Psychopathology

Definitional Issues: Normalcy versus Abnormalcy

Within the overall frame of reference of psychopathology a number of related concepts must be defined and distinguished.

Again, as a term, psychopathology refers to an aberrant or dysfunctional (i.e., pathological) way of functioning, where functioning is defined in terms of behavioral, interpersonal, emotional, cognitive, and psychophysiological patterns.

Whether a particular way of functioning is aberrant can be judged by a number of criteria.

Included in such criteria is whether that functioning causes personal distress, causes others in the person’s social sphere to become distressed, falls outside of accepted social norms or values for functioning, falls within certain criteria for abnormal functioning, or is a statistically rare functional pattern.

Each of these approaches to establishing an aberrant pattern of functioning has advantages and disadvantages. It is due to the presence of these approaches that different approaches to conceptualizing psychopathology exist.

Mental illness is a term that is largely synonymous with psychopathology, although it carries the implication that the unusual or aberrant patterns of functioning seen in these conditions reflect some form of disease or illness.

The medical model reflected in the illness term is rejected by some psychopathologists, as an inappropriate model for either all or some forms of psychopathology.

Another term that is considered synonymous with psychopathology is abnormal behavior.

This term is equally descriptive as psychopathology, as neither implies a belief in the cause of the unusual or aberrant patterns of functioning, but is more focused on the behavioral component of the dysfunction.

A term that is sometimes confused with psychopathology is insanity. Although such terms as insane, mad, and lunatic were once used in much the same way modern society uses the terms psychopathology and mental illness, insanity has taken on a much more narrow definition.

Specifically, insanity is a legal term that addresses the question of whether a particular person can be held criminally responsible for his or her actions.

Several different tests of insanity exists, but in every case the decision as to whether a person is legally insane is made by a judge or jury, and is made with respect to the crime they are alleged to have committed. It is the case that many different forms of abnormal or psychopathological behavior do not meet the criterion for insanity.

Further, it is possible that a person can be legally insane (i.e., not legally responsible for their actions) when they have no discernible form of psychopathology, as define by mental health practitioners.

A term that has relevance to psychopathology is mental health. While one can imagine mental health as the absence of psychopathology, it is also possible to conceptualize mental health in terms of its positive attributes.

The World Health Organization has defined mental health as “inner experience linked to interpersonal group experience,” and is associated with such characteristics as subjective well-being, optimal development and use of mental abilities, social adaptation, and achievement of goals.

In summary, psychopathology is a concept that is similar to mental illness and abnormal behavior, but is distinct from insanity. Mental health can be conceptualized as the absence of psychopathology, but also has other positive components not related to the concept of psychopathology.

Conceptual Approaches to Psychopathology

There are a large number of theoretical approaches to psychopathology, and these have steadily evolved over the centuries.

One dominant belief about the cause of abnormal behavior is that of possession; which is the idea that evil spirits or demons possess the mind and body of the person in question and cause them to behave in an aberrant fashion.

There is fossil evidence that early humans believed in demonic possession as a cause of abnormal behavior, as there are skulls dating from prehistoric times which show purposeful cutting of the skull, or trephination.

Trephination Opens in new window is often explained as an effort to release pressure in the skull, which may have been conceptualized by early humans as possession by an evil spirit.

The idea of demonic possession as an explanation for abnormal behavior continues to persist (for example, the Roman Catholic Church still has procedures for exorcism as part of its accepted canon, and voodooism Opens in new window is still practices in some parts of the world today), but it has largely been supplanted by other explanations of abnormalcy.

One early alternative model to possession was the humoral theory promoted by Hippocrates.

The humoral model proposed that four humors, or fluids, are in the body, and that each is associated with a particular attitude and time of life.

Blood, for example, is associated with growth, optimism, and good health, while black bile, or melancholia, is associated with death, depression, and darkness. The humoral theory was a prominent one in medicine for centuries, but has been since shown to be false.

Contemporary conceptions of psychopathology can be broken down into the two major categories of categorical and dimensional types.

Categorical conceptions of psychopathology view abnormal behavior as discontinuous with normal behavior; as something that has a qualitatively different sense to it. Such conceptions are apt to include ideas of illness or disease processes, as these processes are those that distinguish normal from abnormal functioning.

Categorical approaches to psychopathology are consistent with the practice of diagnosing or labeling dysfunctional patterns of functioning. The categorical approach to psychopathology is very heavily subscribed to because diagnosis is often considered to be necessary prior to the provision of treatment in psychiatric settings.

Dimensional models view psychopathology as deriving from underlying dimensional constructs that explain both normal and abnormal functioning. For example, it is possible to imagine a construct called interpersonal dependency.

At one end of this construct is extreme dependency, as would be marked by such thoughts as being insufficient without others, having to have others around to feel comfortable, and marked by such behavior as constantly seeking out others to be with, talking to others, etc.

At the other end of this construct is extreme interpersonal independency, which would be marked by such thoughts as never needing others, having to be alone to feel comfortable, and such behaviors as spending time alone, not starting conversations with others, etc.

A person functioning at either of the extremes on this dimension would be considered dysfunctional or psychopathological; between these two extremes lies a wide range of normal dependency—independency options.

Research has shown that most constructs are more common at their middle range, and less common at their extremes.

As such, if those constructs related to personality or behaviors that are related to psychopathology could be identified, then it would be possible to identify those points along the continua where abnormal or extreme patterns could be identified.

For example, using the dimension of interpersonal dependency—independency, it might be possible to identify a point along that continuum where the person is either so dependent or independent it causes distress and/or interpersonal problems for the person.

It would be at those points we would talk about the person crossing an imaginary line from normal to psychopathological functioning.

Models of Psychopathology

Psychopathologists are not content with conceptualizing and describing categorical and dimensional aspects of psychopathology. Another key activity of psychopathologists is to develop theoretical models that can potentially explain the cause, course, and required treatment of these disorders as well.

A large number of theoretical models have developed to attempt to explain psychopathology, many of which are very complex and well beyond the scope of this scope of this article. An excellent starting reference for interested readers is Abnormal Psychology, by Davidson and Neale (1991).

Models of psychopathology fall into several major categories. One major dimension which can be used to think of these models is whether their focus is on factors that are external or internal to the person.

Models that focus on external factors might place an emphasis on such issues as early childhood experiences, family dynamics, traumatic experiences, and even social and cultural issues that might lead to different forms of problematic behavior.

These models are likely to focus on the need for changes external to the individual to correct psychopathology, including marital and family therapy.

Some theorists who adopt this type of environmental or social perspective also focus on the need to change societal or cultural variables to lower the likelihood of some forms of psychopathology.

For example, it has been argued that some eating disorders are encouraged by the value that society places on thinness, and that by changing societal values, we may actually be able to lower the future likelihood of some eating disorders.

Theorists who focus on factors internal to the individual typically adopt either a biological or a psychological perspective.

Biologically oriented theorists might focus on genetic contributions to psychopathology, structural problems in the nervous system that cause abnormal behavior, or neurological processes that can be disordered and lead to psychopathology.

These theorists are likely to focus on biological treatments to psychopathology, including psychoactive medications. A large number of medications for treating psychological disorders exist, many of which have documented benefit.

The third major theoretical approach to psychopathology is psychological in nature. Such approaches focus upon psychological models of both normal and abnormal personality, and try to explain psychopathology in terms of these processes.

Within the psychological approaches are a number of discrete models, including psychoanalytic, behavioral, cognitive, humanistic, and other theoretical approaches.

While all of these models share the assumption that there is something within the individual at the psychological level that explains abnormal behavior, the specifics of each model vary dramatically, as do the therapies they promote.