Is ‘abnormality’ in the eye of the beholder?
Rosenhan D (1968) examines the concept of what constitutes abnormal behaviour when he asserts ‘Beauty, we know, exists in the eye of the beholder. But what of madness? Is it possible that a profitable conceptualisation of madness can emerge from the examination, not of the mad, as both psychoanalysts and learning theorists have done, but of those who call them mad? (Cited in Price RH, 1978;p145) Abnormality, as defined by Gregory RL (1987)1 is ‘behaviour that differs from the familiar or usual’.
Just how unusual, or even anti-social in order to be classified as ‘abnormal’ depends on many factors that change with knowledge and with social preconceptions. The classification of abnormal behaviour may depend upon whether or not the behaviour is socially acceptable or whether there are symptoms, however minor, of an underlying problem or disease already regarded as abnormal. This essay attempts to address the following questions posed by Rosenhan D (1975) relating to the issue of madness. ‘If sanity and insanity exist, how shall we know them? 2 and ‘Do the prominent characteristics that lead to diagnoses reside within the patients themselves, or in the environments and contexts in which observers find them? ‘
In an exertion to identify what compounds ‘abnormality’, Perrotto and Culkin (1995) distinguishes four types of abnormal behaviour which consist of behaviours as ‘statistical deviations’, as ‘maladaptive’, as those that induce ‘personal distress’ and finally behaviours that are ‘violations of social norms’. As the questions posed relate to the perception of abnormality, this essay will focus on the violations of social norms, as the primary factor in what constitutes bnormal behaviour. Rosenhan and Seligman (1995) assert that there is no clear-cut definition of abnormality and no definite way to classify abnormality.
This assertion incites the question that if abnormality cannot be defined simply and clearly, does it mean that there is no such thing as abnormal behaviour? According to Rosenhan and Seligman (1995) a precise definition of abnormality requires that there be at least one distinguishing element that only cases of abnormality share and that no cases of normality share.
However, since there is no single factor shared by all cases of abnormality, Rosenhan and Seligman have concluded that ‘abnormality’ indeed cannot be defined precisely. Nevertheless, Rosenhan and Seligman maintain that just because ‘abnormality’ cannot be defined precisely, it does not mean that it does not exist or that it cannot be recognised. On the contrary, abnormality is recognised everywhere and in every culture, furthermore behaviour is sometimes identified as being abnormal clearly and unambiguously, and at other times there is disagreement as to what constitutes abnormal behaviour or thoughts.
Christopher Hill (1972) affirms that ‘… lunacy, like beauty, may be in the eye of the beholder’4 ‘There were lunatics in the 17th Century, but modern psychiatry is helping us to understand that madness itself may be a form of protest against social norms, and that the lunatic may in some sense be saner than the society which rejects him’5 Wing JK (1978) proceeds that madness can mean every type of unreason from stupidity to psychosis, and which include any behaviours or ideas that are unacceptable or incomprehensible in terms of traditional social norms.
As a result ‘madness’ is a diverse term, since it carries different meanings according to the society, epoch and social group concerned. An individual may be regarded as ‘sick’ if her/his behaviour deviates from conventional social standards and these standards vary upon the society in which the behaviour occurs. For Wing (1978) madness is a lay term covering a variety of behaviours from wit to delusion and the dependence upon the social context in which the behaviours are displayed.
Consistent with this conception, Buss AH (1966) affirms that abnormality is socially defined in that it is the community which decides what act is a minor deviation, that is allowed, to that of a major deviation which is not approved. Buss regards this as ‘cultural relativism’; this notion is important in determining abnormality, as what may be defined as abnormal in one society may indeed be accepted and be described as normal in another. Socially defined abnormalities include ‘individual peculiarities’ and ‘asocial’ acts.
An individual peculiarity can be the slight compulsion to jot down the numbers of car license plates, which appears normal enough, and yet is not that far removed from the abnormal compulsion of counting and recounting or checking and rechecking of one’s money. Asocial acts on the other hand consist of the chronic breaking of the unwritten and sometimes written rules of society, which includes delinquency, chronic drunkenness, addiction to drugs and sexual perversions.
Buss adds that sexual perversions are the most difficult to define as deviant as the standard of normality regarding sex not only varies from society to society but also within differing sections of each society. For example; lower-class morality deems masturbation as a normal and healthy act whereas middle and upper-class social groups perceive masturbation as abnormal. Furthermore, Buss identifies a second class of abnormality, which incorporates individuals experiencing hallucinations, delusions and disorientation’s.
These ‘abnormalities’ Buss believes represents a failure of ‘biological rather than social adaptation’6 Buss explains that biological adaptation refers to the adaptation of the physical environment as opposed to the social one. Because the perception of the physical environment is distorted, the individual is at risk from all types of dangers, e. g. ; crossing the road, meeting nutritional needs. Buss postulates that if the brain presents a distorted image of the physical world then the failure of physical adaptation will ensue.
This form of abnormality Buss claims in universal, it is everywhere, in every culture, epoch etc and does not depend upon social evaluation. He asserts ‘biological adaptation does not respect geographical and social boundaries’7 Buss however, does acknowledge that it has been argued that perceptual distortions such as hallucinations and delusions cannot be accepted universally as a sign of madness, due to differences between cultures. Delusions may be accepted in some ‘primitive’ societies and hallucinations’ especially those involved in religion, have been accepted as true and real in some advanced western cultures.
In response to this contention, Buss advances that although some societies have tolerated perceptual distortions it does not necessarily mean that we must accept cultural relativism. Furthermore, the misperception of reality is abnormal wherever it occurs, as the issue concerns the ‘biological’ functioning of the sense organs and the brain. In addition Buss contends that the distinction between reality and fantasy must be made in all societies. Buss concludes that the perceptual symptoms of abnormal behaviour is therefore universal.
In opposition to Buss’s assertion, Scheff (1975) argues that even major forms of psychoses are culturally relative as ‘… there are culturally derived rules about propriety, similarly, it is suggested that there are culture-bound rules about thought and about reality’ (Cited in Horwitz AV, 1982;p22) Horiwitz (1982) adds that there are several important ways in which the relativist position is correct in emphasising the culturally relative nature of mental illness labels. Behaviour cannot be judged as abnormal without first considering the social context in which it occurs.
Labelling an abnormal behaviour requires the recognition of the socially acceptable rules first and then considering the behaviour. Virtually any behaviour that is labelled abnormal in one context may be viewed as normal in another, while what seems normal in one setting maybe labelled crazy in another. Goffman (1971) gives a few examples: ‘The delusions of a private can be the rights of a general; the obscene invitations of a man to a strange girl can be the spicy endearments of a husband to his wife; the wariness of a paranoid is the warranted practice of thousands of undercover agents’ (Cited in Horwitz AV,1982;p23)
Murphy (1976) explains that in other cases , behaviour is part of a recognisable social role, for example; the hallucinations, delusions and bizarreness of the Shaman performing a healing ceremony, is not perceived as a mental illness, but if performed in the same culture outside of a recognised social role, the individual would be labelled as insane. Therefore the cultural and social context of an action is thus an intrinsic aspect of the labelling of abnormality/mental illness.
Since these contentions suggest that madness may well be in the eye of the beholder, does this imply that psychiatric diagnosticians may well be diagnosing sane people as being mentally ill? Szasz (1961) asserts that psychiatric categories are not classifications of diseases, but are labels applied to disorganised social behaviours. Further, Szasz warrants that there is no such thing as a disease of the mind, only people who act out unacceptable social behaviour.
Temerlin MK (1975)8 adds that if Szasz is correct then psychiatric diagnosis is basically unreliable as instead of classifying observable diseases ‘out there’ it is a process of labelling social behaviour in terms of ethical and social norms of society and psychiatry. Further, since such norms are vague, vary with culture and social groups etc, diagnosing abnormality by labelling would also vary with the personal values and ‘perceptual consistencies’ of the individual diagnostician.
In conclusion, it is apparent that when evaluating ‘abnormal behaviour’ or ‘madness’, the social context, culture and the social norms that reside during that time, in which the behaviour is observed, must be considered. Spitzer and Denzin (1968)9 put it well when they asserted ‘mental illness is something ascribed to persons as a function of the definition given certain types of acts by certain audiences’ So is madness in the eye of the beholder? In general yes, but one must not forget Buss’s view that perceptual distortions are universal and induce abnormal behaviour. I think both views are valid arguments.