How do we determine whether behavior is abnormal?

As we will see, it is not as easy as one might assume when it comes to determining whether a behavior exhibited by a person is abnormal.

This issue becomes complicated when we look at abnormal behavior across different cultures.

Cultural relativism versus cross-cultural similarities or universality

Some investigators feel that because culture and psychopathology are so intertwined, abnormal behaviors can only be studied within the cultural framework in which they occur.

This approach is called cultural relativism. Another way to think of this is that whatever behaviors or symptoms we identify as abnormal within our culture have little relevance when we look at psychopathology in other cultures.

A different approach to this issue would suggest that although culture plays a role in how abnormal behavior is identified and manifested, there are cross-cultural similarities or even universalities in the underlying psychological mechanisms and subjective experiences.

Traditional approaches to defining abnormality

Among some conservative Pentecostal Christian congregations, the minister and parishioners engage in such behaviors as handling poisonous snakes (God will protect), speaking in tongues, and faith healing. Those who engage in glossolalia, or speaking in tongues, believe that they are motivated divinely and are speaking a heavenly tongue.

Would you consider this behavior abnormal? The answer depends somewhat on what approach you take to defining abnormality.

Statistical approach

The statistical approach would define a behavior as abnormal or deviant because its occurrence is rare or infrequent.

Which of the following behaviors would not be considered abnormal by this definition?
climbing Mt. Everest
skiing when blind
speaking 4 languages
drinking to the point of drunkenness

Given the above examples, what conclusions might we reach about defining abnormality in a statistical sense?
Not all rare behavior is disordered.
Not all disordered behavior is rare.
Both of the above.

Impairment in carrying out day-to-day functions

In some cases, people with disorders such as schizophrenia or major depression are impaired in their ability to engage in day-to-day activities.

However, some with bipolar disorder claim increased productivity during the manic phases.

Would the Pentecostals described earlier be considered abnormal by this definition?
definitely
not necessarily

If a Pentecostal was bitten by a rattlesnake or relied on God instead of doctors to heal a serious illness, would that be considered abnormal by the above definition?
yes
no

Social deviance

Another way to define abnormality is in terms of violations of social norms. By definition, if a behavior is socially deviant, it is abnormal.

A problem with the deviance definition is that what is considered deviant by some might not be considered deviant by others.
true
false

Matsumoto points out that homosexuality is still considered deviant by many people although it is not longer classified as a mental disorder in DSM IV.

Subjective distress

This criterion for psychopathology considers behavior to be abnormal if it causes subjective distress.

Individuals with psychopathic personality disorder feel little anxiety or guilt over their misbehavior. Are they deviant by the above definition?
yes
no

Summary of approaches

About 10% of the adult population in the United States has experienced a mood disorder, depression or bipolar disorder. By which approach to defining abnormal behavior is a mood disorder “abnormal?”
statistical approach
impairment in carrying out day-to-day functions
social deviance
subjective distress
all of the above
a, b, c
a, b, d

Transsexualism is gender identity disorder in which a person experiences an intense desire and need to change their sexual status, including their anatomical structure. Prevalence is 1 in 100,000 males and 1 in 400,000 females. By which approach to defining abnormal behavior is transsexualism “abnormal?”
statistical approach
impairment in carrying out day-to-day functions
social deviance
subjective distress
all of the above
a, b, c
a, b, d

It has been said that everyone has worries and fears, that is, experiences anxiety. By which approach, primarily, is anxiety considered “abnormal?”
statistical approach
impairment in carrying out day-to-day functions
social deviance
subjective distress

The view that culture and psychopathology are so intertwined that abnormal behavior can only be studied and understood from within a cultural context is called
culture-dependent psychopathology
cultural relativism
emic and etic abnormality
ethnocentric psychopathology

Religious practices and abnormal behavior

As you might tell from my example, it becomes very difficult to determine whether a behavior is abnormal when it is associated with religious practices.

For example, if a person was spouting gibberish on a street corner, we might think this person to be psychotic and lock him up. But do we consider glossolalia abnormal within the context of a religious meeting?

Likewise, it is very common around the world for people to speak with spirits and see visions as a part of their religious practices.

In commenting on 9/11, the Reverend Jerry Falwell, a TV evangelist with thousands of listeners, said that God may have allowed what the nation deserved because of moral decay and said Americans should have an attitude of repentance before God and asking for God's protection.  He specifically listed the ACLU, abortionists, feminists, gays, and the People For the American Way as sharing in the blame for 9/11. His views were not uncommon among the fundamentalist, evangelical community.

By the previously mentioned criteria for abnormality, is Jerry Falwell abnormal?
yes
no

Schizophrenia

Diagnostic criteria

The standard diagnostic symptoms of schizophrenia include gross distortions of reality; withdrawal from social interaction; and disorganization of perception, thought, and emotion (Carson, Butcher, & Coleman, 1988).

How universal is schizophrenia?

WHO study

The World Health Organization investigators looked at schizophrenia in 9 countries around the world and identified a set of symptoms found in all cultures:
lack of insight, auditory and verbal hallucinations, and ideas of reference (assuming one is the center of attention).

Cross-cultural differences

Despite the diagnostic agreement of psychiatrists in different cultures, some cross-cultural differences emerged:

• Patients in developing countries, such as Columbia, India, and Nigeria seemed to recover at faster rates than patients in developed countries such as England, the Soviet Union, and the United States.

What might be responsible for the better prognosis or outcomes for schizophrenics in the developing countries?
Since schizophrenia may have a biological or genetic component, genetic differences between people of the developing world and of the developed world may be responsible for the difference in prognosis
Developing countries are often more collectivist in orientation as well as poorer. This produces the beneficial effect of more community support, extended kin networks, and tendency to return to work earlier.
Both of the above.

• Symptom differences reflect culture. Patients in the U.S. were less likely to demonstrate lack of insight and auditory hallucinations than Danish and Nigerian patients.

Reasons: Insight and self-awareness are highly regarded values in the U.S. Nigerian culture is more accepting of hearing voices.

Depression

Diagnostic criteria

Common symptoms are “intense sadness, feelings of futility and worthlessness, and withdrawal from others” (Sue et al., 1990)

Depression is also characterized by physical changes (appetite and sleep disturbance), motivational changes (apathy, boredom), and emotional and behavioral changes (sadness, hopelessness, loss of energy).

How universal are the symptoms of depression?

WHO study

A WHO study of Canada, Switzerland, Iran, and Japan found some symptoms across all cultures: “sadness, joylessness, anxiety, tension, lack of energy, loss of interest, loss of ability to concentrate, and ideas of insufficiency.” Suicidal ideation is also common.

Therefore, some symptoms of depression seem universal across cultures.
true
false

Cross-cultural differences

A lot of research indicates that culture can affect which symptoms predominate.

For example, Marsella proposed that in cultures with an objective orientation (individualistic cultures), depression takes a primarily affective form.

In subjective cultures (collectivist), somatic symptoms are more predominant.

Among depressed individuals, headaches and other bodily symptoms are more common in ________ while feelings of loneliness and isolation are more common in ________ .
individualistic cultures; collectivist cultures
collectivist cultures; individualistic cultures

Culture-bound syndromes

Some abnormal behavior seems only to be found in particular cultures. These would be referred to as culture-bound syndromes and would provide support for the concept of cultural relativism.

Examples:

Amok has been observed in several SE Asian countries such as Malaysia, the Phillipines, and Thailand.
Its primary symptoms are sudden rage and homicidal aggression.

This disorder has given rise to what common expression?
He’s made a muck of things.
The man was running amok.

Anorexia nervosa. Until recently, this was only identified in the West and not Third World Countries.

Why might this difference occur?
In rich Western industrialized countries, being thin is considered attractive among middle and upper-middle class women.
In poor Third World countries, being overweight is a sign of relative wealth.
Both of the above.

Whakama is found among the New Zealand Maori and includes shame, feelings of inferiority, inadequacy, self-doubt, shyness, excessive modesty, and withdrawal.

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