Mental health articles

The Classification of Abnormal Behavior: An Overview. Introduction From the beginnings of life, as organisms attempt to understand their environment, they seek to organize a vast array of incoming stimuli. The recognition of similarities and the ordering of objects into sets on the basis of their relationships are primordial classificatory abilities that begin at a crude level but grow ever more discriminating as the organism matures. Even before the advent of Homo sapiens, classification ability must have been a component of fitness in biological evolution.

The acquisition of language by humans is clearly the most sophisticated example of this classificatory phenomenon in nature, for it is through learning words that we can select, evaluate, and categorize much of the information that bombards us in everyday life. In short, for human beings, words are classification; a sound or combination of sounds (or its representation in print) communicates a specific meaning. Because we possess this type of communication, we can discriminate a multitude of stimuli into categories that allow us to process, store, and act on additional information at a level that no other organism can approach. In the same way that lay persons use these categories to group concepts in an organized and common language, scientists, too, must have a means of communicating with each other. Their language requires even greater clarity and precision if knowledge is to be enhanced. Scientific classification systems use their own common language to organize and integrate data in a particular f ield and to work toward the goal of developing scientific principles and laws. It should be clear, then, that a science can develop only so far as it can classify the information in its field. Sartorius highlighted the importance of classification when he stated that no other intellectual act is of equal importance: if our classification of things and people in the world around us were to collapse, the world would cease to exist as a coherent and organized environment and would become a nebulous agglomeration of rubbish—matter, people, and things out of place. The early stage in the development of a classif ication system should be guided by naturalistic and experimental observations rather than theoretical postures, despite the claims of some psychologists. In this way, scientific verification of theories and hypotheses generates the facts that can then be integrated into the development of an increasingly sophisticated classification scheme. Unfortunately, in the study of abnormal behavior, the trend has long been to place the cart before the horse. Early efforts in the field have followed the medical model, which views abnormal behavior as a form of illness; specific symptoms are aggregated into patterns of clinical syndromes. Identifying these syndromes is termed diagnosis, which is defined as the use of specific taxonomic schemes or classification systems to identify illness. Other classification systems have been proposed, but these, too, have been based on theoretical concepts of the nature of abnormal behavior, such as trait theory and behaviorism. Defining aberrant behavior on the basis of questionable theoretical beliefs has led to much confusion in the development of adequate classification systems. Furthermore, the self-fulfilling prophecies inherent in this type of approach have made it next to impossible to determine which of the competing theories best explains these disorders. The goal of any system designed to classify behavior is that the assignment of an individual or a response pattern to allocation on a dimension or certain category permits useful statements about the behavior based on membership in that category. Classification should imply further information about the individual or the behavior, including prediction in terms of social interaction, response to treatment, and future behavior. It should be noted that the classification of individuals, particularly the type that involves the diagnosis of deviant behavior, is considered questionable by some mental health professionals. For instance, Rogers  stated that categorizing people is unnatural, arbitrary, and unnecessary. In his view, abnormal behavior is caused by certain ways of perceiving one’s present circumstances; thus, only the person knows the complete dynamics of his or her own perceptions and behavior. Further, Rogers felt that classifying interferes with treatment by hampering communication between the therapist and the client. Thomas Szasz, one of the more vocal opponents of classification, bluntly stated that ‘‘classifiers should be classified, people should not be’’. Indeed, he felt that the doctor–patient relationship fostered by the traditional medical model—in which a ‘‘sick’’ person is classified according to his or her particular ‘‘illness’’—fosters an inappropriate dependency on the part of the person seeking treatment, who is supposed to be learning to be more responsible nd independent in psychotherapy, not merely having a disease ‘‘cured.’’ Similar arguments against classification have involved the assumption that each individual or each response pattern is unique, and therefore classification is rendered meaningless. However, a science searches for common elements in events to integrate them into a conceptual scheme, and psychology is no exception. Its classification schemes are conceptual models that seek commonalities in responses or individuals. It is true that the uniqueness of each individual cannot be accounted for in a conceptual model of classification, because the classification of abnormal behavior implies the categorization of maladaptive responses for future use in predicting proper treatment protocols. For example, a physician classifies a person who has a serious heart condition with regard to the type of ailment and the seriousness of the disease; the classification is based on a complaint, and for all practical purposes, the uniqueness of the individual is set aside until the maladaptive response is remedied. The justification of a particular model of classif ication is determined by how accurately the model facilitates the prediction, control, and understanding of the response. If there are not common elements in behavioral patterns, then these goals cannot be accomplished. This is not to say that the uniqueness of the individual is irrelevant—far from it! Recognizing the individuality of each human being has been a cornerstone of medicine throughout history. However, little can be done for the individual without referring to general principles. It is these principles that allow a diagnosis, and as Cawley  stated, The diagnostic statement represents the point of contact between the experience of the individual patient and the relevant collective knowledge and its organization. The diagnosis is the link which enables the individual to benefit from what is already known, and also allows the assimilation of the individual’s data into the collective store. It must be noted, too, that the debate over classifying abnormal behavior is scientific and has political overtones as well. Much of the criticism of the medical model has resulted from competition between various mental health professions, a competition in which psychiatry has remained dominant.

The medical model has been used to justify the preeminent role of physicians in treating mental disorders; if people exhibiting abnormal behavior are ‘‘ill,’’ then they require treatment by a medical doctor. Current trends in society—that seem to label any persistent, maladaptive behavior a ‘‘disease’’—indicate that the public is implicitly endorsing the medical model. As the cost of health care rises and competition among service providers increases, these issues are likely to take on increasing importance. Consider, for instance, the professional implications of the latest revision of the American Psychiatric Association’s Diagnostic and Statistical Manual, which changed the label of Axis III from ‘‘physical disorders’’ to ‘‘other medical disorders’’, indicating that the medical model continues to have an overarching presence. In summary, the primary purpose of classification is to develop a means of communication among scientists and/or clinicians for the purpose of scientific research. Other purposes served by classification include information retrieval, description, and prediction (Blashfield & Draguns, 1976). In the initial stages, classification should not attempt to explain a phenomenon, but only to identify and describe it. Historically, classification attempts in psychopathology have evolved out of the observations of clinicians working with individuals who exhibited daily aberrant behavior, so that the immediate requirements have seldom permitted systematic investigation.

The clinician begins by noticing the regularity with which certain characteristics occur together and conceptualizing them as a diagnostic entity. These various entities then gain some degree of consensual validation, particularly in the clinical setting, and subsequently become codified into a classification system. This process does not occur in a political vacuum, however, and can be influenced by conceptual as well as empirical considerations. This chapter provides an overview of the principles of classification of abnormal behavior, normative behavior, a definition of abnormal behavior, the relationship between measurement and classification, evaluation and models of classification, and current classification systems used in the study of abnormal psychology.

Tags: abnormal, abnormal behavior, behavior