1. Kardinia International College
Unit 4 Psychology Final Review Series
AOS 2: Mental Health

2. Concepts of Normality
Normality: Normality is considered to be what is acceptable or what can be expected to happen in most circumstances.
In a clinical context, it is a condition that does not require treatment or assistance.

3. EXPLANATION OF NORMALITY
MODEL
EXPLANATION OF NORMALITY
EXAMPLE
BEHAVIOURAL
Behaviour is seen as the result of learning according to the principles of classical and operant conditioning or modelling. Abnormal responses can be treated through new learning via counterconditioning within behaviour therapy
Gambling
Phobias
BIOPSYCHOSOCIAL
A more eclectic, holistic approach that incorporates psychological, biological and societal influences to define behaviour
Stress
Depression
Schizophrenia
COGNITIVE
Cognitive processes are at the centre of behaviour, thought and emotions. They determine ones attitudes and assumptions and views of the world. Dysfunctional behaviour results when this view is flawed or inaccurate. Treatment in this approach involves therapy sessions, which work to change self-defeating beliefs and behaviours by demonstrating their irrationality and rigidity
FUNCTIONAL
Focuses on how effectively an individual is able to do what is expected in everyday life, taking into account the adaptiveness of the behaviour and how it affects the wellbeing of the individual or the social group
Addiction
Anxiety Disorders
Mood disorders
HISTORICAL
As many behaviours evolve and change over time, the definition of normal behaviour involves an examination of the customs, habits and traditions within a particular society / culture to identify what it views as acceptable during a particular era
Smacking children was once permitted, but is now discouraged
Homosexuality was once classified as a mental disorder, but now it is not

4. Normal = Health Abnormal = Sick, ill Dementia Schizophrenia Phobias
MEDICAL
Describes normality in terms of physical health and its underlying physiological causes. Abnormal behaviour is seen as caused by an illness that usually has a physiological or biological cause, which can be diagnosed according to symptoms and signs of disorder, treated and, in most cases, cured by therapeutic methods within a hospital or clinical setting.
Normal = Health
Abnormal = Sick, ill
NEUROBIOLOGICAL
An aspect of the medical approach to normality focussing on the role of the brain and nervous system in behaviour
Dementia
Schizophrenia
PSYCHODYNAMIC
Human behaviour is determined by underlying, usually unconscious, psychological influences. These influences (also called forces) are dynamic in that the relationship between them gives rise to behaviour. Abnormal behaviours result when conflicts arise in the relationship.
Phobias
Depression
SITUATIONAL
Normality is related to the factors to do with context (location or place) used to determine whether behaviour is typical or acceptable within that context
Wearing pyjamas is all right for going to bed, but not for attending school.
SOCIOCULTURAL
Describes normality in terms of what a particular society or culture views as acceptable. Normality is based on influences of nationality, religion, ethnic group, peer group, family or other relevant groups. This approach identifies inappropriate behaviour so that social norms may prevail for the harmonious functioning within a particular society or culture.
Wearing a kilt
Eating raw fish
Walking around naked
STATISTICAL
Conclusions about normality are made on the basis of the analysis of numerical data and calculations as to the way that most people behave. Common measures are mean, median and mode pertaining to the normal distribution curve.
Height
Weight IQ

5. Differentiation of Mental Health from Mental Illness
Mental Health: A state of emotional and social wellbeing in which a person can fulfil his or her abilities, cope with normal stresses of life, work productively and be able to contribute to the community. With sound mental health, individuals feel good about themselves and are able to get on with their lives smoothly.
Mental Health Problem: Where a person’s feelings, thought and actions are negatively affected in an intermittent, transient or short term situation.
Mental Illness: A health condition that affects the way a person thinks, feels and acts and that causes the person distress and difficulty functioning. The condition is overwhelming to the point where the individual has great difficulty coping with day-to-day activities and maintaining relationships. Symptoms occur for significantly longer periods of time than is the case with a mental health problem.

6. Systems of Classification of Mental Conditions and Disorders:
Categorical Approaches to classifying mental disorders are those that place common symptoms in categories or groups.
Examples of categorical approaches are:
Diagnostic and Statistical Manual of Mental Disorders – IV, text Revision (DSM-IV-TR)
The International Classification of Diseases-10 (ICD 10).

7. Underlying Principles of Classification;
Classification Systems allow clinicians and researchers to:
Standardise the description and interpretation of mental disorders – provides clarity and eliminates ambiguity
Provide vocabulary and a clinical shorthand to facilitate communication between professionals
Predict a conditions prognosis (future course)
Consider appropriate treatment
Encourage research into their etiology (cause or origin)
Encompass all known types (of mental disorders).
Serve as an educational tool for teaching psychopathology

8. DSM-IV-TR
Prepared by the APA and regularly revised, the DSM-IV-TR provides a classification of 365 mental disorders in 16 categories.
It also provides criteria sets to help guide the process of differential diagnosis, descriptions of how frequently the disorder occurs in the general population & numerical codes for each disorder for medical record keeping. It does not detail the causes of conditions.
It includes a system of 5 axes or dimensions (Multiaxial System) for assessing all aspects of a patient’s metal and emotional health.

9. DSM-IV-TR Multiaxial System
DESCRIPTION
EXAMPLE
AXIS I
Mental disorder/s that have been diagnosed. A person can suffer from more than one.
Includes all of the mental health conditions except personality disorders and mental retardation
Bipolar disorder
Pathological Gambling
AXIS II
Personality disorders or mental retardation (intellectual disability)
Borderline personality disorder
Moderate mental retardation
AXIS III
General medical conditions
High Blood Pressure
Asthma
AXIS IV
Psychological and environmental factors
Death of a friend
Educational problems
Housing problems
Economic problems
Work difficulties
AXIS V
Global Assessment of functioning
Based on psychological wellness
A score of 1-10 indicates that someone is severely unwell
A score of indicates someone has superior functioning

10. ICD-10
The major international system for the classification of mental disorders – prepared by the World Health Organisation (WHO).
Chapter 5 covers 300 ‘mental and behavioural disorders’.
The ICD-10 has more general categories using a broad aetiology

11. Strengths & Limitations of Discrete Categorical Assessment Tools: DSM-IV-TR & ICD-10
A major advantage of classification systems for mental disorders is that inappropriate behaviours can be distinguished from functional ones.
A range of mental disorders are arranged, organised and described in a particular manner and order. Psychologists and other mental health practitioners use these manuals as they provide a common language for therapists, researchers, social agencies and health workers worldwide. This aids diagnosis, selection of appropriate treatments / therapies for the given conditions.
It allows for consistent diagnoses and treatments from hospital to hospital, clinic to clinic, all over the world.
The DSM-IV-TR does not explain the causes of the various psychological disorders.
This approach ‘boxes people into one of the available categories, sometimes inappropriately, and it does not accommodate the unique nature of the human condition.
These classifications do not account for people who have ‘atypical’ symptoms or those that do not clearly follow the ‘script.
Critics claim that categorical systems reduce humans to one-dimensional sources of data rather than encouraging practitioners to treat the whole person.
Critics also see these systems as tools for social control – giving mental health professionals control over people’s lives.

12. Systems of Classification of Mental Conditions and Disorders:
Dimensional Approach:
Example:
MMPI: Minnesota Multiphasic Personality Inventory:
The dimensional approach is a method of categorising mental illness where an individual has a profile of scores on different continuums of diagnoses and symptoms. Clinicians grade or rate the severity of the symptoms or disorder by allocating a score or grade on specified dimensions.

13. Strengths & Limitations of Dimensional Assessment Tools: MMPI etc
Dimensional classification does not attempt to place people into discrete, diagnostic categories. Instead, key characteristics are identified upon which all persons can be placed, recognising that mental disorders lie on a continuum with mildly disturbed and normal behaviour, rather than being qualitatively distinct.
The dimensional approach is better able to capture many of the subtleties and complexities of person’s life that are missed within the categorical systems.
The dimensional approach evaluates symptoms not only on their presence, but also on their severity or degree.
The distinction between normal and abnormal is not absolute, but rather a zone where there can be a varying degree of the symptom or characteristic.
Dimensional approach is more nuanced and provides an accurate reflection of the state of a given characteristic or symptom in a person.
It allows sufferers to see improvement in their condition more readily and help to identify which factors have the largest impact on their well-being.
In making a diagnosis using the dimensional approach there is much scope for variable judgements on the part of the clinician evaluating or rating the symptom or characteristic – much more inconsistency in its use.
The dimensional approach increases the complexity of the communication of the disorder to fellow professionals and the public.
Most theorists cannot agree on how many dimensions are required; some say one dimension is enough, while others have identified as many as 33 dimensions.

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