Introduction to Psychological Disorders
Senior 6 · Psychology
Introduction to Psychological Disorders
Lesson 1 of 5
25 min
The runner is statistically very unusual, but nobody would call her disordered. Many bereaved people, in many cultures, briefly hear or sense someone they have lost; it is usually a normal part of grief. Only the young man is clearly suffering and unable to live as he wishes. Deciding what counts as a psychological disorder is harder than it looks, and the answer matters: a label can open the door to help, or it can bring stigma. (The three people are illustrative.)
Definition
Abnormality: behaviour, thoughts or feelings that differ from what is typical or healthy in a way that matters, for example because they cause distress or prevent a person from functioning.
Psychological (mental) disorder (DSM-5-TR, 2022, summarised): a pattern of clinically significant disturbance in a person's thinking, emotion regulation or behaviour, reflecting a dysfunction in psychological, biological or developmental processes, and usually linked with significant distress or difficulty in social, work or other important activities. Expected reactions to common stressors (such as grief) and behaviour that is simply socially deviant are not disorders.
Diagnosis: identifying a disorder from its signs and symptoms, using a classification system such as the DSM-5-TR or the WHO's ICD-11.
Stigma: negative attitudes, stereotypes and discrimination directed at people because of a characteristic, such as a mental health condition.
| Definition | Abnormal means… | Strength | Limitation |
|---|---|---|---|
| Statistical infrequency | rare: far from the average, for example an IQ below 70 | Objective and measurable | Some rare traits are desirable (very high IQ, athletic talent); some disorders are common (about 12% of Rwandans surveyed in 2018 had a current major depressive episode) |
| Deviation from social norms | breaking the unwritten rules of a society | Takes the social context into account | Norms differ between cultures and change over time; it has been used to label people who are simply different, such as political dissidents |
| Failure to function adequately | being unable to cope with everyday life: work, study, relationships, self-care | Focuses on the person's suffering and needs | Who judges "adequate"? Some people with serious disorders function well, and some people stop functioning for good reasons (a hunger strike) |
| Deviation from ideal mental health | lacking the features of positive mental health; Marie Jahoda (1958) listed six, including a positive view of oneself, personal growth, autonomy, an accurate view of reality and mastery of one's environment | Positive: it says what to aim for, not only what to avoid | So demanding that almost everyone would be abnormal; the criteria reflect individualist, Western values (autonomy) more than collectivist ones |
David Rosenhan and Martin Seligman (1989) proposed seven features of failure to function, such as suffering, maladaptive behaviour, unpredictability and irrationality, and argued that the more of them are present, the more likely abnormality is. Clinicians today often summarise the features as the four Ds: deviance (unusual), distress (to the person), dysfunction (interfering with daily life) and, in a minority of cases, danger. No single definition works alone; clinicians weigh them together.
For most of history, many societies blamed disturbed behaviour on spirits, curses or sin. Treatments included exorcism, and in European asylums people were chained and displayed to visitors. In the late 1700s, reformers such as Jean-Baptiste Pussin and Philippe Pinel in France and William Tuke in England began a moral treatment movement based on kindness, work and dignity. Today six perspectives compete, and are combined.
| Perspective | Main cause of disorder | Typical treatment | Main criticism |
|---|---|---|---|
| Biological (medical) | Genes, brain structure, neurotransmitters, infection | Medication, and in some cases other physical treatments | Reductionist: ignores thoughts, relationships and circumstances |
| Psychodynamic (Freud) | Unresolved unconscious conflicts, often from childhood | Psychoanalysis and psychodynamic therapy | Hard to test scientifically |
| Behavioural | Maladaptive behaviour learned through conditioning and observation | Behaviour therapy, such as exposure | Ignores thinking and biology |
| Cognitive | Faulty, negative or irrational thinking (Beck, Ellis) | Cognitive and cognitive behavioural therapy (CBT) | Are negative thoughts a cause or a symptom? |
| Humanistic (Rogers) | A gap between the real self and the ideal self, from conditional acceptance | Client-centred therapy | Vague concepts; less help for severe disorders |
| Sociocultural | Poverty, violence, discrimination, family conflict, cultural pressures | Family and community interventions, social change | Cannot explain why only some people exposed become unwell |
The most widely accepted framework combines them. The biopsychosocial model, which you met in Unit 5, looks at biological, psychological and social causes together. The diathesis–stress model (Joseph Zubin and Bonnie Spring, 1977) adds that a disorder develops when a person's vulnerability (diathesis) meets enough stress (Figure 1).
Figure 1. The diathesis–stress model (after Zubin and Spring, 1977). A disorder develops when vulnerability and stress together pass a threshold, so the same stress affects people differently. The bars are illustrative, not measurements.
Two systems are used worldwide: the American Psychiatric Association's DSM-5-TR (2022) and the World Health Organization's ICD-11 (in effect from January 2022). Both list disorders with their criteria, which helps professionals communicate, plan treatment and do research. A classification must be reliable (different clinicians agree on the diagnosis) and valid (the diagnosis describes something real and predicts what will help).
David Rosenhan's famous study "On being sane in insane places" (1973) reported that eight healthy people who said they heard a voice saying "empty", "hollow" and "thud" were admitted to twelve American psychiatric hospitals, almost all diagnosed with schizophrenia, and kept for an average of 19 days although they behaved normally once inside. It shook confidence in diagnosis and helped to make later DSM criteria more precise. But treat it with caution: the journalist Susannah Cahalan (2019) examined Rosenhan's private papers and could not find most of the pseudopatients; she found evidence that he left out data that did not fit, and many researchers now doubt the study's reliability.
The 2018 Rwanda Mental Health Survey, led by the Rwanda Biomedical Centre with 19,110 people aged 14 to 65, found that 61.7% knew that mental health services existed, but only 5.3% had ever used them. Stigma is one reason people stay away. Psychologists therefore use person-first language ("a person living with schizophrenia", not "a schizophrenic"), avoid words like "mad" or "crazy", and remember that most people with mental health conditions are not violent: they are much more likely to be victims of violence than perpetrators (Teplin and others, 2005).
CrashCourse: "Psychological Disorders: Crash Course Psychology #28" (about 10 minutes). It covers how disorders are defined, the medical model, the biopsychosocial approach and the DSM. Note its examples of how culture shapes what is seen as disordered.
Warning
Do not diagnose yourself or your friends. Everyone sometimes feels anxious, low or suspicious; a disorder is diagnosed only by a trained professional, using careful criteria about severity, duration and impact. If you are worried about yourself or a friend, talk to someone, not a search engine.
Important
Where to get help in Rwanda. If you, or someone you know, is struggling, talk to a trusted adult (a parent, teacher or school counsellor) and visit your local health centre. The Rwanda Biomedical Centre asks people to call its toll-free number 114 with questions about its services or in an emergency. Asking for help is a sign of strength, not weakness.
Tip
The four Ds: Deviance, Distress, Dysfunction, Danger. For each definition of abnormality in an essay, give a definition, an example, one strength and one limitation, then conclude that the definitions work best together.
Practice
Sources and credits
Written by Ganzaa: the text, the diagram (Figure 1), the tables and the exercises.
