1 Introduction to Abnormal Psychology

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Learning Objectives

After reading this chapter, you should be able to:

• Define abnormal behavior.

• Discuss the history of mental illness.

• Identify the major theorists and theoretical orientations in psychology.

• Discuss the DSM–5.

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Section 1.1 How Do We Define Abnormal Behavior?

1.1 How Do We Define Abnormal Behavior? If you were to poll a random sample of average people, most would say that they know abnor- mal behavior when they see it. They might assess at-a-glance someone’s behavior as strange, odd, or sick, and they would quickly give reasons for their assessment. Let’s look at an exam- ple of potentially odd behavior that will illustrate this point.

You are walking in your neighborhood on a gorgeous summer afternoon, listening to your favorite songs on your smartphone. Suddenly, without warning, a man runs out from behind the bushes across the street. This wouldn’t usually catch your eye, but you notice that this man has no clothes on. He is running frantically while trying to cover himself with his hands, all the while looking behind him. Before you know it, the man disappears around the corner. Was the man’s behavior abnormal? Do you think he is likely to present a danger to himself or, more important, to other people? Answering questions like these helps practicing psycholo- gists to achieve one of their goals: to ascertain whether an individual’s behavior is abnormal, and to ascertain whether their behavior presents a danger to the individual or to others.

Three Perspectives of Abnormality Psychopathology refers to the study of the causes and development of psychiatric disorders. Many practitioners in the mental health professions (psychologists, social workers, counsel- ors, and psychiatrists, to name a few) agree that it is extremely difficult to arrive at a universal definition of abnormal behavior (Gelo, Vilei, Maddux, & Gennaro, 2015). They agree in gen- eral about what the term means, but they often use different perspectives to define it. Three perspectives commonly used by psychologists are the statistical frequency perspective (behavior is abnormal according to the statistics), the social norms perspective (behavior is abnormal according to the standards set by society), and the maladaptive perspective (behavior is abnormal because it interferes with the individual’s ability to function on a daily basis). Each perspective has its own usefulness and limitations, as discussed in the following sections.

The Statistical Frequency Perspective The statistical frequency perspective labels behavior as abnormal if the behavior exists in (or is exhibited by) only a minority of the population. This definition thus calls behaviors that are numerically rare abnormal. The majority of the “normal” population would fall into the middle range of a bell-shaped curve (when split in half the left side of the curve is a mirror image of the right side). As one moves away from the middle range in either direction, the per- son could be classified as being statistically more extreme and therefore as behaving abnor- mally (Helzer & Hudziak, 2002). An immediate problem with this definition: A person who falls on an extreme end of the frequency distribution would be considered abnormal based on the statistical frequency definition (falling into about 2.2% of the population), but he or she indeed might not be abnormal. Consider a gifted scientist or musician. Mozart, a prodigy, would be considered abnormal based on this definition, as would Einstein.

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Section 1.1 How Do We Define Abnormal Behavior?

A few presumptions here need to be examined. First, this perspective presumes that the gen- eral population’s behavior is considered to be normal. However, what is considered normal today wasn’t necessarily considered normal a hundred years ago, and what’s normal in New York City might not be considered all that normal in New Delhi. For example, consider the following routine: Someone wakes up, eats breakfast, goes to work, has lunch, goes home, eats dinner, spends some time with family, watches television, and then goes to bed. This is a routine that many working adults in the United States follow on a daily basis. Therefore, the general population would consider this to be normal behavior.

So what would you then make of the following: Instead of going to work every day and fol- lowing the previously outlined routine, an individual goes to the beach at 8 a.m. and lies on a blanket until the sun sets, each and every day? Or what about this possibility: A man goes to the beach with a blanket and a guitar, sits on the boardwalk, strums away while singing folk songs, and has a sign asking for handouts as he has lost his job due to a bad economy. Is this considered normal behavior based on current standards in the United States? Or is this behavior crossing over to abnormal behavior?

What about the man described earlier who ran naked from behind bushes? Do people usually run through the streets naked anywhere in the United States? And if the statistical perspec- tive tells us that this is extremely uncommon behavior, does that automatically mean that the individual’s behavior must be abnormal?

The Social Norms Perspective The social norms perspective states that behavior is abnormal if it deviates greatly from accepted social standards, values, or norms. Norms are spoken and unspoken rules for proper conduct. These are established by a society over time and are subject to changes over time. Two types of norms used to assess whether behavior is abnormal are legal norms and psy- chological norms. Legal norms tend to dictate how individuals should behave in the realm of their civic surroundings and with regard to their friends and neighbors. In other words, a legal norm is a mandatory rule of social behavior that is established by the state. If someone is labeled a criminal, his or her behavior violates legal norms as determined by that society. For example, the naked running man described earlier may be demonstrating abnormal behavior based on legal norms, since he could be arrested for indecent exposure.

Behaviors, thoughts, and emotions are also considered to be abnormal if they violate the norms set out by psychologists. Psychological disorders are categorized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM–5), published by the American Psy- chiatric Association (described in more detail later in this chapter). The psychological norms perspective would involve using diagnostic criteria in the DSM–5 to determine if the pattern of such behaviors is likely to point to a mental disorder. For example, Michael Jackson was surely one of the most famous individuals in the world. However, he demonstrated unusual, perhaps odd, and maybe even abnormal behaviors at times. He often wore surgical masks when he was out in public. Perhaps more unusual was how he dressed his children when they went out. He would often cover his children’s faces or heads with blankets, Halloween-style masks,

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Section 1.1 How Do We Define Abnormal Behavior?

burqas, or disguises. Are these behaviors abnormal? It would likely seem so to many observ- ers. However, what if Jackson had a phobia about germs and was afraid of being exposed to cold viruses or other pathogens? What if he had a compromised immune system and there- fore needed to keep his face covered? Perhaps he covered his children’s faces to protect them from kidnappers, since he was an instantly recognizable and very wealthy pop star. Do these latter explanations now make Jackson’s behaviors more rational and therefore not abnormal?

The Maladaptive Perspective The statistical frequency perspective views behavior as abnormal if it occurs with statistical infrequency relative to the general population. A person can function, and might be consid- ered very talented, if his or her behavior is statistically infrequent, like Mozart or Michelan- gelo. The maladaptive perspective, while seemingly similar to the statistical frequency per- spective, views behavior as abnormal if it interferes with the individual’s ability to function in life or in society. By this we mean the ability to work, take care of oneself, and have normal social interactions. Do you think the naked running man is able to function in everyday life? Can you even make these kinds of judgments without knowing much about him? If nothing else, you can say that this naked individual appears to be somewhat unusual. However, is his behavior abnormal or indicative of mental illness? Let’s look at another example.

There is a woman in your neighborhood whom you see often. She works a regular 9-to-5 job, but you notice that it takes her a while to leave for work. You have noticed that she engages in some rather “unusual” yet regular routines before she finally heads off. You notice that it takes her a long time to leave the house. She goes back inside at least five or six times, disappears for a few minutes, and then returns outside. She locks her door, then returns at least four times to make sure it’s locked. When she finally gets in her car and drives off, she returns a few minutes later to ensure the garage door is closed. You also notice that when she finally leaves for good, the time is 10 a.m. Based on the maladaptive perspective, this woman’s behaviors interfere with her everyday life. She is able to function, but her daily rituals make her late for work every day. She has extreme difficulty leaving the house until she is absolutely certain that all the doors are locked and that her gas oven and range are turned off (we will discuss behaviors like this in more detail in Chapter 3,which covers obsessive-compulsive and related disorders).

Other Considerations Let’s consider several other factors used to classify abnormal behavior. First, is a person’s behavior endangering the individual or other people? Often this is not the case. The idea that individuals who have a mental illness are dangerous or violent people, like Adam Lanza, Omar Mateen, or Charles Manson, is simply not true (see the accompanying Highlight). Most indi- viduals with a mental illness are not dangerous, and of those who are, most are more likely to pose a threat to themselves than to others.

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Section 1.1 How Do We Define Abnormal Behavior?

Highlight: How Would We Categorize Mass Shooters?

By definition, a school shooting is a form of mass shooting involving a gun attack on an educational institution, such as a school or university. The U.S. Secret Service defines them as shootings in which schools are “deliberately selected as the location for the attack” (Vossekuil, Fein, Reddy, Borum, & Modzeleski, 2004, p. 4). Let’s use the Newtown, Connecticut shooting as an example. On December 14, 2012, Adam Lanza, age 20, entered the Sandy Hook Elementary School in Newtown, and fatally shot 20 children who were 6 or 7 years old, as well as six adult staff members. Prior to driving to the school, Lanza shot and killed his mother at their Newtown home. As first responders arrived at the scene, Lanza killed himself by shooting himself in the head. This was the deadliest mass shooting at a high school or grade school in U.S. history and at the time was the third-deadliest mass shooting by a single person in U.S. history. What could cause a 20-year-old to murder his mother, then drive to an elementary school and murder 20 young children? A report issued by the Connecticut State’s Attorney’s Office (Sedensky, 2013) concluded that Lanza acted alone and planned his actions, but none of the evidence collected provided any indication as to why he did so, or why he targeted the school. This leads to many questions, many of which remain unanswered. Colleagues and I are often asked how we would categorize someone like Lanza.

How about Omar Mateen? On June 12, 2016, Mateen, a 29-year-old security guard, killed 49 people and wounded 53 others in a terrorist attack/hate crime inside Pulse, a gay nightclub in Orlando, Florida. Pulse was hosting Latin Night and most of the victims were Latino. At the time, it was both the deadliest mass shooting by a single shooter and the deadliest act of violence against LGBT people in U.S. history. While not a school shooting, this incident was somewhat easier to classify. Regardless, what would cause someone to enter a nightclub where people go to dance and to have fun, and systematically murder 49 patrons? Is this someone who has a mental illness? How about Lanza, who was previously diagnosed with Asperger’s syndrome as well as obsessive-compulsive disorder? Just because we have agreed-upon models to help us define abnormal behavior does not mean we can always explain its causes or the reasons some people do certain things. We also need to exercise caution. When a clear explanation for an individual’s behavior is lacking, does this mean we should not provide treatment to the individual?

Balkis Press/Sipa USA/AP Photos On June 12, 2016, Omar Mateen killed 49 people and wounded 53 in an attack on Pulse, a gay nightclub in Orlando, Florida.

(continued)

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Section 1.1 How Do We Define Abnormal Behavior?

Another consideration is whether the individual’s behavior is causing him or her distress. Not all abnormal behavior causes stress to the individual. In many cases, the individual’s family or loved ones are more distressed than the individual is. This makes it especially important for the family to be involved in as many aspects of treatment as possible. For example, suppose you have a friend who finds it impossible to dispose of old newspapers. The papers are piling up around his house, eventually making it difficult to enter certain rooms and creating a fire hazard. You ask him about this, and he says he “needs to keep them” in case he must refer to an article for his job as a Wikipedia editor. He appears not to be bothered by his actions, yet he becomes uncomfortable when you start to gather up some of the papers for removal. Thus, his behavior is not causing him stress, but trying to change his behavior does create stress.

Finally, we must consider factors such as the duration, the age of onset, and the intensity of the behavior(s). By duration, we mean the length of time the troublesome behaviors have existed. By age of onset, we mean the age at which the troublesome behaviors first become noticeable. This is especially important, since some mental illnesses cannot be diagnosed until an individual has reached a certain age, or cannot be diagnosed once an individual has passed a certain age. By intensity, we mean how extreme the behaviors in question are.

So, where does our naked running man fit? Let’s see if more information about him helps to clear up the picture. This man is a sophomore at a major university in the United States. He is a psychology major and has made the dean’s list, a status granted only to the best students.

Highlight: How Would We Categorize Mass Shooters? (continued)