Concepts of Normal and

Concepts of Normal and. DR. S. ABUZAR RAHIMAN DEPARTMENT OF PSYCHIATRY VBMC, KURNOOL..

Normality is often defined as a pattern of thoughts, feelings and behaviours that confirms to a typical or expected standard, although this can depend upon many factors. Abnormality may be defined as a pattern of thoughts, feelings and behaviours that are deviant, distressing and dysfunctional..

Throughout the history of psychology, many approaches to defining or describing normality and abnormality in relation to mental processes and behaviour have been proposed.

Six approaches that have been influential are: Socio-cultural approach Functional approach Historical approach Situational approach Medical approach Statistical approach.

Considers normality and abnormality in terms of what a particular culture deems acceptable or unacceptable. Behaviour that is not common or not socially acceptable in a certain culture is considered abnormal whereas behaviour that is accepted and common in that culture is considered normal Example – in some cultures it would be normal to bury the deceased where in other cultures this would be considered abnormal.

The functional approach defines behaviour as normal if a person’s thoughts, feelings and/or behaviour allows them to function in everyday life Dysfunctional (abnormal) behaviour is when a person’s thoughts, feelings or behaviours interfere with daily life to the extent that the person is so upset, distracted or confused that they cannot function productively Example – a person being able to feed and clothe themselves so they could work/go to school etc would be considered normal where as a person who was so unhappy they could not get out of bed, hold relationships or a job would be considered abnormal.

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Historical Approach. The historical approach classifies behaviour as normal or abnormal according to the era in which the behaviour occurred What is considered normal behaviour can change over time While the historical approach is useful in describing the ways in which society has viewed normal and abnormal behaviour over time, it is of little use in classifying individual behaviour..

Example – Sati was considered normal behaviour till the 17th century where it is now considered more abnormal behaviour..

Situational Approach. The situational approach considers normal and abnormal behaviour within a particular society according to the time when it occurs and the situation in which it occurs Behaviour which may be considered acceptable in one situation may not be in another.

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Medical Approach.

Statistical Approach. The statistical approach considers how often thoughts, feelings and behaviours occur in relation to other people in the same sample group Persons who are greater than two standard deviations away from the mean are considered abnormal..

Biopsychosocial framework. The bio psychosocial framework is an approach to describing and explaining how biological, psychological and social factors combine and interact to influence a person’s physical and mental health The framework is based on the idea that both health and illness are best understood by considering specific factors from within each domain and how these factors may combine and influence our wellbeing.

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Biological factors refer to physiologically based or determined influences, often not under our control, such as genes we inherit and our neurochemistry Psychological factors involve all those influences associated with mental processes such as how we think, learn, make decisions etc. Sociological factors are described broadly to include such factors as our skills in interacting with others, the range and quality of our interpersonal relationships, as well as things such as culture, family upbringing, education etc. The biopsychosocial framework reflects a ‘holistic’ view of health, that is, the individual should be considered as a ‘whole person’ functioning in their unique environment..

Focusing on influencing factors from one or two of the domains, rather than all three, is likely to give an incomplete picture of a person’s health The framework therefore views each of the three domains as equally important for both physical and mental health.

Health and Illness. According to the WHO, health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or illness The WHO definition describes physical, mental and social wellbeing as being equally important.

Health and Illness. The WHO definition of health also emphasises the relationship of health to illness and disease Illness refers to a person’s subjective experience of feeling unwell in relation to one or more aspects of their health Disease refers to identifiable physiological changes associated with an abnormal bodily condition – it is a medical doctors objective findings of physiological changes to a persons body Illness does not always need to be present with disease – a person with a brain tumour (disease) may not feel unwell or ill.

Differentiating Physical Health from Physical Illness.

Differentiating Mental Health from Mental Illness.

Differentiating Mental Health from Mental Illness.

Differentiating Mental Health from Mental Illness.

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Models of mental health. Six different emperical approaches to mental health: Model A: Mental health as above normal Model B: Mental health as maturity Model C: Mental health as positive or spiritual emotion Model D: Mental health as socio emotional intelligence Model E: Mental health as subjective well being Model F: Mental health as a resilience.

Mental health as above normal. This first perspective differs from the traditional medical model to health and illness In medical model, if one were to put all individuals on a continuum, normality would encompass the major portion of adults, and abnormality would be the small reminder. This definition of health correlates with traditional role model of the doctor who attempts to free his patients from grossly observable signs of illness.

Mental health as maturity. Identity : in such a model the social radius of each developmental task fits inside the next. First adolescents must achieve an identity that allows them to become separate from their parents. The task of identity requires mastering the last task of childhood. Sustained separation from social, residential, economic and ideological dependence on family of origin..

Identity is not just a product of egocentricity, of running away from home There is world of difference between the instrumental act of running away from home and developmental task of knowing where ones family values end and ones own value begins.

Intimacy : young adults should develop intimacy, which permits them to become reciprocally ‘and not selfishly, involved with a partner. Sometimes the relationship is with a person of same gender, sometimes it is completely asexual ,and sometimes as in religious disorders ,the interdependence is with a community. Superficially ,mastery of intimacy may take very different guises in different cultures, but mating for life and marriage type love are developmental tasks built into developmental priorities of many warm blooded species , including ours..

Career consolidation: it is a task that is usually mastered together with or that follows mastery of intimacy. Mastery of this task permits adults to find a career as valuable as they once found play. There are four crucial developmental criteria that transform a job or a hobby into career-Contentment,Compensation,Competence,Commitment. To the outsider this process of career consolidation appears as a selfish but without this one becomes selfless and has no self to give away in the next stage of Generativity..

Not only schizophrenics , but also individuals with severe personality disorder often manifest a lifelong inability to achieve either intimacy or sustained , gratifying employment..

Generativity : it involves the demonstration of a clear capacity to care for and guide the next generation. Depending upon the opportunities that the society make available, generativity can mean serving as a consultant, guide ,mentor or coach to young adults in the larger society. Like leadership generativity means to be in a caring relation ship in which one gives up much of control that parents retain over children..

Generativity reflects the capacity to give the self –finally completed through mastery of the first three tasks of adult development-away. Its mastery is strongly correlated with the successful adaptation to old age..

Integrity : finally in old age it is common to feel that some life exists after death and that one is part of something greater than ones self Thus the last task in Erikson’s words is integrity ,the task of achieving some sense of peace and unity with respect both to ones life and whole world..

He described integrity as an experience which conveys some world order and spiritual sense. Admittedly, healthy adult development doesnot follow rigid rules . Some often due to great stress tackle developmental tasks out of order or all at once. We have inspirational and generative leaders in their 20’s like Alexander , Napolean , Joan of Arc , On the otherhand William Osler who did not confront the task of intimacy till 40years.And also Ludwing enjoyed a brilliant n commited carrer but never enjoyed intimacy..

Mental health as positive or spiritual emotions. This model defines both mental and spiritual health as the amalgam of positive emotions that bind us to other human beings Love, hope, joy ,forgiveness ,compassion, faith and gratitude comprise the important positive and moral emotions included in this model. Negative emotions originating in hypothalamus such as fear and anger are elaborated in the human Amygdala..

Of tremendous importance to individual survival the negative emotions are all about me. In contrast ,positive emotions apparently generated in the limbic system and unique to mammals ,have potential to free the self from self..

Mental health as socio emotional intelligence. High socio-emotional intelligence reflects above average mental health in the same way that a high intelligence quotient reflects above average intellectual aptitude. Aristotle defined socio-emotional intelligence as follows : any one can become angry –that is easy. But to be angry with right person ,to the right degree and in right way is not easy..

All emotions exists for basic survival. Although the exact number of primary emotions is inarguable, seven emotions are currently distinguished according to characteristic facial expression. They are anger, fear, excitement, interest, surprise, disgust and sadness. The capacity to identify these different emotions in ourselves and in others play an important role in mental health ..

Ethologically, emotions are critical to mammalian communication, because such communications are not always consciously recognised, the more skillful individuals are in identifying their emotions, the more skilled the individual will be in communicating with others and empathically recognising their emotions.

Social and emotional intelligence can be defined by following criteria : Accurate conscious perception and monitoring of ones emotions Modification of emotions so that their expression is appropriate. Accurate recognition of and response to emotions of others. Skill in negotiating close relationship with others. Capacity for focussing emotions towards a desired goal..

Mental health as subjective well being. Positive mental health does not just involve being a joy to others, one must also experience subjective well being. For ex: objective social support accomplishes little if subjectively the individual cannot feel loved. Thus capacity for subjective well being becomes an important model for mental health ..

Subjective well being is not just absence of misery, but the presence of positive contentment. Through centuries philosophers have sometimes regarded happiness as highest good, but psychologists and psychiatrists tended to ignore it. On one hand” no man is happy who does not think himself so ”. Happiness that comes from joy or unselfish love and deep but effortless reflects health..

On the other hand, subjective happiness can have maladaptive as well as adaptive facets. The search for happiness can appear, selfish, narcisstic, superficial. Pleasure can come easily and be soon gone. Happiness is often based on illusion or dissociative states. Illusionary happiness is seen in BPAD. Examples of maladaptive happiness can be excitement from risk taking, being high on drugs, binge eating, temper tantrums and revenge. Maladaptive happiness can bring temporary bliss but has no sticking power..

Mental Health as Resilience. Claude Bernard stated that “We shall never have a science of medicine as long as we seperate the explanation of pathological from explanation of normal, vital phenomena. Adolf Meyer contributed to understanding of Mental health that there were no mental diseases and these were only characteristic patterns to stress. Much of what is called mental illness like symptoms of anxiety disorders, depression and most personality disorders are outward manifestations of homeostatic struggles to adapt to life..

There are 3 broad classes of coping strategies that humans use to overcome stressful situations. First, “Consciously seeking social support” the way in which an individual elicits help from appropriate others Second, ”Conscious cognitive strategies” that are intentionally used to master stress. Third, ”Adaptive involuntary coping mechanisms” that distort our perception of internal and external reality in order to reduce subjective distress, anxiety and depression..

Involuntary coping mechanisms. Involuntary coping mechanisms reduce conflict and cognitive dissonance during sudden changes in internal and external reality. These defences shield us from sudden changes in 4 lodestars of impulse- Affect and emotion, reality, people and social learning. This being called “id” Firstly these can restore psychological homeostasis by ignoring or deflecting sudden increases in affect and emotion..

Second, such can provide a mental time to adjust to sudden changes in reality and self image which cannot be immediately integrated. Third, these can also mitigate sudden unresolvable conflict with important people living or dead. Eg; Death. Finally, the fourth source of conflict is social learning called “superego” which is formed by our whole identification with culture and sometimes by irreversible learning from overwhelming trauma..

Healthy involuntary mental mechanisms: Humour : humour makes life easier. With humour one sees all, feels much, but does not act. humour permits the discharge of emotion without individual discomfort and without unpleasant effects upon others. Altruism: when used to master conflict, altruism involves an individual getting pleasure from giving to others what the individual would have liked to receive..