4Ds

Question 1

AO1/Description- Deviance

Answer 1

• Social Norms=agreed ways of acting/ ‘normal ways’
• Those who break them are abnormal (abnormal in society)
• E.g. Schizophrenia, OCD, Dissociative identity disorder, Hearing voices
• Effected by: culture, context, age, gender and historical context
• Can also be ‘statistical deviation’- those in society who have a characteristic which is infrequent are ‘abnormal’ i.e. Sz only effects 1% of the population, if you’re more than 2Sd away from the mean then you might be abnormal

Question 2

AO1/Description- Dysfunction

Answer 2

• Behaviour that interferes with a person’s everyday life is one way to diagnose mental disorders.
• Dysfunction can affect their working life.
• Inability to function normally, live life effectively etc is abnormal
• Ties to Rosenthal and Seligman ‘Failure to function’
• Suffering, Maladaptiveness, Vividness / Unconventional behaviour, Unpredictability & loss of control, Irrationality & incomprehensibility, Observer discomfort

Question 3

AO1/Description- Distress

Answer 3

• An abnormal behaviour is abnormal because it causes upset to the individual. i.e. they are unhappy with the symptoms they experience
• E.g. OCD, Phobia, Depression, Schizophrenia
• Can be thought of on a continuum (persistent and serious is concern)
• Deals with subjective experience

Question 4

AO1/Description- Danger

Answer 4

• People who are a danger to themselves or others (usually because of faulty thinking/behaviour) are abnormal
• E.g. self-harm, suicide and violence
• Can be thought of on a continuum (varying degrees of danger to themselves or others)

Question 5

AO3/Evalution- Deviance

Answer 5

• Subjective to those making the diagnosis/decision about whether someone has broken the social norm or not
• Thomas Szasz suggests that this is particularly a problem and that this D is an example of ‘social control’ in his work ‘the myth of mental illness’ we take behaviours which we see as negative and use our power to diagnose them as a mental health issue.
• It does not consider anything about the patient other than do they fit within norms (reductionist).
• This also means it isn’t directly helping/concerned with the patient wellbeing
• The fact that this takes into account so many factors which make something a social norm e.g. gender, age, historical context etc it makes this a little more holistic as a definition as it doesn’t just say there is only one social norm. One clear example is the inclusion of ‘context’ as a factor which takes into account the fact that different behaviours may be allowable in different situations.
• However, a problem with this is given enough factors it becomes very difficult to classify things as abnormal.
• Effected by cultural differences
• This definition runs into problems because many behaviours break social norms without actually being considered as a mental health problem i.e. crime breaks social norms, therefore questioning the validity of this definition.

Question 6

AO3/Evalution- Dysfunction

Answer 6

• Subjective in the assessment of whether something is dysfunctional or not
• However, we do try to create objective measures of this D which doctors can use to test various illnesses, for example the 5th axis of DSM IV measured ‘global functioning’ which measures this.
• This definition is better than deviance as it considers the life quality of the patient as a factor in whether their behaviour is abnormal or not as a key factor
• This definition runs into problems because many behaviours are dysfunctional without being classes as an abnormality i.e. repeated drunkenness therefore questioning the validity of this definition.

Question 7

AO3/Evalution- Distress

Answer 7

• Subjective in the assessment of whether something is distressing or not
• However, we do try to create objective measures of this D which doctors can use to test various illnesses, for example the 5th axis of DSM IV measured ‘global functioning’ which measures this.
• This definition is better than deviance as it considers the life quality of the patient as a factor in whether their behaviour is abnormal or not as a key factor. In this case whether their illness causes them distress or not.
• There is a problem with subjectivity with this one too as the exact same behaviour might be considered abnormal in one patient but not in another patient depending on their distress.
• This definition runs into problems because many behaviours cause distress but aren’t themselves counted for example over-eating, binge drinking, weight gain or remaining in an unhappy relationship without actually being considered as a mental health problem therefore questioning the validity of this definition.

Question 8

AO3/Evalution- Danger

Answer 8

• Subjective
• However, we do try to create objective measures of this D which doctors can use to test various illnesses, for example the 5th axis of DSM IV measured ‘global functioning’ which measures this.
• This definition is better than deviance as it considers the life quality of the patient as a factor in whether their behaviour is abnormal or not as a key factor. In this case whether their illness makes them a danger to themselves or others.
• This definition runs into problems because many behaviours that may be dangerous which aren’t themselves counted e.g. smoking, drinking, driving quickly consistently without actually being considered as a mental health problem therefore questioning the validity of this definition.

Question 9

AO3/Evalution- Overall

Answer 9

• The DSM focuses on the Four Ds, showing each has validity and is useful. For example, in the DSM, it’s not enough for schizophrenia to include deviant behaviour; distress must also be present as well as dysfunction.
• The lack of objectivity of the four Ds raise issues about reliability of diagnosis. If the four Ds are used by two different therapists, they may not reach the same diagnoses. For example, Dissociative Identity Disorder (multiple personality) is a recognised disorder in the USA but not in Britain.
• Timothy Davies proposes that a 5th D - Duration - needs to be included. Grief is a good example, because a period of grief is normal after the death of a loved one (in fact, not grieving would be abnormal) but if the grief goes on too long then that becomes abnormal instead. Another example is the different types of schizophrenia. Schizophrenia Undifferentiated requires symptoms to have lasted for more than a few hours, whereas Schizophrenia Disorder is a possible diagnosis if symptoms have lasted for a month but not longer than six months