnosis, which assumes that disorders have characteristic clusters of positive and negative symptoms.
Thomas Szasz – The Myth of Mental Illness article (1960): http://psychclassics.yorku.ca/Szasz/myth.htm
Video Transcript
Hi I’m Michael Corayer and this is Psych Exam Review. In this video, we’re going to start the unit looking at psychopathology or the study of psychological disorders. And these are illnesses of the mind that cause distressful thoughts, feelings or emotions. And this is an area of psychology that’s often referred to as abnormal psychology. But that raises the question. What do we mean by abnormal? What is normal? How do we determine which traits and behaviors should be considered normal and which should be considered abnormal?
Now, one way we can do this is just to rely on statistics. And so if we took a statistical approach to abnormality, what that would mean is we say that we have some distribution for traits in the population. So physical and psychological traits, we could look at how people vary on these traits, and then we could look at the extremes of that distribution and say that these are statistically abnormal. And that would be our definition of what it means to be normal or abnormal based on the percentage of the population that falls in that particular area, or falls in that particular section of the distribution. So for instance, we can look at something like adult height and say, okay, if we look at height for all adults, we see a roughly normal distribution. And then we can look at the tail ends of that distribution, very low and very high extremes. We can say that these are statistically abnormal. And we might say that that indicates some sort of problem. So with a very low height, we might say, maybe this indicates something like dwarfism. And the same could be true at the very high end of the distribution. Say, this is also statistically abnormal, and it might indicate something like gigantism, somebody’s eight feet tall. That’s abnormal in this statistical sense. And that might be an indication that there’s a disorder or illness associated with that.
Now, the problem that we have is this doesn’t work quite as well for psychological traits, because sometimes things are statistically abnormal but that doesn’t mean that they represent an illness or a disorder. So for instance, if we look at intelligence, we look at the distribution of IQ scores. Again, we have roughly a normal curve. We could look at the tail ends of that distribution, and we could say, for very low IQ, we might say that this represents a problem. And there’s illnesses or syndromes or disorders associated with very low IQ. So that might indicate a problem when somebody scores in that statistical extreme. But when we look at the other end of the distribution, very high IQ, we don’t think in the same way. We don’t say if your IQ score is over 145 “well, that’s statistically abnormal and therefore you have a disorder and we should do something about it. We need to bring your IQ score down so it can be more normal.” So even though high IQ is statistically abnormal, it doesn’t necessarily mean that it’s an indication of the psychological disorder. And the same is true for other traits. So we can pick something like green eyes. This is statistically abnormal. Only about 2% of people in the world have green eyes. And yet, we don’t consider that to be a sign of any sort of illness or disorder. So the point is that abnormality is not necessarily an indication of illness. So just because something is statistically abnormal, we can’t rely on that to indicate illness.
And the opposite is also true, just because something is an illness doesn’t mean that it will necessarily be abnormal in a statistical sense. So for instance, we can have a particular population. We might find, let’s say, a very high rate of depression in that population. And so just because it’s common in that population doesn’t mean that it’s no longer an illness. So when I say it’s still an illness, even though it’s not abnormal in this group, right?
So one way we can think about this is to recognize that people vary in many ways. We have lots of physical and psychological differences. We have lots of variation, and we have to try to determine which variations should we consider to be disorders. Now, it’s also important to recognize that our views on this might change over time. And one of the best known examples of this is looking at homosexuality, which was considered to be a psychological disorder until 1973. So this is a case where we say that we have some variation in people’s behavior. And for some reason, people have decided that this variation was not to be considered normal, was considered to be a sign of a disorder or an illness. And views on that variation have changed over time. Where now we say, yes, people still vary in the same ways on that distribution, but we no longer consider that this section of the variation is a sign of a disorder or syndrome, or some sort of illness. Now this brings up the larger point that our societal views are therefore shaping what we consider to be illness. And we might ask, does this mean that all of our disorders could be considered to be socially invented, that variations in traits, depending on the side of you, might be considered a disorder, or might not be? And this means it’s kind of hazy how we determine whether something’s a disorder.
And this is why, in 1961, the Hungarian American psychiatrist, Thomas Szasz, wrote a book called The Myth of Mental Illness. And he proposed sort of an extreme version of this view in that there’s no such thing as mental illness. That it is all socially constructed. He said, certainly people have “problems in living“. And Szasz was not anti-psychiatry. He was a psychiatrist himself. And he believed in helping people and helping them solve the problems in living. But he thought it should always be voluntary, that we shouldn’t be institutionalizing people just because they vary for certain traits, and we shouldn’t be thinking of these things as diseases. He said that psychological disorders necessarily involve judgment. And that means they’re always involved in a social context. So a psychiatrist who’s diagnosing is doing so based on the societal context, not necessarily a biological context.
And this is a criticism that still stands nearly 60 years after Szasz wrote The Myth of Mental Illness. And what I mean by that is that we still don’t have objective, biological markers for nearly all of the psychological disorders that are being diagnosed. If we look at the DSM-5 which is the diagnostic and statistical manual for mental illness, which is the classification system that lists all of the possible psychological disorders you might have, there are very few exceptions that actually have biological markers for them. So if you get diagnosed with something like depression or obsessive compulsive disorder, or schizophrenia, there’s not any sort of objective test that you’re given to confirm that diagnosis. We don’t have a blood test or a brain scan that can say, yes, you definitely have schizophrenia, or you definitely have depression. Now, there are a few very recent exceptions to this, with things like Alzheimer’s disease, where we can actually have some brain scanning that can confirm a diagnosis by looking at things like buildup of amyloid plaques in the brain. But for the most part, most psychological disorders don’t have biological tests that can confirm them.
Now, nevertheless, we apply what’s called a medical model to the diagnosis of mental illness. And the medical model is simply that we believe there are psychological disorders, or syndromes, and that each disorder, or each syndrome, has a cluster of symptoms that’s associated with it. And so by looking at the pattern of symptoms in a particular patient, the psychiatrist can determine which disorder or which symptom, sorry syndrome, the person has.
Now, these symptoms come in two main types. We have what are called positive symptoms and negative symptoms. And so positive symptoms refer to traits or behaviors that are not seen in healthy people. So one example of a positive symptom would be in the case of schizophrenia, a common symptom is auditory hallucinations. And so some people with schizophrenia will hear voices of people that are not there. Now, this is something that we don’t see in healthy people. We don’t see this auditory hallucination happening in healthy people. But we do see it in people who might have schizophrenia. And that would suggest that this is a positive symptom of schizophrenia, something that we don’t see in most people. But then if we see it, that’s a sign of this particular disorder
And we also have negative symptoms. And so this is where we have the absence of a behavior that’s common in most healthy people or that was common in the person before the onset of the disorder. And so a common example of a negative symptom is what’s called anhedonia; this is a lack of pleasure. And this is seen in a number of different psychological disorders. But this is where somebody used to enjoy certain behaviors and now they’re no longer doing them because they no longer get any enjoyment from there. So they’re not having the experience of pleasure from particular activities that they used to experience. And so this is a negative, something has been taken away. And we can often see these negative symptoms with the prefix “a” or “an”, which is Greek for “without”. So we see it in anhedonia; without pleasure. We see it in apathy; where people lose a sense of motivation. We see it in avolition; people lose a feeling of a sense of will. And so these are example of negative symptoms.
And now I said that the psychiatrist will look for a particular combinations of symptoms, and that a particular pattern of symptoms will indicate a particular disorder. And that sounds pretty straightforward, but it’s actually very complicated. And there’s a number of difficulties associated with this. And so these difficulties, first of all, are that symptoms often overlap. So for instance, anhedonia is a symptom that occurs in many different psychological disorders. So you see it in depression. You also see it in schizophrenia. And so just having anhedonia doesn’t clearly indicate which disorder you have. It might narrow the list down a little bit, but there’s still a broad range of psychological disorders that feature this symptom. And so this makes it very difficult.
And another problem we have is that the timing of the expression of symptoms can vary. So you might have a particular cluster of symptoms. And you might not be showing one symptom that would help to differentiate that, but perhaps two weeks later, you will start showing that symptom. The symptoms don’t all necessarily appear at the same time. And so if they appear in different orders, or one symptom has not appeared yet, this can make the diagnosis very difficult. And then later, when that symptom appears, you might say, actually, the original diagnosis was incorrect, because you didn’t have that symptom at that time. And now that you have that symptom, it changes with the diagnosis might be.
And then lastly, we have the problem of comorbidity. This is the idea that more than one illness can be present at once. We say that disorders are comorbid if they’re occurring at the same time. And so this is very common in psychological disorders. So often, if somebody has something like an eating disorder, like anorexia nervosa, they may also be diagnosed with depression, where they might be diagnosed with an anxiety disorder and a depressive disorder. And this makes things very complicated, because now you have a bunch of symptoms, some of which go with one disorder, and others which go with another disorder. Or we might think, well, maybe all of them go with some other 3rd disorder that includes all of those. And how do we determine exactly how we divide up these symptoms into which disorders they go with? And this makes the process very complicated.
And then we have the question of, what’s causing these symptoms? And it’s three main ways we can think about the cause of the symptoms. One is the somatogenic hypothesis. And this comes from originating from the body, somatogenic. And this means that there’s a physiological problem in the body, and that’s the cause of the symptoms that are being expressed. So you have perhaps levels of a particular hormone, or levels of a particular neurotransmitter, or damage in a certain brain area and that physiological problem is causing the symptoms that you’re experiencing. We also have a psychogenic hypothesis. And this is the idea that it’s originating from the mind. And so this is the idea that psychological factors, thinking patterns or interpretations of situations might be causing the expression of some symptoms. And then lastly, we have a learning approach, which is that our experience with society, within our culture, our personal experience of rewards and punishments, this might shape how we experience the world. And that might influence the expression of certain symptoms. So perhaps I have some very stressful experience in the world, and that might trigger certain symptoms of a psychological disorder, whereas somebody who didn’t have that same experience might not have that same expression of those symptoms
And so the question is, well which of these is the correct approach? And if you watched other videos on this channel, or you’re taking a psychology class, you probably already know the answer is, we don’t have a single answer. It’s very complicated. It’s a very complex problem. And that means that all of these factors might be involved in different mental illnesses. And so generally, we’ll adopt what’s called a biopsychosocial approach, or a multicausal model of mental illness. And this means that we consider all of these possibilities, and we recognize that these may influence each other, and they might be influenced and different factors might have greater or lesser influence at different times, so they might be more important in the development of a disorder. So maybe very stressful experience relates to the development of a disorder. But maybe there are biological or cognitive factors that then relate to the progression of the disorder. And they might also differ in how much they’re involved in the treatment of the disorder. So certain approaches to treatment, we might emphasize a biological approach or a cognitive approach, or a learning approach, depending on the disorder that we have, and depending on how has developed or progressed over time. And so this is our way of trying to deal with the incredible complexity of mental illness by recognizing that any of these factors might be playing a role. And so we have to consider all of them. We can’t just narrow everything down to a simple biological approach, or purely cognitive approach. And so in the next few videos in this unit, we’ll be looking at these different approaches in more detail. I hope you found this helpful. If so, please like the video and subscribe to the channel for more. Thanks for watching!
