1. DEFINING “ABNORMALITY” OR CONSTRUCTING PSYCHOPATHOLOGY?: LECTURE OUTLINE Some warnings about “abnormality” Difficulties defining abnormality Thomas Szasz (1960) – the myth of mental illness Rosenhan (1973) – on being sane in insane places Myths and misconceptions Various ways of defining abnormality

2. SOME WARNINGS Clinician’s bias – look for abnormality and you will find it Tendency to focus on problems and ignore the whole person and her/his strengths Fundamental attribution error – tendency to downplay the importance of the environment as contributing to problems – are people “abnormal” or doing the best they can to cope in stressful circumstances?

3. SOME WARNINGS Words can hurt – “crazy”, “wacko”, “psycho” are inappropriate All this can lead us to turn the individual into one of “those people,” uncovering societal prejudices towards people with mental health problems that we may have internalized

4. SOME WARNINGS So, focus on the person first, the problem second; and look at the person in context Use “people first” language – person’s proper name or more generally, e.g., “person experiencing depression”; avoid language like “a schizophrenic”

5. SOME WARNINGS Pay attention to how mental illness is portrayed in the media Use STOP criteria to think about stigma – Stereotype, Trivialize, Offend, Patronize Recognize the potential for recovery Think critically, be a skeptic, question current views!

6. DIFFICULTIES DEFINING ABNORMALITY What is considered to be “abnormal” is a value judgment, assumption that normality is clearly defined. But what is normality? Some warning signs for normality – serious, nice, always right, boring, obedient, gullible (Janet Foner, Support Coalition Survivor and Psychiatric Survivor) – please note this is a joke!

8. DIFFICULTIES DEFINING ABNORMALITY Values depend on social context, and values and social context are variable Are individuals abnormal or are social conditions stressful? Defining abnormality is a social act

9. THE MYTH OF MENTAL ILLNESS Psychiatrist Thomas Szasz argued that mental illness does not exist, but rather problems in living No known lesions, defects, or diseases of the nervous system underlie any mental illness “symptoms” of mental illness are not linked to anatomical context, but to social context

10. THE MYTH OF MENTAL ILLNESS Deviation from social norms is judged by mental health professionals Whose agent is the mental health professional? (the person, relatives, organization, the state) Psychiatry is different than other branches of medicine, more tied to problems of ethics and values

11. ROSENHAN (1973) – ON BEING SANE IN INSANE PLACES 8 “pseudo” patients sought admission to hospitals voices – “empty”, “hollow”, “thud” no simulation of symptoms after admission all except 1 admitted with diagnosis of schizophrenia, discharged with “schizophrenia in remission”

12. ROSENHAN (1973) – ON BEING SANE IN INSANE PLACES this is an example of the clinician’s bias detection “stickiness” of diagnostic labels - stigma experiences of hospitalization powerlessness and depersonalization

13. MYTHS AND MISCONCEPTIONS People with mental illness are strange and different People with mental illness should be treated differently Mental illnesses are inherited Mental illnesses are incurable Mental illnesses are caused by the stresses of modern life

14. MYTHS AND MISCONCEPTIONS Mental illness and genius go hand in hand Mental illnesses is caused by personal weakness and can be overcome through will power People with mental illness are irrational and dangerous People with mental illness need to be hospitalized

15. MYTHS AND MISCONCEPTIONS People with mental illness are poor People with mental illness are less intelligent than others All homeless people are mentally ill Mental illness is a single, rare disorder

19. SUMMARY Abnormality and mental illness are problematic concepts because of values and social context Remember that mental illness is not something absolute and unchangeable, but a concept that is constructed in a social context