Definitions of abnormality: failure to function adequately
The failure to function adequately definition of abnormality sees mental disorders as resulting from an inability to cope with day-to-day living. Behaviour is perceived as abnormal when individuals become so distressed with the pressures of everyday life that their behaviour becomes dysfunctional, for example, when an individual’s ability to work properly is affected or when individuals cannot conduct normal interpersonal relationships. Due to an inability to cope with life, harmful behaviours are indulged in, like heavy drinking or drug taking. Such behaviours are themselves dysfunctional, but also contribute to further declines in personal functioning, leading to a diagnosis of abnormality.
Rosenhan & Seligman (1989) proposed that personal dysfunction has 7 features and that the more of these features an individual has, the more they are classed as abnormal:
1 Personal distress, which is seen as a key feature of abnormality and involves such things as depression and anxiety disorders
2 Maladaptive behaviour, which consists of exhibiting behaviour that prevents people from realising their life goals, both socially and at work
3 Unpredictability, which consists of exhibiting unexpected behaviours characterised by a loss of control, like mutilating oneself after a relationship is terminated
4 Irrationality, which consists of exhibiting behaviours non-explicable in any rational way, like heavy drinking in response to work pressures
5 Observer discomfort, which entails the exhibition of behaviours that cause discomfort to others, like behaving in an aggressive manner
6 Violation of moral standards, which consists of exhibiting behaviours that go against society’s ethical standards, like being naked in a public place
7 Unconventionality, which entails the exhibition of non-standard behaviours, like dressing in the clothes of the opposite gender.
An overall assessment of how well individuals can cope with life is made by clinicians using the Global Assessment of Functioning scale (GAF), which rates levels of social, occupational and psychological functioning. In general, this is a definition used by clinicians that focuses on individuals’ perceptions of their own mental health and is judged through criteria such as ’can hold down a job’, ’is able to dress themself’ etc.
Most people who seek clinical help do so because they see themselves as suffering from psychological problems that interfere with their ability to function normally, both socially and at work. Therefore, sufferers’ perceptions of their problems match the criteria of the definition, giving it support.
The GAF scale, used by clinicians to calculate an individual’s overall level of functioning, is scored on a continuous scale. It therefore allows clinicians to see the degree to which individuals are abnormal and helps them to decide who needs what degree of psychiatric help.
The definition permits judgement by knowledgeable others, as to whether individuals are functioning properly, because it focuses on observable and therefore measurable behaviour. This also allows the formation of a practical ’checklist’ of factors that individuals can use to assess their own level of abnormality.
As the definition recognises the importance of the role of the personal experience of individuals, it permits mental disorders to be regarded from the personal perspective of the individuals suffering from the disorders, therefore giving a greater depth of understanding to the definition.
Although an individual’s behaviour may be distressing to others and perceived as an inability to function adequately, it may bring no distress to the individual and be perceived by them as perfectly functional. For example, Stephen Gough is known as the ’naked rambler’ for his long-distance walks that he conducts in the nude. He has been jailed many times for his behaviour, which he sees as perfectly normal and which causes him no distress.
Mental disorders are not always accompanied by personal dysfunction; indeed the opposite may be true. Harold Shipman, a Lancashire doctor, displayed an outwardly normal disposition, while over a 23-year period as a doctor he murdered at least 215 of his patients before killing himself in prison.
Some of the features comprising ’adequate functioning’ are subjective and difficult to define and measure objectively. This also applies to individual differences between people; what is normal behaviour for introverts, like wearing non-flamboyant clothes, would be completely different for extroverts. The definition fails to incorporate this.
Fig 4.1 Harold Shipman
A great practical application of the definition is that it permits a large element of self-diagnosis by individuals. Using a checklist of factors to assess their own level of abnormality, individuals are then able to seek clinical help through self-recognition that this is necessary. Most people receiving clinical help sought it themselves in the first instance.