How do psychologists determine what symptoms or behaviors are abnormal enough to diagnose their patients with a disorder? It can be difficult to diagnose sometimes, especially when culture plays a role into the diagnosis as well. The goal of a psychologist is to help the patient, but they don’t want to diagnose them with something if they don’t truly have the disease, but they also don’t want to not diagnose them and not give them a treatment that they could benefit from. Something that may seem abnormal from a certain cultural belief could be totally normal in another cultural belief. If there was a clear cut way of deciding if a patient has a disease or not, it would be easy, but there is not and that’s why it can sometimes be difficult to diagnose people.
So, what do we mean when someone is considered abnormal? Someone who has difficulties in the following seven departments could likely have some type of mental disorder: Subjective distress, maladaptiveness, statistical deviancy, violation of the standards of society, social discomfort, irrationality and unpredictability, and dangerousness (Hooley et al., 2020). Subjective distress is considered abnormal for someone who suffers or experiences psychological pain. When suffering from subjective distress, there may be feelings of anxiety or emotional distress because of their behaviors. If a patient committed a serious crime and didn’t feel any distress they could be considered abnormal. Maladaptiveness is when the behavior interferes with the person’s everyday life and well-being such as not getting enjoyment out of relationships or work. Often times people get depressed and aren’t getting an enjoyment out of life, but having a maladaptive behavior is extreme. These types of people may not work for months or need to go to the hospital. When this happens to people, they could consider their behaviors abnormal. Statistical deviancy is something that is statistically uncommon or rare. An example is having a rare talent like Mariah Carey’s voice. Her voice range can reach to 5 octaves, but it doesn’t cause her any harm or distress and she isn’t considered abnormal, it’s just not as common as the average person. A rare talent doesn’t make a person mentally ill, so when this happens, psychologists one has to use value judgments to determine if a person would be considered mentally ill or not.
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Violation of the standard of society is also something that could help classify a person as abnormal (Hooley et al., 2020). This happens when a person violates or fails to follow the social and moral rules of their culture. For example, something that is common for the average American citizen like driving would be very uncommon or abnormal for Amish people (Hooley et al., 2020). Abnormalism will also depend on the magnitude of a violation or broken law. In America, a lot of people have been pulled over for speeding and breaking the law, that wouldn’t be abnormal, but if they were to deliberately drive their car into a side of a building, that would be considered abnormal.
Sometimes, abnormality depends on how a person was raised and what culture they follow as to how they could violate the norms within their culture. For example, in India the social norm is to eat their food with their hands. If somebody from India were to come to the United States and eat their food with their hands, that person would probably get some weird looks, even though that is completely to them. Social discomfort is when a person violates an unwritten social norm (Hooley et al., 2020). Everyone around them might get uncomfortable, but the person violating this social norm may not think anything of it. Some of this can depend on the circumstances that are happening around them as well. If it's someone you know it may not be so awkward, but if it's someone you don’t know, it could be considered an abnormal behavior. Irrationality and unpredictability is another criteria for determining abnormality. This is when a person starts acting out or screaming at something for no reason. This type of behavior is unpredictable and irrational because there should be no reason for this person to be doing what they are doing at that moment. Lastly, dangerousness can help determine abnormal behavior. Dangerousness is considered abnormal when someone wants to intentionally cause harm to themselves or other people. Dangerousness is one of the most helpful when determining if a person’s behavior is abnormal; it’s an obvious behavior.
Overall, when it comes to determining abnormal behaviors, society as a whole and social judgements are always involved. This can change from year to year or decade to decade because what was considered abnormal a few years ago may not even be the cause with today’s culture and society. Diagnosing abnormal behaviors is ever changing (Hooley et al., 2020).
In the 19th and 20th centuries four major advances changed how abnormal behaviors were treated and viewed. From brain discoveries, to a new classification system, to theories about unconscious motives, and to experiments involving memory and sensation. The discoveries that were found and made has changed the way psychologists figure out if a patient is considered abnormal. The four major advances were: biological discoveries, development of an agreed-upon classification system for mental disorders, scientifically informed views about causes of abnormal psychology, and experimental psychology emerged. Biological discoveries study both the physical and mental disorders, and during this time scientists found that general paresis, which is syphilis in the brain, was a mental disorder and the scientists found some of the reasons why general paresis even existed. The development of an agreed-upon classification system for mental disorders is all thanks to Emil Kraepelin. Kraepelin put together a classification system with all of the mental disorders and grouped them together according to the similarity of symptoms (Hooley et al., 2020). He also included genetics, the course, and the outcomes of mental illnesses in his classification system. Scientifically informed views about abnormal psychology started to emerge when Freud studied decades worth of observation, treatment, and writing to develop theories about the inner dynamics of unconscious motives within a person (Hooley et al., 2020). Finally, experimental psychology emerged when Wilhelm Wundt conducted a study involving memory and sensation. Since then there have been so many advancements in technology that just about anything can be tested. (Hooley., et al 2020).
The Diagnostic and Statistical Manual of Mental Disorders (DSM), is a reference book that is used by psychologists or health care professionals. It includes descriptions and symptoms of all of the mental disorders. It acts as a guide to help professionals properly diagnose their patient. The American Psychiatric Association (APA) and the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) worked together to form something called the Cultural Formulation Interview (CFI). The CFI is an evidence-based tool that includes a series of questions that help the psychologist get a great view into the patient’s everyday life. The CFI has four domains that cover a thorough cultural evaluation that can help diagnose and plan treatments (Desilva et al., 2015). The first domain is the cultural definition of the problem. This domain asks questions such as the reason for the visit, how the circumstances are described with the people closest to the patient, and what is the most troubling thing for the patient. The second Domain is cultural perceptions of cause, context, and support. This domain is used for clarifying what the patient and his or her social network consider to be the problem. Questions used in this domain include what makes the problem better or worse, how their culture relates to the problem, and how their background causes other problems for them. Domain 3 is cultural factors that affect self-coping and past help seeking. This domain asks the patients what coping skills the patient has tried in the past by themselves to see what worked and what didn’t work for them. The final Domain is cultural factors that affect current help seeking. In this domain, the goal is to figure out what the patient prefers for future care or treatment, including the patient’s social network. This helps both the patient and the psychologist by knowing that if the patient ever needed help in the future, the patient and psychiatrist can know what to expect. It also emphasizes that it is something that the patient wants (DeSilva et al., 2015).
“Culture is defined as a set of behavioral norms, meanings, and values or reference points utilized by members of a particular society to construct their unique view of the world, and ascertain their identity” (Alarcón, R., 2009 “Culture and Cultural Factors In Psychiatric Diagnosis”). Culture plays a much bigger role into a diagnosis than the average person might expect. According to Alarcón (2009), To diagnose a patient, the patient’s cultural beliefs and background should be fully understood by the therapist. Knowing their cultural beliefs and background also includes knowing the patient’s race, ethnicity, and languages. Knowing these can unlock some questions that the therapist may have. Being able to understand and get those answers can be a huge stepping stone to getting the patient the diagnosis or help that they may need. c A few things that are suggested to be added to a modern-day diagnosis is: cultural variables, family data, pathogenic and pathoplastic factors, explanatory models, and the patient’s strengths and weaknesses. Within cultural variables, specifics that should be included is language and how it is mastered, religion and spirituality and the main rules, gender and sexual orientation, traditions and beliefs, and migration history. In family data it’s important to figure out what the patient’s eating habits, social interactions, help-seeking patterns, and activities that add value to their life. Pathogenic and pathoplastic factors should ask the questions that can answer what their rituals are, schedules, schooling, church affiliation, sociopolitical structures, and public health behavior. Explanatory models could be considered the most important factor that is suggested for a modern-day diagnosis. This type of model could answer the “why?” question as to why the patient is experiencing symptoms and why are they a “target.” It’s important to try to figure these out so they can try to help their patient try to overtake their symptoms. Lastly there is the patient’s strengths and weaknesses. This part of the exam is based off the family members or the patient’s own answers. Questions asked are: issues of self-image and self-esteem, social skills, interaction styles, or wanting a change (Alarcón, R., 2009).
When deciding to diagnose a patient with a mental illness or abnormal behavior, it is best to fully understand them. There are resources that a psychologist can use, but the best way to properly diagnose a patient is getting to know them on a deeper level, all of the other resources are ways that can back up what the psychologist is trying to accomplish. Getting to know as much as possible about the patients will be very beneficial when it comes time to decide if they should or should not be diagnosed with a mental illness.
References
- Alarcón, R. (2009, October). Culture, cultural factors and psychiatric diagnosis: Review and projections. Retrieved November 09, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755270/
- DeSilva, R., Aggarwal, N. K., & Lewis-Fernandez, R. (2015, June 30). The DSM-5 Cultural Formulation Interview and the Evolution of Cultural Assessment in Psychiatry. Retrieved November 09, 2020, from https://www.psychiatrictimes.com/view/dsm-5-cultural-formulation-interview-and-evolution-cultural-assessment-psychiatry
- Hooley, J. M., Nock, M. K., & Butcher, J. N. (2020). Abnormal psychology (18th ed.). Boston: Pearson. doi:https://revel-ise.pearson.com/courses/5f330a0bea3154001a6a64aa/contents
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