Concepts of Normal and Abnormal Behavior in Psychiatry

1. Introduction

In psychiatry, understanding what constitutes normal and abnormal behavior is crucial for diagnosing and treating mental health conditions. These concepts help professionals distinguish between behaviors that are socially accepted or functional and those that may indicate underlying psychiatric disorders.

2. Definition of Normal Behavior

Normal behavior refers to actions, thoughts, and emotions that conform to the expected and accepted patterns within a given society or culture.
It aligns with social norms, laws, cultural values, and personal responsibilities.
Normal behavior typically reflects:
- Adaptability: The ability to adjust to changes in life, cope with stress, and function effectively in day-to-day activities.
- Social conformity: Adhering to social roles and expectations.
- Psychological stability: Maintaining balanced emotions, thoughts, and relationships.

3. Definition of Abnormal Behavior

Abnormal behavior refers to patterns of emotion, thought, and action that deviate significantly from societal norms, impair a person’s functioning, or cause distress.
It may be indicative of a mental disorder and is often marked by:
- Maladaptiveness: Behavior that hinders a person’s ability to function effectively in daily life or meet basic needs.
- Distress: Emotional pain and suffering, both for the individual and others around them.
- Deviation from norms: Behavior that violates social norms or laws, such as aggression, isolation, or inappropriate actions.
- Dysfunction: Impairment in personal, social, or occupational functioning.

4. Criteria for Identifying Abnormal Behavior

Several criteria are commonly used in psychiatry to identify abnormal behavior. These are helpful in assessing whether an individual’s actions, emotions, or thoughts warrant further evaluation.

4.1. Statistical Deviance

Behavior that significantly deviates from what is considered typical or average within a population.
For example, extreme IQ levels or chronic depressive symptoms would be considered statistically abnormal.

4.2. Social Deviance

Behavior that violates the accepted norms and expectations of a society or culture.
What is seen as abnormal can vary greatly depending on the cultural context. For instance, hearing voices might be regarded as abnormal in some cultures, while in others, it could be interpreted as a spiritual experience.

4.3. Maladaptiveness

When behavior interferes with a person’s ability to achieve life goals, maintain relationships, or fulfill personal responsibilities, it is considered maladaptive.
Examples include substance abuse, avoidance of social situations, or compulsive behaviors that limit normal functioning.

4.4. Personal Distress

Behavior that causes significant suffering or emotional pain to the individual may be considered abnormal.
Symptoms like chronic anxiety, depression, or suicidal thoughts are examples of distressing conditions that often prompt psychiatric intervention.

4.5. Dysfunction

When behavior leads to impairment in everyday functioning, such as inability to maintain employment, relationships, or personal hygiene, it is often labeled as abnormal.
This criterion helps psychiatrists assess how severely a person’s mental health is affecting their ability to manage daily responsibilities.

4.6. Danger

Abnormal behavior that puts the individual or others at risk of harm.
This includes suicidal tendencies, violent behavior, or reckless actions that endanger others.

5. Models for Understanding Normal and Abnormal Behavior

Several models in psychiatry help frame the distinction between normal and abnormal behavior. These models integrate biological, psychological, and sociocultural factors.

5.1. Medical/Biological Model

This model sees abnormal behavior as a result of biological factors, such as genetic inheritance, brain chemistry imbalances, or physical injury.
Disorders like schizophrenia or bipolar disorder may be viewed through this lens, with treatments focusing on medications, such as antipsychotics or mood stabilizers.

5.2. Psychodynamic Model

Based on Freudian theory, this model focuses on unconscious conflicts, childhood experiences, and repressed emotions as causes of abnormal behavior.
Abnormal behavior is seen as a result of unresolved psychological conflicts that manifest in distorted ways.

5.3. Behavioral Model

This model emphasizes that abnormal behavior is learned through conditioning, reinforcement, and environmental influences.
Abnormal behaviors can be unlearned through behavioral therapies, such as exposure therapy for phobias or cognitive behavioral therapy (CBT).

5.4. Cognitive Model

Focuses on how negative or irrational thinking patterns can lead to abnormal behavior.
Cognitive distortions, such as catastrophizing or all-or-nothing thinking, are seen as the root of disorders like anxiety or depression.

5.5. Humanistic/Existential Model

Stresses personal growth, self-actualization, and free will. Abnormal behavior is seen as a result of an inability to fulfill one’s potential or find meaning in life.
Therapies focus on improving self-awareness and fostering personal growth (e.g., client-centered therapy).

5.6. Sociocultural Model

This model emphasizes the influence of social and cultural factors on behavior. It views abnormal behavior as a response to social issues such as poverty, discrimination, and societal expectations.
Culture-bound syndromes and the impact of society’s norms are key considerations here.

6. Cultural and Social Considerations

Cultural Relativity: The idea that what is considered normal or abnormal can vary significantly from one culture to another. For instance, certain religious practices or healing rituals might be viewed as abnormal in one culture but perfectly normal in another.
Social Norms: Social standards and rules play a significant role in determining what behaviors are acceptable. For example, public displays of anger may be abnormal in one society but expected in others.

7. The Continuum Between Normal and Abnormal Behavior

Dimensional vs. Categorical Approaches:
- Categorical: Some models treat normal and abnormal behavior as distinct categories. Either a person has a mental disorder, or they don’t.
- Dimensional: Many psychiatric professionals view behavior on a spectrum, where normal and abnormal behaviors exist along a continuum. For example, anxiety can range from mild (normal worry) to severe (debilitating anxiety disorder).

8. Diagnosis of Abnormal Behavior in Psychiatry

Psychiatrists use classification systems like the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11) to diagnose abnormal behaviors and mental disorders. These systems provide criteria for identifying specific disorders based on symptoms, duration, and the impact on functioning.

9. Treatment of Abnormal Behavior

Treatment of abnormal behavior in psychiatry depends on the underlying cause and the severity of the condition. Common treatment modalities include:

Psychotherapy: Cognitive-behavioral therapy (CBT), psychoanalysis, and humanistic therapy are widely used to address abnormal thoughts, feelings, and behaviors.
Medications: Antidepressants, antipsychotics, anxiolytics, and mood stabilizers are prescribed based on the specific psychiatric disorder.
Behavioral Therapy: Focuses on modifying harmful behaviors through techniques such as positive reinforcement and desensitization.
Community and Social Support: For disorders with social causes, community-based interventions, support groups, and social services may be necessary.

10. Conclusion

The distinction between normal and abnormal behavior is a central concept in psychiatry, influenced by cultural, social, and biological factors. It involves a complex interplay of criteria like statistical deviance, dysfunction, distress, and cultural norms. Understanding these concepts allows mental health professionals to diagnose, treat, and manage psychiatric disorders effectively, while also considering the nuances of what is considered "normal" in different contexts.

CONCEPTS OF NORMAL AND ABNORMAL BEHAVIOR

Psychiatry as evident from the above is concerned with abnormal behavior in its broadest sense, but defining the concepts of normal and abnormal behavior as such has been found to be difficult.

These concepts are much under the influence of sociocultural factors. Several models have been put forward in order to explain the concept of normal and abnormal behavior. Some of them are:

Medical Model

Medical model considers organic pathology as the definite cause for mental disorder. According to this model abnormal people are the ones who have disturbances in thought, perception and psychomotor activities. The normal are the ones who are free from these disturbances.

Statistical Model

It involves the analysis of responses on a test or a questionnaire or observations of some particular behavioral variables. The degree of deviation from the standard norms arrived at statistically, characterizes the degree of abnormality. Statistically normal mental health falls within two standard deviations (SDs) of the normal distribution curve.

Sociocultural Model

The beliefs, norms, taboos and values of a society have to be accepted and adopted by individuals.

Breaking any of these would be considered as abnormal. Normalcy is defined in context with social norms prescribed by the culture. Thus cultural background has to be taken into account when distinguishing between normal and abnormal behavior.

Behavior Model

Behavior that is adaptive, is normal, maladaptive is abnormal. Abnormal behavior is a set of faulty behaviors acquired through learning.

PROBLEMS OF MENTAL DISORDERS

• Self-care limitations or impaired functioning related to mental illness

• Significant deficits in biological, emotional and cognitive functioning

• Disability, life-process changes

• Emotional problems such as anxiety, anger, sadness, loneliness and grief

• Physical symptoms that occur along with altered psychological functioning

• Alteration in thinking, perceiving, communicating and decision making

• Difficulties in relating to others

• Patient's behavior may be dangerous to self or others

• Adverse effects on the well-being of the individual, family and community

• Financial, marital, family, academic and occupational problems.

CURRENT ISSUES AND TRENDS IN CARE

(SCOPE)

A psychiatric nurse faces various challenges because of changes in patient care approach. Some

of these changes that affecther role are as follows:

Demographic Changes

• Type of family (increased number of nuclear families)

• Increasing number of the elderly group

Social Changes

• The need for maintaining intergroup and intragroup loyalties

• Peer pressure

Economic Changes

• Industrialization

• Urbanization

• Raised standard of living

Technological Changes

• Mass media

• Electronic systems

• Information Technology

Mental Health Care Changes

• Increased awareness in the public regarding mental health

• Need to maintain mental stability

• Increased mental health problems

The above changes set the current trends in mental health care. Some of these are:

PSYCHIATRIC NURSING SKILLS

Mental health nursing is the practice ofpromoting mental health as well as caring for people who have mental illness, potentiating their independency and restoring their dignity. In order to fulfill this arduous occupation, a mental health nurse must possess a sound knowledge base and the requisite skills for good nursing practice.

Prerequisites for a Mental Health Nurse

Personal Skills

Self-awareness It is a key component of psychiatric nursing experience. It is an answer to the question, "who am I". The nurse must be able to examine personal feelings, actions and reactions as a provider of care. A firm understanding and acceptance by the nurse allows acknowledging a patient's differences and uniqueness.

Adaptability A mental health nurse needs to be adaptable to different settings and cultures.

Working within residential settings, for example, may demand attitudes and roles which are different from working in a community, as in a residential setting the nurse may have an authoritative or a supervisory role which she necessarily does not have in a community.

A mental health nurse also needs to cope with a variety of social and cultural settings. Social settings involve the class and status of the individuals while cultural settings involve race, ethnicity and gender. Therefore she may need to be familiar with the issues that arise in cross cultural mental health nursing.

Care values and attitudes

These include:

• Self-awareness and self-esteem

• Respecting the person's rights

• Listening

• Responding with care and respect

• Supporting with trust and confidence

• Reassuring with explanation and honesty

• Physically nursing the helpless with compassion

• Carrying out procedures skillfully

• Working within personal and ethical boundaries.

Counseling Skills

These include:

• Unconditional positive regard/non-judgemental approach

• Empathy

• Warmth and genuineness

• Confidentiality

• Non-verbal sensitivity, non-verbal attending, non-verbal responding

• Other interpersonal skills required are paraphrasing, reflecting, clarifying, summarizing.

Behavioral Skills

These are based on Pavlovian principles and Skinner's principles. They include:

1. To increase adaptive behavior

• Positive reinforcement

• Negative reinforcement

• Token economy

2. To decrease maladaptive behavior

• Extinction

• Timeout

• Restraining

• Over correction

3. To teach new behavior

• Modeling

• Shaping

• Chaining

• Cueing.

Supervisory Skills

Supervision is an integral necessity for any worker in the caring profession, to ensure the best quality service for clients and best quality developmental opportunities for workers. A good supervisor requires interpersonal and professional skills, technical knowledge, leadership qualities and human skills.

Crisis Skills

Aggressive and assaultive behavior of violent patients, self-harm, acute alcohol intoxication are some of the cases a nurse is likely to encounter in the course of her practice. Such situations may cause the nurse to feeloverwhelmed with feelings of helplessness, powerlessness and inadequacy.

Exercise of self-control, calm, rational thinking and identifying ways of obtaining help from the other people are some of the skills to be cultivated by the psychiatric nurse when confronted with such crises situations.

Teaching Skills

This relates to the nurse's ability to explain, enabling full understanding on the part of the client. It also involves enhancing the client's environment in order to maximize his awareness of the things around him. It is necessary for the nurse to be enthusiastic about activities and choices of the clients and also give the client every opportunity to use his power of judgment in order to make decisions.

STANDARDS OF MENTAL HEALTH NURSING

The purpose of Standards of Psychiatric and Mental Health Nursing practice is to fulfill the profession's obligation to provide a means of improving the quality of care. The standards presented here are a revision of the standards enunciated by the Division on Psychiatric and Mental Health Nursing Practice in 1973.

Professional Practice Standards

StandardI: Theory

The nurse applies appropriate theory that is scientifically sound as a basis for decisions regarding nursing practice. Psychiatric and mental health nursing is characterized by the application of relevant theories to explain phenomena of concern to nurses and to provide a basis for intervention.

Standard II: Data Collection

The nurse continuously collects data that are comprehensive, accurate and systematic. Effective

Standard Ill: Diagnosis

The nurse utilizes nursing diagnoses and/ or standard classification of mental disorders to express conclusions supported by recorded assessment data and current scientific premises. Nursing' s logical basis for providing care rests on the recognition and identification of those actual or potential health problems that are within the scope of nursing practice.

Standard IV: Planning

The nurse develops a nursing care plan with specific goals and interventions delineating nursing actions unique to each client's needs.

The nursing care plan is used to guide therapeutic intervention and effectively achieve the desired outcomes.

Standard V: Intervention

The nurse intervenes as guided by the nursing care plan to implement nursing actions that promote, maintain or restore physical and mental health, prevent illness and effect rehabilitation.

(a) Psychotherapeutic interventions The nurse uses psychotherapeutic interventions to assist clients in regaining or improving their previous coping abilities and to prevent further disability.

(b) Health teaching The nurse assists clients, families and groups to achieve satisfying and productive patterns of living through health teaching.

(c) Activities of daily living The nurse uses the activities of daily living in a goal directed way to foster adequate self-care and physical and mental well being of clients.

(d) Somatic therapies The nurse uses knowledge of somatic therapies and applies related clinical skills in working with clients.