Chapter 11 - Normality, mental health and mental illness

Question 1

What are the six approaches to defining normality and abnormality?

Answer 1

• Socio-cultural approach
• Functional approach
• Historical approach
• Situational approach
• Medical approach
• Statistical approach

Question 2

Describe the socio-cultural approach.

Answer 2

Thoughts, feelings and behaviour that are appropriate or acceptable in a particular society or culture are viewed as normal and those that are inappropriate or unacceptable are considered abnormal (e.g. loud crying at the funeral of a stranger).

Question 3

Describe the functional approach.

Answer 3

Thoughts, feelings and behaviour are viewed as normal if the individual is able to cope with living independently (‘function’) in society, but considered abnormal if the individual is unable to function effectively in society (e.g. being able to feed and clothe yourself, find a job, hold relationships with others).

Question 4

Describe the historical approach.

Answer 4

What is considered normal or abnormal in a particular society or culture depends on the era, or period of time, when the judgment is made (e.g. smacking children).

Question 5

Describe the situational approach.

Answer 5

Within a society or culture, thoughts, feelings and behaviour that may be considered normal in one situation may be considered abnormal in another.

Question 6

Describe the medical approach.

Answer 6

Abnormal thoughts, feelings or behaviour are viewed as having an underlying biological cause and can usually be diagnosed and treated.

Question 7

Describe the statistical approach.

Answer 7

This approach is based on the idea that any behaviour or characteristic in a large group of individuals is distributed in a particular way. Generally, if a large majority of people (the statistical average) thinks, feels or behaves in a certain way, it is considered normal.

Question 8

How is normality often defined?

Answer 8

It is often defined as a pattern of thoughts, feelings or behaviour that conforms to a usual, typical or expected standard.

Question 9

What factors influence what is considered to be a ‘usual, typical or expected standard’?

Answer 9

• All thoughts, feelings and behaviour originate from a cultural context.
• The specific situation/context in which a thought, feeling or behaviour is expressed in.
• The quality of an individual’s functioning in different situations in everyday life.

Question 10

How is abnormality defined?

Answer 10

It is defined as a pattern of thoughts, feelings or behaviour that is deviant, distressing and dysfunctional.

Question 11

When are thoughts, feelings or behaviour considered to be deviant?

Answer 11

When they differ or vary so markedly from social or cultural norms ‘governing’ behaviour that they can reasonably be considered inappropriate or unacceptable.

Question 12

When are thoughts, feelings or behaviour considered to be distressing?

Answer 12

When they are unpleasant and upsetting to the person experiencing them and/or others around them.

Question 13

When are thoughts, feelings or behaviour considered to be dysfunctional?

Answer 13

If they interfere with the person’s ability to carry out their usual daily activities in an effective way.

Question 14

According to the World Health Organisation, what is health?

Answer 14

Health is a state of complete physical, mental and social wellbeing and not merely the absence of illness or disease.

Question 15

What does physical wellbeing involve? Give examples.

Answer 15

Physical wellbeing primarily involves the body (e.g. exercising regularly, eating a well-balanced diet, getting rest when required, maintaining a body weight that is appropriate).

Question 16

What does mental wellbeing involve? Give examples.

Answer 16

Mental wellbeing primarily involves the mind (e.g. expressing feelings calmly, rationally thinking about personal problems, approaching life with a view that there is much to be learnt through experience throughout the lifespan).

Question 17

What does social wellbeing involve? Give examples.

Answer 17

Social wellbeing primarily involves personal relationships and interactions with others (e.g. getting along with family, friends and acquaintances, giving and receiving social support when needed, making and keeping friends).

Question 18

Define illness.

Answer 18

Illness is a person’s subjective experience of feeling unwell in relation to one or more aspects of their health, and involves how an individual thinks and feels about their physical, mental and/or social wellbeing.

Question 19

How can the symptoms of illness be described?

Answer 19

They can either be acute (sudden in onset, lasting for a short duration) or chronic (having a gradual onset, and being frequently recurring or longlasting).

Question 20

Define disease.

Answer 20

Disease refers to identifiable physiological changes associated with an abnormal bodily condition. It is a medical doctor’s objective findings of physiological changes that are common to all people with a particular disease and have been documented by the medical profession.

Question 21

Describe the relationship between illness and disease.

Answer 21

Although disease often accompanies illness, it is possible to have a disease and not feel ill, or for someone to feel ill even though a doctor cannot find evidence of any known disease.

Question 22

What does the term physical health refer to?

Answer 22

Physical health refers to the body’s ability to function efficiently and effectively in work and leisure activities, to be in good condition, to resist disease and to cope in threatening or emergency situations.

Question 23

What are some signs of physical health?

Answer 23

Having a normal temperature, heart rate, blood pressure, cholesterol level, breathing rate, eyesight and hearing; feeling bright and alert; having regular and normal stools and normal urine; having healthy gums.

Question 24

What does the term physical illness refer to?

Answer 24

Physical illness refers to our subjective experience of a disease or physical health problem that interferes with the normal functioning of our body and adversely impacts on our ability to function effectively in everyday life.

Question 25

What is mental health?

Answer 25

The capacity of an individual to interact with others and the environment in ways that promote subjective wellbeing, optimal development throughout the lifespan and effective use of the person’s cognitive, emotional and social abilities.

Question 26

What are some characteristics of people who are mentally healthy?

Answer 26

They can:
• form positive relationships with others
• cope with the normal stressors arising in everyday life.
• think logically and clearly
• manage feelings and emotions
• experience pleasure and enjoyment
• use their abilities to reach their potential

Question 27

What are some characteristics of people with a mental health problem?

Answer 27

They may:
• feel tense, low, irritable, quiet, confused, angry
• experience increased or decreased sleep and appetite
• experience a loss of energy and motivation
• feel that things are somehow ‘different’
• have difficulties concentrating
• become withdrawn

Question 28

What are some examples of mental disorders?

Answer 28

• Anxiety disorder (e.g. phobia)
• Mood disorder (e.g. depression)
• Psychotic disorder (e.g. schizophrenia)
• Impulse control disorder (e.g. gambling)

Question 29

What is mental illness?

Answer 29

A psychological dysfunction that usually involves impairment in the ability to cope with everyday life, distress, and thoughts, feelings and/or behaviour that are atypical of the person and may also be inappropriate within their culture.

Question 30

What is psychological dysfunction?

Answer 30

A breakdown in cognitive, emotional and/or behavioural functioning, thereby interfering with the person’s ability to adjust to the challenges of everyday life and carry out some or all of their usual daily activities in an effective way.

Question 31

What is the biopsychosocial framework?

Answer 31

An approach to describing and explaining how biological, psychological and social factors combine and interact to influence a person’s physical and mental health.

Question 32

What are biological factors in relation to the biopsychosocial framework?

Answer 32

Biological factors involve physiologically based or determined influences, often not under our control, such as the genes we inherit or our neurochemistry.

Question 33

What are psychological factors in relation to the biopsychosocial framework?

Answer 33

Psychological factors involve all those influences associated with mental processes such as how we think; learn; make decisions; solve problems; perceive our internal and external environments; perceive, understand and experience emotions; manage stress; reconstruct memories etc.

Question 34

What are social factors in relation to the biopsychosocial framework?

Answer 34

Social factors are described broadly to include such factors as our skills in interacting with others, the range and quality of our inter-personal relationships, the amount and type of support available from others when needed, as well as socio-cultural factors such as our cultural values and traditions, family upbringing, exposure to trauma and stressors, educational and employment history, income level and access to medical care.

Question 35

Describe three characteristics of the biopsychosocial framework.

Answer 35

• It reflects a holistic view of health, viewing the ‘whole person’ functioning in their unique environment.
• It views each of the three domains as equally important for both physical and mental health.
• It shows how factors often combine and interact in a complex way.

Question 36

What is a categorical approach?

Answer 36

A system of classifying mental conditions and disorders by organising and describing mental conditions and disorders in terms of different categories and subcategories, each with symptoms and characteristics that are typical of specific mental conditions and disorders.

Question 37

What is the all-or-nothing principle of a categorical approach?

Answer 37

An individual either has a diagnosable mental disorder or does not have a diagnosable mental disorder.

Question 38

What is a key principle of categorical approaches in relation to the symptoms of a mental disorder?

Answer 38

A mental disorder can be diagnosed from specific symptoms reported and/or presented by a client during a mental health assessment conducted by a qualified mental health professional. This is based on an assumption that thoughts, feelings and behaviour can be organised into categories representing disorders.

Question 39

What does validity mean in relation to the categorical approach?

Answer 39

Validity means that the classification system actually organises mental disorders into discrete and distinct disorders and enables diagnosis and classification of a discrete and distinctive disorder that accurately represents the symptoms that have been assessed.

Question 40

What does reliability mean in relation to the categorical approach?

Answer 40

Reliability means that the classification system produces the same diagnosis each time it is used in the same situation.

Question 41

What does inter-rater reliability indicate?

Answer 41

Inter-rater reliability indicates the degree to which different mental health professionals diagnose the same client with the same mental disorder.

Question 42

How many mental disorders are comprehensively described in the DSM-IV-TR?

Answer 42

365

Question 43

How many categories are the mental disorders in the DSM-IV-TR grouped into?

Answer 43

16 major categories, with one additional section (‘other conditions that may be a focus of clinical attention’).

Question 44

What are diagnostic criteria?

Answer 44

They enable identification of each disorder in the DSM by indicating the symptoms that are characteristic of the disorder and therefore enable assessment of the presence of the disorder.

Question 45

What are inclusion and exclusion criteria?

Answer 45

Inclusion criteria are used to identify the symptoms that must be present in order for the disorder to be diagnosed. Exclusion criteria identify the symptoms, conditions or circumstances that must not be present in order for the disorder to be diagnosed.

Question 46

What are polythetic criteria?

Answer 46

Polythetic criteria sets are a list of diagnostic criteria in which only some symptoms, not all, need to be present in order for the disorder to be diagnosed.

Question 47

What other information is provided by the DSM?

Answer 47

The typical course of each disorder, the age where a person is most likely to develop the disorder, the degree of impairment, the prevalence (frequency) of the disorder, whether the disorder is likely to affect others in the family, and the relationship of the disorder to gender, age and culture.

Question 48

What is absent from the DSM?

Answer 48

There is no mention of theories about the specific causes of the disorder unless a cause can be definitely established.

Question 49

What does DSM stand for?

Answer 49

The Diagnostic and Statistical Manual of Mental Disorders.

Question 50

What are the five axes in the DSM-IV-TR multiaxial system?

Answer 50

I. Clinical disorders and other conditions that may be a focus of clinical attention.
II. Personality disorders and mental retardation.
III. General mental conditions.
IV. Psychosocial and environmental problems.
V. Global assessment of functioning (GAF).

Question 51

Give examples of problems considered in axis IV of the DSM-IV-TR.

Answer 51

• Problems with primary support groups.
• Problems related to the social environment.
• Educational problems.
• Occupational problems.
• Housing problems.
• Problems with access to health care.
• Legal problems

Question 52

What is the GAF?

Answer 52

The Global Assessment of Functioning provides an overall numerical rating on a 100-point scale. The higher the score on the GAF, the more effectively the person is considered to be functioning in everyday life.

Question 53

What does ICD stand for?

Answer 53

The International Classification of Diseases and Related Health Problems

Question 54

Who is the ICD published by?

Answer 54

The World Health Organisation

Question 55

Where is the ICD primarily used?

Answer 55

Europe

Question 56

How many chapters are contained in the ICD-10?

Answer 56

It consists of 21 chapters that cover the whole of medical practice.

Question 57

When was the ICD-10 published?

Answer 57

1992

Question 58

What chapter of the ICD-10 are mental disorders located?

Answer 58

Chapter V

Question 59

What are diagnostic guidelines?

Answer 59

Diagnostic guidelines identify the symptoms that are characteristic of the disorder and therefore indicate the presence of the disorder.

Question 60

List some similarities between the DSM-IV-TR and the ICD-10.

Answer 60

• Both are categorical systems.
• Both are used to help mental health professionals decide whether or not a person has or doesn’t have a particular mental disorder.
• Both list the symptoms that are characteristic of each mental disorder.
• Both have multi-axial systems available for mental health professionals to use.
• Both do not specify the causes of each mental disorder.
• Both do not specify how each mental disorder should be treated.
• Both have categories and subcategories.

Question 61

List some differences between the DSM-IV-TR and the ICD-10.

Answer 61

• The ICD does not provide information about the course, prognosis and prevalence of each disorder.
• The ICD has a number of different versions whereas the DSM has only one.
• The list of symptoms that are characteristic of the disorder are called ‘diagnostic criteria’ in the DSM and ‘diagnostic guidelines’ in the ICD.
• The ICD has 11 categories, while the DSM has 16 + 1.
• The ICD covers the whole of medical practice with chapter V being dedicated to mental disorders.

Question 62

What are some strengths of categorical approaches?

Answer 62

• They contribute to the scientific literature and teaching about mental disorders.
• They are familiar.
• They facilitate communication.
• They are user-friendly.
• They have higher inter-rater reliability for some (e.g. psychotic) disorders.
• They are consistent with clinical decision making.

Question 63

What are some limitations of categorical approaches?

Answer 63

• They have low inter-rater reliability for some disorders (e.g. personality disorders).
• The amount of overlap between disorders makes it difficult to allocate a client’s symptoms to a category.
• Stigma can arise from labeling.
• There is a loss of valuable clinical information.
• Polythetic criteria can result in two people being diagnosed with the same disorder even though they may not share a single symptom.

Question 64

What is a dimensional approach?

Answer 64

A system of classifying mental conditions and disorders by quantifying a person’s symptoms or other characteristics of interest and representing them with numerical values on one or more scales or continuums, rather than assigning them to a mental disorder category.

Question 65

What is a dimension?

Answer 65

A cluster of related psychological and/or behavioural characteristics that tend to occur together and can be measured.

Question 66

What are three key features of dimensional approaches?

Answer 66

• A mental disorder is not considered in terms of whether it is present or absent. It grades a person in terms of the magnitude, degree or severity on particular dimensions rather than assigning them to a specific category.
• A graphical representation of an individual’s scores can be produced.
• Transition of changes over time can be measured.

Question 67

What are two key assumptions of dimensional approaches?

Answer 67

They assume that normality and abnormality are end points on the same continuum with no clear dividing line between them. They also assume that the symptoms of mental disorders are just extreme variations of the traits or behaviours that we all possess to some degree.

Question 68

What are some strengths of dimensional approaches?

Answer 68

• It eliminates the use of labels with negative connotations and reduces stigma.
• It communicates more clinical information by considering the full range of a client’s behaviour.
• Some disorders may be more accurately represented as they are extremes of normal human characteristics.

Question 69

What are some limitations of dimensional approaches?

Answer 69

• They are less familiar.
• They are more difficult and time-consuming in everyday practice.
• It is difficult to know what dimensions are useful and more accessible to measurement.