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The Pathology of the Pathology
2008-12-02 20:23:05
The question of defining the term 'psychopathology' is an inherently difficult question to answer. Unlike a physical object or a directly observable action which are all relatively simplistic to define, a psychopathology is of the mental, unseen realm. Let us now discuss the difficulties surrounding the definition of the term 'psychopathology'.
The Penguin Dictionary of Psychology defines the term 'pathology' in the following way :
An abnormal condition or biological state in which proper functioning is prevented. The specific medical usage connotes an organic dysfunction or disease, not a functional one. However, in clinical psychology and psychiatry, the usage has been extended so that disorders for which there are no known biological components are included, hence the term psychopathology.
(Reber, 2001)
As is clearly evident, the term pathology is specifically related to the originating abnormality which thus causes dysfunction, which we can refer to as symptoms of the pathology. However, in the case of a psychopathology, the originating cause comes from psychical origins; whether that be the mind or the brain. The brain being the physical 'context' of the mind.
A related question to 'what is a psychopathology' is 'what is abnormal behaviour?' Unfortunately, with psychological disorders, we mostly are unable to peer inside the psyche of the patient and see a cleanly defined pathology as we can with organic, physiological disorders. We thus have to resort to investigating the psychopathology by virtue of presenting symptoms. These symptoms are in relation to normal behaviour. However, the question of normal/abnormal behaviour is an important one, as the term 'normal' or 'normality' is a deceptively complex one. There is a prevailing trend in modern society to correlate or see as synonyms normal and natural. We tend to assume that the the societal average in terms of behavioural characteristics comes from some biogenic, genetic or biological force.
However, as Billington et al. (1998) show, what is considered normal, healthy or mature in one culture may be quite the opposite in another, where that same behaviour could be considered sick, abnormal or immature. (Billington et al., 1998, pg. 49). Thus arguing, that what is considered 'normal' is actually socially constructed, and not something given to us by our genetic makeup. This concept of normality being constructed is expounded upon by Vygotsky (1978). He argues that culture is internalized by the infant through the 'cell' of psychological behaviour; namely interaction. By interacting with the care-giver, the infant internalizes meaning and the mental organization of the parent. Thereby internalizing the culture of the care-giver, along with the associated values, belief systems and cultural norms that go along with a particular culture.
When looking at how a culture defines psychological abnormality, what we are essentially looking at is how that society distinguishes normal from abnormal behaviour, as well as which unacceptable behaviours are seen as evidence of a 'disorder', and not simply as undesirable characteristics. (Alloy et al., 2004, pg. 2) Added to this, the symptomatic expression of the underlying cause can have varied manifestations which are also affected by culture. If we take a historic look at psychopathologies in Europe, we notice that during Freud's time, there were many cases of patients presenting with bodily manifestations, such as neurotic paralysis, fainting, and neurotic blindness. In modern Western or European societies, these bodily manifestations are much more rare. It has been noted that psychopathologies such as Multiple Personality Disorder have viciously emerged since the turn of the 20th century.
Apart from the dilemma presented from distinguishing between nature and society, in defining the concept of normal and abnormal behaviour, we need to also realise that human behaviour and psychology is never binary in nature, but rather always falls along a continuum. The question that arises is where do you draw the line on the continuum that separates normal from abnormal behaviour, and thus normal from pathological psychological functioning? Wakefield (1999) proposes that the term 'mental disorder' should be taken as “harmful dysfunction, where dysfunctions are failures of internal mechanisms to perform naturally selected functions.” (Alloy et al., 2004, pg. 4) The problem with this definition is that we are seldom able to directly observe the 'internal mechanisms' of the psyche to allow us to determine dysfunction.
In mainstream contemporary psychology, it is generally accepted that behaviour can be classified as pathological when it begins to interfere with daily functioning of the person. This is generally assessed using four criterion; norm violation, statistical rarity, personal distress, and maladaptive behaviour. (Alloy et al., 2004) From what has been previously discusses regarding the nature of normality, we can see that these four criterion are constructed and 'given to us' by our cultural environment. The first criterion, norm violation, is the degree to which the culturally constructed norms are deviated from. The second criterion, statistical rarity, is equally constructed, as it has to do with the
The other related question we should ask ourselves is whether or not we stick to the medical model when addressing the problem of abnormal behaviour? Do we, as with the medical model, consider the pathology to be the root cause of the presenting symptoms, or do we consider the pathology to be the manifestation of the problem? Here is a hypothetical situation which we can use to answer this question : Two children undergo (separately) sexual abuse. This abuse is repressed and in later life, it manifests in Obsessive Compulsive Disorder (OCD) in the one child, and as a Phobia in the other. Now, do we take the pathology to be referring to the repressed sexual abuse, or to the collection of symptoms that result from the repressed sexual abuse? There are pros and cons for either of these. If we consider the repressed content to be the pathology, then that would mean that both children have the same pathology. It would be beneficial in that the psychotherapist would be able to then treat the root cause, and through resolving the repressed conflict, would cease the presenting symptoms. However, if we take the collection of resulting symptoms as the pathology, we have the benefit of knowing the expected prognosis of the disorder, and would also be able to employ specific therapeutic techniques for that collection of symptoms to which we give a label.
Publications, such as the DSM-IV TR, employ the latter definition of a psychopathology, and apply labels to the patients with specific collections of symptoms. However, as Jung (1966) points out, each individual is unique with regards to their genetic predisposition, as well as their unique life experience. Thus, no two patients will be exactly the same with regards the manifestation of the pathology. By labeling, the therapist might firstly overlook additional symptoms or causes, and secondly might attribute too much to the supposed label. The aim of psychotherapy, in Jung's opinion, is to aid the patient in establishing a better relationship with the unconscious, and so the only use the label has, is to guide the therapist in a course of treatment. In Jung's view, a psychopathology is thus merely an abstract, conceptual element used purely to aid the therapist, and does not exist as a fixed, concrete object. This view greatly complicates the question of what is a psychopathology, as it suggests that there is, in fact, no actual thing that is a 'psychopathology', but that a psychopathology is merely a conceptual construct used for therapeutic treatment.
In conclusion, we can see how the question of defining the term, 'psychopathology', is an inherently difficult and complex one. We have seen how it is determined by cultural aspects, social construction, the debate over whether or not to adhere to the medical model, and the controversy over whether to focus on the manifestation or the root cause.
References
Alloy et al. (2004). “Abnormal Psychology: Current Perspectives”. MacGraw Hill.
Billington, R et al. (1998). “Exploring Self and Society”. New York: Palgrave.
Jung, C. G. (1966). “The Practice of Psychotherapy: Essays on the Psychology of the Transference and other Subjects” (Collected Works Vol. 16). Princeton, N.J.: Princeton University Press.
Reber, A. S., Reber, E (2001). “The Penguin Dictionary of Psychology”. Third Edition. London: Penguin Books Ltd.
Vygotsky, L. S. (1978). “Mind in Society: The Development of Higher Psychological Processes”. Massachusetts: Harvard University Press.
