Abnormality

From time immemorial, individuals have recognized a small minority of members of their societies as psychologically "abnormal." The research of Jane Murphy (1976) further demonstrates that people in non-Western cultures, such as the Yorubas of Nigeria and the Yupic-speaking Eskimos of Alaska, readily recognize certain behaviors as abnormal. Moreover, many of these behaviors, such as talking to oneself, are similar to those regarded as abnormal in Western society. Murphy's findings suggest that the concept of abnormality is not entirely culturally relative.

Nevertheless, these observations leave unanswered a crucial question: What is abnormality? Surprisingly, a definitive answer to this question remains elusive. In this entry, we examine several conceptualizations of abnormality and their strengths and weaknesses. All of these conceptualizations strive to provide a definition of abnormality that encompasses both physical and mental disorders, although most place primary emphasis on the latter.

The first and most radical conception examined here is that abnormality is entirely a function of societal values. According to this subjective values model, which has been championed by Thomas Szasz (1960), abnormal conditions are those deemed by society to be undesirable in some way. Although this model touches on an important truth— namely, that many or most abnormal conditions are perceived as undesirable—it does not explain why many socially undesirable behaviors, such as rudeness, laziness, and even racism, are not perceived as pathological. A comprehensive definition of abnormality involves more than subjective values. This fact helps to explain in part why Harvard psychiatrist Alvin Poussaint's (2002) recent efforts to include extreme racism in the current diagnostic manual have met with little success.

Proponents of a statistical approach, such as Henry Cohen (1981), posit that abnormality can be defined as statistical deviation from a norm. Thus, any behavior that is rare is abnormal. Although this conceptualization is appealing in its simplicity, it suffers from several shortcomings. First, the cutoff points for abnormality are scientifically arbitrary. Should abnormality be defined as the uppermost 1% of the population, the uppermost 3%, or some other figure? Second, a statistical approach provides no guidance regarding which dimensions are relevant to psychopathology. As a consequence, it erroneously classifies high levels of certain socially desirable dimensions, such as creativity and altruism, as abnormal. Third, a statistical approach mistakenly classifies all common conditions as normal. For example, it implies that the bubonic plague ("Black Death"), which killed approximately one third of Europe's population in the fourteenth century, was not abnormal because it was widespread.

Some writers, such as F. Kraupl Taylor (1971), have embraced the pragmatic position that abnormality is nothing more than the set of conditions that professionals treat. According to this view of disorder as whatever professionals treat, psychologically abnormal conditions are those that elicit intervention from mental health professionals. Although this view avoids many of the conceptual pitfalls of other definitions, it does not explain why many conditions treated by professionals, such as pregnancy, a misshapen nose corrected by plastic surgery, and marital conflict, are not per se regarded as pathological.

Advocates of a subjective discomfort model maintain that abnormal conditions are those that produce suffering in affected individuals. Although many psychopathological conditions, such as Major Depressive Disorder, clearly produce considerable subjective distress, several others, such as psychopathy (a condition characterized by guiltlessness, callousness, and dishonesty) and the manic phase of bipolar disorder (a condition characterized by extreme levels of elation, energy, and grandiosity), are often associated with minimal subjective distress. Moreover, like the statistical model, the subjective discomfort model provides no guidance concerning what cutoffs should be used to define abnormality. How much discomfort is required for a condition to be pathological?

Most of the aforementioned definitions focus on subjective judgments concerning the presence of abnormality. In contrast, proponents of a biological model, such as R. E. Kendell (1975), contend that abnormality should be defined by strictly biological criteria, particularly those derived from evolutionary theory. For example, Kendell argued that abnormal conditions are characterized by a reduced life span, reduced biological fitness (the capacity of an organism to transmit its genes to future generations), or both. Despite its potentially greater scientific rigor relative to other models, a biological model is subject to numerous counterexamples. For example, being a soldier in a war tends to reduce one's longevity but is not a disorder; priesthood (which results in having no children) tends to reduce one's fitness but is similarly not a disorder. Moreover, a biological model falls victim to the same problem of arbitrary cutoffs that bedevils the statistical model: How much below average must life span or fitness be for a condition to be abnormal?

Whereas some of the preceding conceptualizations of abnormality invoke primarily social criteria, such as value judgments, others invoke primarily biological criteria. Jerome Wakefield (1992) suggests that the proper definition of abnormality requires both social and biological criteria. Specifically, he posits that all abnormal conditions are "harmful dysfunctions." The harm component of Wakefield's conceptualization refers to social values regarding a condition's undesirability, whereas the dysfunction component refers to the failure of a system to function as "designed" by natural selection. For example, Panic Disorder is abnormal, according to Wakefield, because (1) it is viewed by society as harmful and (2) the fear system was not evo-lutionarily designed to respond with intense anxiety in the absence of objective danger. Wakefield's analysis is a significant advance in the conceptualization of abnormality, because it distinguishes those features of abnormality that are socially constructed from those that are scientifically based. Nevertheless, his analysis assumes that all disorders involve failures of psychological or physiological systems. Yet some disorders, such as Post-Traumatic Stress Disorder and perhaps other anxiety disorders, probably represent evolved defensive reactions to subjectively perceived threats. Moreover, Wakefield's analysis presumes the existence of a clear-cut demarcation between adaptive function and dysfunction. But the functioning of many systems, such as the anxiety system, may be distributed continuously, with no unambiguous dividing line between normality and abnormality.

In response to the problems with earlier efforts to provide an adequate definition of abnormality, some authors, such as David Rosenhan and Martin Seligman (1995) and Scott Lilienfeld and Lori Marino (1995), have proposed a family resemblance model of abnormality. According to this model, the concept of abnormality cannot be explicitly defined, because abnormality is an inherently fuzzy concept with indefinite boundaries. Instead, conditions perceived as abnormal share a loosely related set of characteristics, including statistical rarity, maladaptiveness, impairment, and the need for treatment. The family resemblance view implies that all efforts to construct a clear-cut conceptualization of abnormality are doomed to failure. Nevertheless, this view implies that there will often be substantial consensus regarding which conditions are perceived as abnormal, because individuals rely on similar features when identifying abnormality.

REFERENCES

Cohen, H. (1981). The evolution of the concept of disease. In A. Cap-lan, H. Engelhardt, & J. McCarthy (Eds.), Concepts of health and disease: Interdisciplinary perspectives (pp. 209-220). Reading, MA: Addison-Wesley.

Kendell, R. E. (1975). The concept of disease and its implications for psychiatry. British Journal of Psychiatry, 127, 305-315.

Kraupl Taylor, F. (1971). A logical analysis of the medico-psychological concept of disease. Psychological Medicine, 1, 356-364.

Lilienfeld, S. O., & Marino, L. (1995). Mental disorder as a Roschian concept: A critique of Wakefield's "harmful dysfunction" analysis. Journal of Abnormal Psychology, 104, 411-420.

Murphy, J. M. (1976). Psychiatric labeling in cross-cultural perspective. Science, 191, 1019-1028.

Poussaint, A. F. (2002). Yes: It can be a delusional symptom of psychotic disorders. Western Journal of Medicine, 176, 4.

Rosenhan, D., & Seligman, M. (1995). Abnormal psychology (3rd ed.). New York: Norton.

Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15, 113-118.

Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373-388.

Scott O. Lilienfeld Emory University

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