Attempts to define abnormal, deviant, disordered, or psychopathological behavior in psychology have largely been disastrous, although this process is necessary to develop a classification system. Any number of attempts ranging from statistical to theoretical positions have been made; all cause more confusion than clarification. One possible solution to this problem is Wakefield's (1992a,b) notion of ''harmful dysfunction," which is similar to the definition used by the DSM-IV.
A definition of abnormal behavior should be quite distinct from models or theories of behavior or abnormal behavior, contrary to the claims of Follette and Houts (1996). A definition of abnormal behavior is used to identify the domain (i.e., what it is) that theories or models attempt to explain (i.e., the causes or mechanisms of the disorder). Abnormal behavior defined in terms of a theory or causal model eliminates the possibility of empirically evaluating the theory or contrasting it with other explanations or theories of the behavior. If abnormal behavior is ''mental illness,'' then by definition only a medical model is an appropriate explanation. Other definitions such as a ''learned habit'' or ''residual deviance'' cause similar problems. To avoid tautology, universal, plausible, ''atheoretical'' definitions and diagnostic criteria were important goals of individuals who devised the recent diagnostic and statistical manuals (i.e., DSM-III, DSM-III-R, and DSM-IV) (APA, 1980, 1987, 1994; Spitzer & Williams, 1983; Wakefield, 1992a,b).
Wakefield's analysis of the concept of disorder is one possible solution to this problem. He states, ''a disorder exists when the failure of a person's internal mechanisms to perform their functions, as designed by nature, impinges harmfully on the person's well-being, as defined by social values and meaning'' (Wakefield, 1992a, p.373). The ''harmful dysfunction'' notion is similar to the definition of disorder used by the DSM-IV. It requires two necessary conditions for a diagnosis of a disorder: ''dysfunction'' and ''negative conse quences.'' This definition addresses a number of vexing problems in defining abnormal behavior. We shall address a few of them.
Mental Disorders: Scientific Concepts or Value Judgments?
It is true that many forms of abnormal behavior are normative concepts based on value judgments. Most mental disorders are negative conditions that justify social concerns, but defining them in terms of pure value judgments allows classifying many socially disapproved behaviors as disorders when they clearly are not. Incarcerated Soviet dissidents, "childhood masturbation disorder,'' drape-tomania (slaves running away from their masters), or other socially deviant behavior, which violated social norms of the time or a particular culture, are clearly not disorders. In spite of Houts and Fol-lette's (1998) claim that abnormal behavior is, first and foremost, a social judgment, this cannot and should not be the case because this means that disorders can become a method of social control associated with repression of unpopular behavior, as was done in Russia. Recent controversies about "self-defeating personalities" (Caplan, 1988) and homosexuality (Bayer & Spitzer, 1982) clearly illustrate this problem.
Similarly, if disorder is defined as a "dysfunction" in purely scientific terms, there are serious limitations. For example, a person in our culture who hears voices that others do not is assumed to have a disorder of cognitive processing. But, what about prophets, saints, and holy men who hear voices in other cultures or subcultures. Are they suffering from mental disorders? The point is that some internal malfunctions do not cause harm to the individual nor do they cause harm to others. Thus, to consider the dysfunction a mental disorder it must be harmful to the individual or society. A hybrid definition where the behavior represents both a dysfunction (i.e., a scientific concept) and harm (i.e., a value concept) is necessary to label a condition as a mental disorder. Both components are necessary, and neither is sufficient alone.
Mental Disorders: External Behavior or Internal Mechanisms
Two frequent criticisms of Wakefield's concept of internal mechanisms are that the notion is both
"mentalistic" (a term that drives strict behavior-ists crazy) and biological. Most psychologists would agree that what goes on inside a person is important. However, important scientific methods and procedures must be considered when dealing with "unobservable" events. Operational definitions and similar procedures have facilitated the cognitive revolution in psychology, which is interested, primarily, in unobservable events. Not even the most radical behaviorist would deny the importance of internal mechanisms insofar as they are addressed scientifically. Consider, for example, the topics of memory, information processing, and similar areas of important recent cognitive research. Are we to dismiss these advances as mentalistic? The criticism of internal mechanisms as biological or genetic is also nonsensical. Few cognitive psychologists who deal constantly with internal mechanisms would label their explanations of these mechanisms as biological or genetic. Internal mechanisms can be created by environmental events and learning, as well as by biological factors. Internal does not necessarily mean biological. A person with a memory disorder may not exhibit obvious behavior that indicates this problem, and a "fine-grained analysis with all neuropsychological tests'' may be necessary to detect the problem. Further, the memory deficit may be psychological or biological. There are numerous other examples.
On occasions, labeling a person as "disordered" when the problem resides in the environment is a mistake. For example, the loss of loved ones will cause people to look like they are depressed, but when a suitable time has passed, they again appear normal. The point is that a depressive disorder resides in the person and is due to the disruption of a normal mechanism, such as the emotional response system. This does not mean that environmental events cannot cause disruption of internal events. They can and do. Posttraumatic stress disorder is one such example. There are numerous other conditions caused by a malignant environment or an interaction of a malignant environment and biological predispositions.
Internal dysfunctions must be demonstrated by careful evaluation of environmental events, behavior, and internal functions. This process is called case formulation. Not all abnormal behavior is a disorder. This distinction is important legally (e.g., is the individual innocent because of mental disorder?) and socially (is oversensitivity to a Black person due to a politically repressive environment or a disorder such as "paranoia"?).
Disorders: Mental or Medical?
A widespread controversy involves the medical model of mental illness as a "disease." Interestingly, definitions of disease or illness have the same conceptual difficulties in disentangling a scientific or neutral definition from value statements as definitions of abnormal behavior. All disorders are usually undesirable and harmful according to social values, but disorders are more than just values. They are failures of internal mechanisms that maintain coping behavior as well as psychological and physiological adjustment. The general concept of disorder applies to both mental and physical conditions, whereas the notion of internal mechanism refers to both physical structures and functioning as well as mental structures and functioning such as memory, perception, and other psychological systems that we shall discuss later. In the former case, the disorder is labeled a physical disorder, and in the latter case a mental disorder. The former involves the physiological response systems, and the latter the psychological response systems.
The overlap of the two types of disorders causes confusion among lay people as well as professionals. For example, cancer can cause severe depression, but it should be a ''mental disorder" only if the physical illness has caused a dysfunction of the internal psychological mechanisms that control emotional behavior. If that is the case, then the individual has both a physical and mental disorder. The reverse can also occur. A mental disorder, such as alcohol abuse, can cause a physical disorder (i.e., liver damage). Physical and mental disorders can occur together or separately, but it is important to understand that they are different conditions. The relationship of the two conditions has instigated the growth and development of behavioral medicine and health psychology.
Mental Disorders: What Are Dysfunctions?
A dysfunction is a failure of some mechanism to perform its natural function as designed by nature. For example, the natural function of the heart is to pump blood; the natural function of perception is to convey information about the environment; the natural function of emotions is to avoid harm and enhance pleasure. A mechanism may have other characteristics as well, such as the heart producing sounds. However, pumping blood is the natural function of the heart even though it has other characteristics, such as sounds, which may be helpful in diagnosing heart conditions.
The clause "as designed by nature" is the evolutionary explanation of the structure, existence, and activity of the organ or mechanism. In other words, mechanisms that contributed to the organism's coping and reproductive success over successive generations increased in frequency or were "naturally selected" and exist in today's organism (Buss, 1999). This evolutionary explanation is bound to cause criticism; however, determining how these organs and mechanisms came to be is not central to this notion. The fact that such organs and mechanisms exist is sufficient.
The major difficulty is that we know a great deal about physiological mechanisms and structures because of the basic research into normal functioning conducted by biological scientists. This is the basis of modern medicine, which uses the basic research to understand physical disorders and treatment. Physicians know what normal physiological functioning is and usually they can quickly spot a deviation from this normalcy. Psychology, on the other hand, is in a great state of ignorance regarding the causes of normal psychological functioning or its related mechanisms. To make matters worse, psychological practitioners are typically ignorant of basic research in psychology and fail to use the wealth of basic research available to them in clinical problems. As a group, clinical psychologists, particularly private practitioners, have disowned basic research, which has stifled advancements in applying basic knowledge.
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