Head case

http://www.signonsandiego.com/news/science/20060222-9999-lz1c22abnorm.html

San Diego Tribune

Head cased

For 100 years, the Journal of Abnormal Psychology has made mental note of our ever-changing (mis)behavior
By Scott LaFee

UNION-TRIBUNE STAFF WRITER
February 22, 2006

The latest edition of the Diagnostic and Statistical Manual – a kind of field guide to mental illness – cites more than 350 specific disorders, from autism and dyslexia to trichotillomania, which is the irresistible compulsion to pull one's hair out.

Then there's the list of generally recognized phobias, currently at almost 300, from apeirophobia (fear of infinity) to zemmiphobia (fear of the great mole rat).

In a world of 6 1/2 billion people, it's been said there are 6 1/2 billion personalities and 61/2 billion cases of human behavior outside the norm. Everyone, the argument goes, acts out in some way, displaying an eccentricity or behavior that is, well, abnormal.

But what's wrong with that? Is it really so bad to be terrified of the dark (achuophobia) or to become nervous, twitchy and a little scatter-brained after a few cups of coffee – all symptoms of a condition called “caffeine intoxication”? Is grumpiness a psychological malady?

For 100 years, cloaked beneath its plain cover, the writers and editors of the Journal of Abnormal Psychology have debated the tumultuous state and nature of human deviance, constantly asking themselves: What constitutes abnormal behavior? What causes it? What should be done?
“Psychology is the science of human behavior and the things that happen in the mind to create it,” said David Watson, a professor of psychology at the University of Iowa and a former Journal editor. “It's a subject that fascinates almost everyone because we all have notions of what's normal and what's not.”
In 1906, when Boston physician Dr. Morton Prince and colleagues founded the Journal, the psychological sciences were fledgling and fragmented. Seminal work was being done by Sigmund Freud, Carl Jung, Alfred Binet and Ivan Pavlov, but the early years of the Journal were frequently weighted with essays describing singular cases of people or behaviors that struck their authors as beyond the pale.
In 1914, for example, the Journal included accounts of reputed demonic possession, the analysis of a single dream recounted by the author and a paper titled “Hysteria as a weapon in marital conflicts.”

“The early Journal was a bit analogous to Lewis and Clark going west, describing everything they saw,” said Watson. “I don't know what kind of peer review existed then, but most people working in the field probably had never seen anyone with some of the problems described in the Journal. In fact, they may not have known some of these behaviors existed at all.”

Psychology, of course, has matured significantly over the past 10 decades, with the Journal providing a venue for greater scientific insight and debate. Superficial description has given way to deeper questions of causality. Advances in technology (brain imaging, computers) and techniques (surveys and diagnostic tools) have elevated the field.

Still, the original question posed by Journal founder Prince remains imperfectly and incompletely answered:

What is abnormal behavior?
Psychology 101
There is no normal – that is, no standard – definition. Abnormal behavior defies absolute description.

“It's still being debated,” said Tim Baker, a professor of psychology at the University of Wisconsin and the Journal editor. “To what extent is abnormal behavior something that is merely unusual? To what extent does it have to be problematic in terms of having harmful consequences to the individual or to people around the individual? It's a somewhat fuzzy concept.”

Depending on training and expertise, psychologists, psychiatrists and other mental health professionals employ various defining criteria. A textbook definition, however, would probably include one or more of these factors:
Statistical deviation: Broadly speaking, human behavior resembles a bell curve. Most people clump in the bulging middle. Behavioral characteristics that fall a certain distance from the average value tend to be considered abnormal.

Social norm violation: All cultures establish rules, expectations of the right and wrong way to do things. People whose behavior frequently violates these rules may be deemed abnormal.
Maladaptive behavior: Any behavior that causes harm, either to the individual or others. An alcoholic may be doing himself physical injury, but if he generally functions within society, that's individual maladaptive behavior. If the alcoholic's behavior harms others, that's socially maladaptive behavior.

Personal distress: If you are depressed, anxious or upset, the behaviors and thoughts relating to those feelings may be regarded as abnormal.
Medical disorder: Some abnormal behaviors relate to physiological disorders, such as Alzheimer's.
Each category has weaknesses.

“Who is to say that a person should or should not feel depressed about this or that in the world?” asked Jeffrey Schaler, a psychology professor at American University in Washington, D.C.


Schaler and others support the ideas of Dr. Thomas Szasz, a professor emeritus of psychiatry at State University of New York, who has long argued that mental illness is a myth because it cannot be “approached, measured or tested in a scientific fashion.”

“People label one another and they often call that label a diagnosis,” said Schaler. “But the labels we apply to those whose behavior disturbs us are not actual disease diagnoses. There are no signs when people label others with psychological disorders. There are only symptoms, claims, subjective reports. It takes at least two people for one to be labeled with mental illness.”

Shades of gray
The views of Schaler, Szasz and the similarly minded are the minority. Most psychologists say mental disorders are real afflictions, even if they can't be fully explained or cultured in a Petri dish.

Watson at the University of Iowa says it's all a matter of degrees. “There aren't necessarily clear points of difference between what's normal and abnormal. Abnormal behavior may just be an exaggeration of normal behavior.”

And what's normal depends on the tenor of the times. Ailments like schizophrenia have been the subject of Journal papers from the beginning.
“The patients studied back then sound similar to those studied now,” said Tom Oltmanns, a professor of psychiatry and psychology at Washington University in St. Louis. “The terms have changed, but not necessarily the diagnosis.”
But other disorders have emerged or changed with shifting social perspectives and mores. A century ago, he said, sexual disorders were “much more concerned with who was doing what to whom.” Abnormal sexual behavior was anything beyond heterosexual intercourse with one's spouse. Now, the focus is more on sexual dysfunction, a topic that was unheard of a century ago.

“I would like to think that psychology is driven more by science than culture, but people who think and write most clearly about it would say it's both,” Oltmanns said. “You can't define mental disorders in an abstract way independent of culture.

“The classic example is homosexuality. The first DSM (Diagnostic and Statistical Manual, published in 1952) considered it to be a form of abnormal psychology. But by the time the third DSM was published in 1980, the American Psychological Association had declared homosexuality was not a mental disorder. Our society had changed; our cultural view had changed.”

In one sense, though, homosexuality seems an exception to the rule. There are clearly a lot more recognized mental disorders and forms of abnormal behavior today than in Morton Prince's time, with more identified each year.

Depression, for example, wasn't a major topic in the Journal until the 1970s. Now it's a subject of serious clinical study, with dozens of subtypes. The same can be said of addictions. There are the obvious ones – alcohol, drugs, gambling – but who would have imagined discussions of Internet addiction even 20 years ago?

Some critics worry that this is a case of disorder-naming run amok. The current fourth edition of the DSM, published in 2000, is a whopping 943 pages. Baker, the Journal editor, is sympathetic to critics' concerns.

“I understand the fear that we might get to the point of having a disorder for earlobe-pulling. Or more seriously, the question about why disorders like autism and ADHD are being diagnosed so much more frequently now. Part of the answer is that we're simply more knowledgeable. The scope of psychology has broadened considerably.”

Richard Bootzin, a professor of psychology at the University of Arizona in Tucson, goes further: “I think more behaviors are seen as targets (for) medication and treatment. In the past, a lot of behaviors were dismissed as merely eccentric or odd because nobody believed or knew they were treatable.”

Mind meld
One of the major movements in modern psychology, according to Baker, is an increased attention to whether disparate disorders share common cause. Depression and anxiety disorders produce dramatically different kinds of abnormal behavior, for example, but perhaps they share certain causal factors.

Such factors, he said, are likely to be organic. Psychology, combined with molecular biology, genetics and medicine, is now morphing into a multifaceted endeavor. Watson speculates that continued advances may bring a day when psychologists and others will be able to identify genetic markers predisposing people to certain mental disorders.

“If that happens, perhaps we can devise treatments or therapies to prevent the disorder in the first place,” he said.

Would that spell an end to abnormal behavior?
Hardly, answered Watson. “New pathologies are always emerging. Our environment constantly encourages people to get into trouble in new and different ways.”

Put another way, nobody is devoid of at least a few minor psychological quirks or emotional eccentricities. Any person who is utterly and absolutely normal probably is not.