Psychopatho Lect1

NORMALITY AND
ABNORMALITY IN MENTAL
HEALTH
1
Dr. Gema Simbee
Psychiatrist
Mirembe Hospital
INTRODUCTION
 Mental health is not the opposite of mental
disorder
 Mental health is a positive state of mind in

which one enjoys and posses a zest for life
 Itis a state of mind in which the individual is

able to experience sustained joy of life while
working productively, interacting with others
meaningfully and facing adversity without
losing capacity for physical, psychological 2
and social functioning.

INTRODUCTION 2
 Tobe in this state one has to enjoy good
physical, psychological and social well-
being
 Therefore the state of mental disorder or

mental abnormality can not just be a state of
mind that is just short of mental health as
this would include many people who do not
enjoy optimal mental health
3
INTRODUCTION 3
 Absence of gross psychopathology does not
constitute optimal mental health and just
falling short of optimal mental health does
not constitute mental abnormality
 In
physical health it is easier to determine
the distinction between normality and
abnormality
 Surgeons can for example independently 4
agree on the existence of a tumour or ulcer.

INTRODUCTION 4
 Inmental health an arbitrary cut off point
between normality and abnormality has to
be decided upon based on the degree of
disturbance or impairment of functioning
 There
are 4 perspectives of defining
normality in mental health:
 Normality and health
 Normality as utopia
 Normality as average
5
 Normality as process
NORMALITY AND HEALTH
 Normality as Health – this is the traditional
clinical approach to health and illness.
 Behaviour is assumed to be within normal
limits if there is no manifest
psychopathology
 If behaviour was to be placed on a scale,
normality would be a continuum of most
of it and abnormality a small fraction
 Health is absence of signs and symptoms
 Health is reasonable rather than optimal 6
state of functioning
CULTURAL RELATIVISM
 This
is related to cultural relativism in which
abnormality is a label that society gives to
behaviour that deviates from social
expectations in an undesirable way.
 Different
societies even within one country
may have difficulties in agreeing on whether
malingering, homosexuality is normal or
abnormal, whereas
 Mostcommunities agree that sexual activity 7
between an adult and a minor is grossly

CULTURAL RELATIVISM 2
 Another difficulty with this approach is that
cultural norms also change over time, just
witness the developing tolerance of
homosexuality in the West
 In
ancient Greek civilization homosexuality
was acceptable and even condoned
 Thisperspective also assumes that there

cannot be a ‘sick’ society, only ‘sick’ people 8
in society
NORMALITY AS UTOPIA
 Normality as utopia – is harmonious and
optimal blending of the diverse elements of
the mind in optimal functioning
 Positiveenjoyment, joyful interaction with

others and the environment, joyful
achievements of life’s goals and enjoying an
appetite for life and all its rewards
 In
this perspective emphasis is on positive 9
aspects of adjustment and functioning

REASONABLE INSTEAD OF UTOPIA
 Reasonable state of mental health –
drawn from the utopian view is more
practical
 Reasonable rather than ideal state of

mental health that is rarely achieved
 An estimate rather than a precise scientific

construct
10
 This in addition to absence of physical,
psychological and physical discomforts
REASONABLE INSTEAD OF UTOPIA 2
 In this approach emphasis is on practical
criteria of abnormality observed in clinical
groups (discomfort, bizarreness and
inefficiency)
 Discomfort such as worry is examined by a
professional who determines that it is
abnormal or not
 Bizarreness may include such deviations as
delusions
 Pronounced inefficiency demonstrated by 11
marked fall off of functioning

 Thisperspective includes personal criteria
of normality
 One’s
own self-appraisal psychological
comfort or discomfort
 One’s own self-appraisal of capacity to

function psychologically
12
 Often employed in mental health except in
psychotic conditions when the patient
reports that he is enjoying being god but
relatives are very concerned at how
disturbed he is!
 Selfreporting also fails in transitory

emotional disturbances that are in keeping
with changing fortunes of life
13
 Examples include normal grief reaction

NORMALITY AS AVERAGE
 Normality as average – is based on
mathematical principle of normal distribution
(the bell-shaped curve)
 Deviations from middle range would be
deviant
 Variability is described only in the context
of total groups not within the context of
the individual
 If an undesirable behaviour was to be
taken up by the majority it would cease to
be abnormal! 14
NORMALITY AS AVERAGE 2
 Mentalabnormality in this sense is defined
as behaviour that deviates from the norm
 The difficulty is that many gifted people

would not be normal in this sense, their
intelligence or creativity being outside two
deviations from the mean
15
NORMALITY AS PROCESS
 Normality as process – stresses that
normal behaviour is the result of interacting
systems
 Temporary changes are taken into
account in definition of normality
 Cross-sectional view is not as important
as observation of the process and
changes
 This approach accords with Erikson’s
theory of epigenesis of personality
development and the 8 developmental 16
stages to mature adult functioning
INTEGRATION OF THE PERSPECTIVES
 Integration of these 4 perspectives of
normality in mental health approximates
practice in delineating normality from
abnormality,
 normal range of behaviour from deviant
forms
 ability to function from disturbance to non
function
 presence of emotional discomfort and
absence of it. 17
OFFER AND SABIN’S
LONGITUDINAL STUDIES
 The longitudinal studies of adolescents
identified three normal types of
development:
 continuous growth,
 surgent growth,
 and tumultuous growth
 Different but on a continuum of normality
18
OFFER AND SABIN’S
LONGITUDINAL STUDIES 2
 Criteriaof normality emanating from this:
1. Almost complete absence of gross
pathology psychologically and physically
2. Mastery of previous developmental tasks

without serious setbacks
3. Abilityto experience emotional states

flexibly and to resolve conflicts actively
19
with reasonable success
OFFER AND SABIN’S
4. values relatively good relationships
with parents, siblings and peers
5. Feeling part of a larger cultural

environment and being aware of its
norms
20
OFFER AND SABIN’S
 Valliant
and others also use developmental
approach for adults.
 Studies
on adaptation to marriage,
parenthood, work and leisure activities
 Inold age, normative research asks:

 How do older people cope and adapts to
tasks presented by being 75 and beyond?
21
PROPORTION OF POPULATION
WITH MENTAL DISORDERS
 Employing various instruments developed
for estimating mental disorders in the
community, one year point prevalence
varies from 12 to 70 percent
 Thelower figure represents members of the

community who presents with more
psychological symptoms and signs
22

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NORMALITY AND

 Mental health is a positive state of mind in

 Itis a state of mind in which the individual is

and social functioning.

 Therefore the state of mental disorder or

 Surgeons can for example independently 4

agree on the existence of a tumour or ulcer.

 Mostcommunities agree that sexual activity 7

between an adult and a minor is grossly

 Thisperspective also assumes that there

 Positiveenjoyment, joyful interaction with

aspects of adjustment and functioning

 Reasonable rather than ideal state of

 An estimate rather than a precise scientific

marked fall off of functioning

 One’s own self-appraisal of capacity to

 Selfreporting also fails in transitory

 Examples include normal grief reaction

 The difficulty is that many gifted people

 Different but on a continuum of normality

2. Mastery of previous developmental tasks

3. Abilityto experience emotional states

5. Feeling part of a larger cultural

 Inold age, normative research asks:

 Thelower figure represents members of the

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