1' INTRODUCTION

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1. INTRODUCTION

• Broad goals of lectures
• The problem who legitimately are subjects of
  study in psychopathology?
• Questions
• what is abnormal behaviour?
• who are legitimate subjects?
• what are social or political complications?
• Wakefield science/facts and values

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2. NEED TO DEFINE

• Why is there a need to carefully define?
• Scientific reason
• Professional reason
• Ethical reason
• Claim confusion of scientific facts with social,
  cultural, political agendas (Hook Parker,
  2002)
• What criteria to decide who is abnormal?

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3. Psychopathology, deviance and abnormal
behaviour.

• Abnormal psychology or psychopathology (medical
  study of diseases of psyche).
• psychiatric expertise rests on a secure
  collection of bare facts (Hook, 2002)
• Danger of essentialist assumptions vs seeing
  psychiatric conditions as socially constructed
• Claim abnormal psychol related to deviance
• Regulation of how people think and behave.

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3.1. Deviance and social control.

• Deviance failure to conform to social or
  cultural norms in thought, speech, behaviour,
  values etc.
• Social control social, psychological, political
  mechanisms to control deviance.
• Discrimination against the other.

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3.1. Deviance and social control contd.

• Range of forms of deviance
• criminal
• subcultural
• ideological
• existential
• illness
• For example killing another

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3.1. Deviance and social control contd.

• Social control of deviance is controversial
  because a political act.
• Danger that diagnosis and treatment of
  psychiatric disorder may really be a form of
  social control of deviance.
• Guise of treating people suffering as a result of
  biological, factual conditions.

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3.2. Psychopath social control.

• Psychopath claims to be concerned with medical
  illness
• Risk that really social control of deviance
• Szasz and anti-psychiatry movement
• Myth of mental illness / Manufacture of madness
• manifest and latent processes
• Malcolm Lader Amnesty International
• Medicalization as social control
• Examples
• Scottsville - Jeffrey Dahmer

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3.2. Psychopath social control contd

• Is there deviance?
• What forms of deviance? (See categories)
• Should deviance be controlled and how?
• How can we decide whether the deviance or
  abnormality arises from a medical or
  psychologically dysfunction?
• The very decisions about (a)-(d) can be coloured
  by values as much as facts.

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3.3. Psychopath and definition of normality.

• How has psychopath defined abnormal behaviour?
• For example, homosexuality or schizophrenia
• Development of theoretical models.
• Statistically abnormal
• Socially or culturally abnormal
• Normative-organismic abnormality

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3.3. Psychopath and definition of normality
contd.

• Danger of confusing facts/values.
• ..individualistic, decontextualized,
  essentialized, organic forms of sickness (Hook,
  p.34)
• Essentialist notions of normality
• Soft version recognizing cultural context
• Radical version social construction of
  psychiatric conditions

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3.4. Conclusions about deviance, abnormality
and psychopathology

• Psychopath as arbitrary, value-driven, rather
  than factual and scientific.
• Risk of seeing psychopath as essentialist and
  decontextualized
• Deviance from norms not sufficient for deciding
  on mental illness

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3.4. Conclusions about deviance, abnormality
psychopathology contd

• Defining and treating abnormality is inherently
  political
• Caution in systems such as DSM about use of
  criteria around normality

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4. Normality Debate Alternatives

• 4.1. Ego syntonic/dystonic distinction
• Ego syntonic conditions
• Ego dystonic conditions

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4.2. Maladaptive behaviour

• Maladaptive behaviour "refers to behaviour
  that fails to maintain an effective interaction
  between the person and his environment, in terms
  of meeting personal maintenance requirements and
  those of significant others" (Ballis, p.41)

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4.2. Maladaptive behaviour contd

• Recognizes people operate in context
• Moves away from
• essentialist notions of psychopath
• conformity to social norms
• Towards criterion of effectiveness of behaviour
  in context

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4.2. Maladaptive behaviour contd

• Basis for many disorders in DSM
• Homosexuality
• DSM-II homosexuality (conformity)
• DSM-III ego-dystonic homosexuality
  (effectiveness)
• DSM-IV disappears (neither)
• Schizophrenia deterioration is social, personal
  and occupational functioning

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4.2. Maladaptive behaviour contd

• still reservations
• the arbitrary question of who decides on
  effectiveness ?
• can still inherently be an act of political
  control.
• criterion of effectiveness can still present
  scientific facts as disguise for values

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4.3. Dysfunctional behaviour.

• Widely used in abnormal psychology
• Moves away from normative to evolutionary
  framework
• Wakefield adaptiveness of behaviour as major
  criterion for health
• Efficacy of behaviour in terms of function for
  survival (and adjustment)
• When mechanisms do not serve survival functions
  for which they are designed, they are
  dysfunctional

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4.3. Dysfunctional behaviour.

• Easy to apply to physical mechanisms, but more
  difficult with mental mechanisms.
• Dysfunction is necessary, but not sufficient for
  (psychiatric) disorders.
• Dysfunction provides factual aspect of
  disorder.

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4.3. Dysfunctional behaviour contd

• Barlow defines dysfunction Psychological
  dysfunction refers to a breakdown in cognitive,
  emotional or behavioural functioning.
• But what is a breakdown. Tautological.
• Wakefields defn is more precise and
• Provides a harder criterion for function in terms
  of evolutionary survival.

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4.4. Disordered behaviour

• Distinction disorder vs dysfunction?
• Wakefield, Barlow and DSM partly define disorder
  in terms of dysfunction
• Disorder a psychological dysfunction
  associated with distress or impairment in
  functioning that is not a typical or culturally
  expected response
• Consistent with DSM which requires subjective
  distress or impaired function
• Recognizes context e.g. Ukuthwasa experience

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4.4. Disordered behaviour contdWakefields
version

• Wakefield suggests that disordered behaviour
  requires scientific facts and social values.
• Scientific fact dysfunctional behaviour
• Social values human context which renders it
  harmful
• Latter defined by social cultural context
• Both criteria are necessary
• Similar to Barlow better defn of function

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4.4. Disordered behaviour contdWakefields
version contd

• Only dysfunctions that are socially devalued
  (and therefore harmful) are disorders.
  (Wakefield, p.384)
• The dysfunction must cause significant harm to
  the person under present environmental
  circumstances and according to present cultural
  standards (p.383)

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4.4. Disordered behaviour contdWakefields
version contd

• A disorder is a disorder if, and only if, (a)
  the condition causes some harm or deprivation of
  benefit to the person as judged by the standards
  of the persons culture, and (b) the condition
  results from the inability of some internal
  mechanism to perform its natural function,
  wherein a natural function is an effect that is
  part of the evolutionary explanation of the
  existence and structure of the mechanism (p.384).

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4.4. Disordered behaviour contd problems with
concept.

• Both scientific facts and social values are
  necessary to define disorder
• only facts risks essentialism
• only values risk of social controll
• Even Wakefields notion is not without
  difficulty.
• functionality of mental processes more difficult
  to establish than physical
• values may influence assessment of function

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4.4. Disordered behaviour contd problems with
concept.

• Dysfunction is a purely scientific concept.
  However, discovering what in fact is natural or
  dysfunctional may be extraordinarily difficult
  and may be subject to scientific controversy,
  especially with respect to mental mechanisms,
  about which we are still in great ignorance.
  (Wakefield, p.383)

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4.4. Disordered behaviour Homosexuality as
example

• Example Is homosexuality a disorder?
• Is it dysfunctional? Only if reproduction is
  criterion of sexuality.
• What if homosexuality is more adaptive?
• Is it harmful? To person or society? Back to
  ego-syntonic vs ego-dystonic

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4.4. Disordered behaviour contd Controversies
according to Wakefield

• .agreement about the facts of function and
  dysfunction might not lead to agreement about
  which conditions are disorders because of
  difference in values. Such value differences,
  rather than any dispute over facts, may be what
  makes some diagnostic controversies, such as that
  over the pathological status of homosexuality, so
  intractable (p.386).

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5. DSM and mental disordered.

• "In DSM-III each of the mental disorders is
  conceptualized as a clinically significant,
  clinical or behavioural syndrome or
  pattern....that is typically associated with
  either a painful symptom (ego-dystonic) or
  impairment in one or more important areas of
  functioning (syntonic/dystonic). In addition
  there is an inference that there is a
  behavioural, psychological or biological
  dysfunction, and that this disturbance is not
  only between the individual and society
  (deviance). When the disturbance is limited to a
  conflict between the individual and society,
  this deviance, which may or may not be
  commendable (see categories of deviance), is not
  by itself a mental disorder."

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5.1. DSM and mental disorder contd.

• Demarcates particular subcategory of deviance to
  avoid risk of social control.
• Clear recognition of harm.
• inference of dysfunction types of
• This may be an unrecognized effect of values.
• Explicitly takes account of context.
• Inconsistency e.g. PTSD.