We’ve reached a point in society where judgments have been made about what constitutes the wellbeing of its citizens. Actually, we've been been doing this in one form or another for quite some time, but the net result for mental health is anything that promotes individual growth is viewed as normal but behavior that prevents or limits growth and independence is considered abnormal. If such criteria strike you as just a little clunky then I would agree. The sub-text is that behavior seen as conforming, dependable and reliable is easy for group cohesion. Anything outside of this we tend to consider as deviant – at which point there are implications.
Who at some points in their life isn’t maladaptive? Who hasn’t become angry, anxious, depressed or done things that are dangerous, risky or just stupid? What differentiates these behaviors as acceptable is the frequency, the context, the way in which others are affected, and whether everyday living suffers as a result. What remains is our subjective value as to the tipping point between adaptive and maladaptive behavior. Essentially it comes down to impaired functioning, bizarre behavior and disruptive behavior.
The judgment call over impaired functioning comes down to a couple of things. The first of these is whether a reason is known as to the cause and the second is the duration. Is it normal or abnormal to keep losing a job when there is no obvious reason this should happen, or for an academically gifted person to fail exams? The lack of justification seems to be an important factor in deciding whether a person has impaired functioning, but this isn’t sufficient to regard the individual as abnormal.
Serious forms of mental illness are more generally associated with bizarre forms of behavior. Hearing voices and delusions, for example, have no rational basis and can cause the individual to behave in unusual ways, often as means for their own protection, but sometimes because of a belief outside forces are controlling them. Cultural trends involving dress, make-up, bizarre hair styles and the like may appear odd or sometimes threatening but the motivation is understood and the person is otherwise unaffected.
When I worked in psychiatry a commonly held view was that society could tolerate most things involving impaired functioning and bizarre behavior so long as it wasn’t disruptive. Disruption, in this respect, involves seemingly uncontrollable behavior that deprives others of their rights, threatens them, or causes a danger. The point about danger is key because our current systems state if the person is a danger to others or themselves, it’s a problem that should be addressed – usually by treatment. To an extent this works well with the more overt forms of disruptive behavior that tend to be coupled with hallucinations and delusions and where impaired functioning is clear. It perhaps works less well with people who are exploitative, aggressive, and that appear to lack conscience but who also manage to function within society in ways that appear adaptive.
Our history is full of interesting milestones. There was a time, not so long ago, when homosexuality was viewed as abnormal behavior and open to cure. Abnormal behavior has been associated with ‘badness’ and it has also had strong religious and moral dimensions. My first experience of long-stay mental institutions was an eye-opener in this respect. Some of the older residents appeared to have been incarcerated for little more than having a child out of wedlock.
Depending on who you read current estimates suggest that up to 20 percent of the general population has some form of psychological or psychiatric disorder. It will be interesting to see how history evaluates our current attempts at distinguishing adaptive from maladaptive behavior and what does and does not require treatment.
Published On: October 22, 2013