Defining abnormality
No two people are the same; we all differ in psychological characteristics such as intelligence, sociability, and our general outlook on life (âglass half full or glass half emptyâ). Because people are so different from each other, this makes it difficult to decide what makes someone âabnormalâ rather than just âdifferent from meâ. To start thinking about what makes behaviour abnormal, it is helpful to think of the âfour Dsâ (Bennett, 2005):
- Deviance (from the norm) This assumes that there is a normal range for specific aspects of psychological function, and that anyone who falls outside that range might be classed as abnormal. For example, letâs imagine that the majority of the population score between 25 and 75 on a 100-point measure of depressed mood. If this was the case, anyone who scored below 25 or above 75 would be considered âabnormalâ, and the more extreme their score was, the more abnormal they would be.
- Distress This means that a person might be considered abnormal if they feel distressed in some way. This requires us to define âdistressâ, which isnât too difficult, but what level of distress makes a person abnormal?
- Dysfunctional This means that a person is thinking and/or behaving in a way that is hindering their daily life, for example their relationships or their performance at work or school. Again, we need to set a threshold to determine at what point psychological dysfunction is abnormal: nobody is perfectly functional all of the time!
- Dangerous This means that a person can be considered abnormal if their psychological condition puts them or other people at risk of harm â for example, someone who feels suicidal, or a person with paranoid delusions that drive them to physically hurt other people.
The âfour Dsâ are not intended to be a prescriptive checklist, but they are a useful way of thinking about which kinds of human behaviour are normal, and which kinds are abnormal. Most psychological disorders fit some but not all of the four Ds. For example, a person with generalised anxiety disorder (GAD; see Chapter 6) is in distress, and this is dysfunctional (it prevents them from engaging in many activities). However, it is difficult to say how âdeviantâ this is: we all feel anxious from time to time, and GAD is a very common disorder, so is it fair to say that people with GAD are actually any different from ânormalâ people? Furthermore, most people with GAD are not a danger to themselves or others.
With regard to the notion of deviance, on what types of individual differences can somebody be âdeviantâ, in order to be considered abnormal? Perhaps we can start with an extreme depressed mood, but what about intelligence? Is someone abnormal if they are extremely intelligent? As for distress, we need to decide how to define this. It is relatively uncontroversial to say that someone who feels very depressed or anxious is in a state of distress. But we all feel these emotions from time to time, and at certain periods of our lives we may experience them more intensely than others (e.g. when starting a new job, or after a relationship break-up). At what point does distress become a sign of abnormality? Or maybe we shouldnât talk about the severity of distress, but instead focus on how long people have been distressed?
Dysfunctional behaviour is also tricky. If someone is so paralysed by anxiety or depression that they cannot go to work or talk to their friends, then that is dysfunctional. But many other behaviours are dysfunctional in some sense, and we donât consider that people who engage in them are abnormal. For example, young people who use fake ID to buy alcohol and then drink it in the park on a school night are doing something dysfunctional (it is illegal, not good for them and wonât help their performance at school). But even though we might not approve of this type of behaviour, many people would not see it as âabnormalâ.
Finally, defining abnormality based on a person being a danger to themself or others is fraught with difficulty. The vast majority of people with psychological disorders do not intend to harm themselves and they pose no risk to others. On the other hand, some people are just bad tempered and physically aggressive â which makes them a risk to others â but this wouldnât necessarily make them candidates for a psychiatric evaluation.
The overarching point is that each of these things is very difficult to define because there are no objective measures for them, and that is because our personal network dictates how we view these things. The example of teenage drinking is a case in point here: this might be viewed as dysfunctional by most members of society, particularly schoolteachers (!), but other groups, such as teenagers, may see it as completely normal and even something to aspire to! There are also cross-cultural differences. For example, in some cultures a person who has âvisionsâ and speaks to themself is considered to have magical powers, whereas the same behaviour in many European countries would be considered âabnormalâ and cause for psychiatric investigation. Finally, these things have changed over time within cultures. For example, homosexuality was categorised as a psychological disorder until as recently as 1973, but today most people (extreme fringe groups aside) are quite shocked by that historical fact! To give another example, the distinction between someone who suffers from major depressive disorder and someone who is just a bit miserable and pessimistic (but basically âhealthyâ) is always going to be a difficult call to make. Successive revisions of psychiatric diagnostic manuals have generally reduced their thresholds for making this distinction, such that someone who would have been considered miserable but healthy in the 1950s might be diagnosed with a major depressive disorder from 2013 onwards (see Chapter 5). We revisit this issue throughout the book.
