In addition, to prepare for this discussion, read
of your textbook, review the articles
Freud Was Right . . . About the Origins of Abnormal Behavior
Links to an external site.
The Myth of Mental Illness
Links to an external site.
Personality Disorder Is Disease
Links to an external site.
Is “Abnormal Psychology” Really All That Abnormal?
Links to an external site.
, as well as the video
How Mental Illness Changed Human History – for the Better: David Whitley at TEDxManhattan Beach
Links to an external site.
. Lastly, review any announcements posted by the instructor.
To successfully complete this discussion,
· Based on your required resources, define abnormal psychology.
· Interpret why you believe it is important for clinicians to consider the three perspectives of abnormality.
· Discuss the origins of mental illness and how theories throughout time have affected the metamorphosis of abnormal psychology.
· Identify at least two of the theoretical foundations associated with abnormal psychology.
· Discuss your understanding for the use of the
DSM-5, and how it too has changed the process for diagnosis.
· Based on the controversial viewpoints of Szasz (1960) and Ausubel (1961), as well as the other required resource information, evaluate your own beliefs about mental illness. Is it real? Is it common or uncommon? Is creativity supported by behaviors resembling mental illness? Support your viewpoints using citations.
· Elaborate on why culture should be considered, associated with behaviors, and what might be considered normal versus abnormal.
· Be sure to use your own
Links to an external site.
and apply in-text citations, according to
APA: Citing Within Your Paper
Links to an external site.
, appropriately throughout your post.
Post your initial response of 300 words or more by
Day 3 (Thursday). Respond to at least two of your peers by
Day 7 (Monday). Peer postings should be a minimum of 200 words each.
Guided Response: Peer responses should be carefully crafted and insightful. The goal of the discussion forum is to foster continual dialogue, similar to what might occur in a verbal face-to-face exchange. Consider discussing areas of interest as well as the following questions in your responses:
· What additional questions do you have about your peer thoughts about the origin and controversies surrounding abnormal psychology?
· Are there relevant connections between your understanding and that of your peer?
· Share examples from your own experiences or knowledge that support your evaluation of the weekly prompt. (Only share information that you are comfortable sharing in a public forum.)
Instructor Responses: Review any instructor feedback on your postings. Often feedback is shared to help you to elevate your level of critical thought or make corrections. Reply based on this feedback to advance your understanding of the content addressed.
Observe the following guidelines for all responses:
· Remember that discussion forums should be conversations; dialogue is encouraged throughout the course.
· Provide a courteous and interactive learning environment.
· Continue to monitor this discussion through 5:00 p.m. on Day 7 of the week and reply to anyone (instructor or classmate) who has chosen to respond to your original post.
· Your grade will reflect the quality of your initial post, the depth of your peer replies, and your active support of forum dialogue.
· Your responses should demonstrate that you have read the existing replies on the board. (In your response mention information and viewpoints already expressed by existing responses to the same post.)
· The peer responses should
deeply reflect on the content.
Journal of Child and Family Studies, Vol. 15, No. 1, February 2006 ( C© 2006), pp. 1–12
Freud was Right. . . About the Origins of Abnormal
Peter Muris, Ph.D.1,2
Published online: 24 February 2006
Freud’s psychodynamic theory is predominantly based on case histories of pa-
tients who displayed abnormal behavior. From a scientific point of view, Freud’s
analyses of these cases are unacceptable because the key concepts of his theory
cannot be tested empirically. However, in one respect, Freud was totally right:
most forms of abnormal behavior originate in childhood. In this paper various
factors are discussed that play a role in the etiology of abnormal behavior in chil-
dren and adolescents. Furthermore, problems are signaled that hinder effective
interventions for disordered youths.
KEY WORDS: psychological disorders; etiology; children and adolescents.
Freud’s psychoanalytic theory is still one of the most influential theoretical
models of abnormal human behavior. On the basis of a series of intriguing case
studies, Freud illustrated the key constructs of his theory thereby attempting to
explain why his patients were exhibiting aberrant behaviors. For example, take the
case of Little Hans, which was described by Freud as the “Analysis of a phobia in
a five-year-old boy” (Freud, 1909/1955). Little Hans was afraid of horses. He was
so terrified that he did not dare to go outside anymore, a phenomenon that current
clinical psychologists would label as ‘agoraphobia.’ Freud’s analysis of this case
was crystal clear. Hans suffered from a so-called Oedipus complex. That is, Hans
wanted to have sex with his mother and therefore expected to be punished by his
father. As a result, Hans became afraid of his father. However, this was considered
as unacceptable by his Ego and, therefore, the fear was displaced to another object,
1Professor, Institute of Psychology, Erasmus University Rotterdam, The Netherlands.
2Correspondence should be directed to Peter Muris, Ph.D., Institute of Psychology, Erasmus University
Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.; e-mail: email@example.com.
1062-1024/06/0200-0001/1 C© 2006 Springer Science+Business Media, Inc.
resulting in a phobia of horses. In another case, Freud described an adult lawyer,
Paul Lorentz, also known as the Ratman (Freud, 1909/1955). The Ratman was
plagued by the obsession that his father had to undergo the rat punishment. This
rat punishment implied that a cooking pot was attached to his father’s backside in
which rats were placed. The rats ate their way into the anus of his father. How is it
possible that Lorentz was plagued by such disturbing thoughts about his beloved
father? Freud’s analysis was again clear: the obsessions of the Ratman had to do
with sex-related, hostile impulses against his father.
THE HOLY GRAIL
Freud’s theory is largely based on case studies of abnormal human behavior.
Without exceptions, these cases are fascinating and interesting. However, from
a scientific point of view, Freud’s analyses of these cases are unacceptable, as
the main concepts of his theory cannot be validated empirically (Eysenck, 1985).
Since Freud, a lot of researchers in the field of clinical psychology have devoted
their attention to what can be called “the quest of the Holy Grail.” The purpose of
this quest is to find an answer on two questions: (1) where does abnormal human
behavior come from? and, (2) how can we use this knowledge to help people who
show clear signs of aberrant behavior?
Abnormal behavior or psychopathology is concerned with various types of
disorders, including eating disorders, depression, disruptive behavior, and anxi-
ety disorders (American Psychiatric Association [APA], 2000). In their quest for
the Holy Grail, an increasing number of researchers are focusing on the study
of abnormal behavior in children and adolescents. The reason for this is obvious
and has to do with what is known about the age of onset of many disorders. For
example, specific phobias usually start in childhood (Öst, 1987). Social phobia,
depression, and eating disorders frequently have their onset during adolescence
(Burke, Burke, Regier, & Rae, 1990; Mussell, Mitchell, Weller et al., 1995), while
people who suffer from a personality disorder by definition already show signs
of their problems before the age of 18 (APA, 2000). In other words, many types
of abnormal behavior that are seen in adults have already started in youth. Re-
cent epidemiological research with children and adolescents has demonstrated
that psychopathology indeed is a serious problem in this age group (Costello,
Mustillo, Erkanli, Keeler, & Angold, 2003). In a large sample of youths from the
general population, the one-year prevalence of internalizing (i.e., anxiety disor-
ders, depression) as well as externalizing disorders (i.e., oppositional-defiant and
conduct disorders) was about 5%. The most striking finding of this study was
that before their 16th birthday, 36.7% of all youths at some point in time had
suffered from a psychological problem. It is important to note that these prob-
lems concerned clinical diagnoses, which implies that youths really experienced
considerable discomfort in their daily functioning.
About the Origins of Abnormal Behavior 3
THE ORIGINS OF ABNORMAL BEHAVIOR IN YOUTHS
Why do a substantial proportion of children and adolescents come to suffer
from a psychological disorder? Briefly, the answer to this question can be found in
four groups of factors. The first group of factors is concerned with characteristics
of the child. The second group of factors involves the family, and especially the
interaction between children and their parents. The third group of factors has to
do with influences of the environment and from the child’s point of view can be
labeled as learning experiences. The fourth and final group of factors pertains to
Genetics and Temperament
Genetic make-up is one important child factor that is involved in the origins
of psychopathology. The influence of genetics is typically established in twin
studies. Based on the fact that monozygotic twin pairs share 100% of the genetic
material, whereas dizygotic twin pairs only share 50%, one can determine the level
of agreement and compute a hereditary factor for each type of psychopathology.
For most disorders, the agreement in psychopathology is larger in monozygotic
than in dizygotic twins, which points in the direction of a genetic influence. More
precisely, for the three most common psychological disorders in youths (i.e.,
anxiety disorders, depression, and disruptive behavior disorders), twin studies
have demonstrated that about 50% of the variance in these problems can be
attributed to heredity (Rutter, Silberg, O’Conner, & Siminoff, 1999).
In what way does heredity contribute to the etiology of psychopathology in
youths? One factor that is thought to play a role in this respect is the child’s tem-
perament and, in particular, the temperament factor of emotionality (also known as
neuroticism or negative affectivity). Emotionality refers to emotional instability
and there are clear indications that this temperament factor has a genetic basis
(Eysenck, 1990). Research has also shown that children and adolescents with high
levels of emotionality are at greater risk for developing psychological disorders
(Asendorpf & Van Aken, 2003; Barbaranelli, Caprara, Rabasca, & Pastorelli, 2003;
Erler, Evans, & McGhee, 1999; Huey & Weisz, 1997; John, Caspi, Robins, Moffitt,
& Stouthamer-Loeber, 1994; Muris, Winands, & Horselenberg, 2003). Further, it
is important to note that emotionality consists of various lower-order components
of which fear, anger/frustration, and sadness can be considered as most relevant
as they seem to play an important role in the type of psychopathology from which
children eventually come to suffer (Rothbart & Bates, 1998). That is, a child with
a fearful temperament is more prone to develop an anxiety disorder, a child with a
temperament characterized by high anger/frustration runs greater risk to develop
a disruptive behavior disorder, whereas a child with a sad temperament is more
susceptible to develop a depression (Muris & Ollendick, 2005).
It is important to note that the contribution of temperament to the etiology
of child psychopathology should not merely be viewed as a reactive process
guided by the temperament factor of emotionality. In the past five years, an
increasing amount of research has focused on ‘effortful control,’ which is viewed as
a regulative temperament factor that enables children and adolescents to modulate
their emotional reactions. Effortful control can be defined as “the ability to inhibit
a dominant response to perform a subdominant response” (Rothbart & Bates,
1998), and essentially consists of two important components: inhibitory control,
which pertains to the ability to inhibit one’s behavior if necessary, and attention
control, which can be defined as the ability to focus and shift attention as needed.
Current temperament researchers assume that vulnerability to psychopathol-
ogy is characterized by a combination of high levels of emotionality and low levels
of effortful control (Calkins & Fox, 2002; Lonigan & Phillips, 2001). More specif-
ically, high levels of emotionality make children prone to develop psychological
disorders, but it may well be the case that the negative impact of this reactive
temperament factor can be buffered by effortful control. That is, a stressful life
event will elicit negative emotions in children and particularly in those who are
characterized by high levels of emotionality. However, only children with low
levels of effortful control will experience difficulties to deal adequately with these
negative feelings and hence will react with avoidance behavior, aggression, and
depression. In contrast, children with high levels of effortful control are capa-
ble of regulating these negative emotions by employing more strategic, flexible
and effective coping strategies (Muris & Ollendick, 2005). Recent research has
indeed demonstrated that reactive and regulative temperament factors of respec-
tively emotionality and effortful control each make a unique contribution to the
frequency of psychopathological symptoms in youths (Muris, De Jong, & Engelen,
2004). Finally, it should be mentioned that different aspects of effortful control are
allied to specific psychopathological symptoms (Muris, Meesters, & Rompelberg,
submitted). More precisely, a lack of attentional control was more strongly linked
to internalizing symptoms, whereas a deficiency of inhibitory control was more
clearly related to externalizing symptoms. Note that these differential relations are
in keeping with the clinical observation that internalizing disorders are typically
characterized by uncontrollable negative thoughts, while externalizing disorders
are frequently marked by impulsive and disinhibited behavior (see APA, 2000).
Parental Rearing and Modeling
The second group of factors that is involved in the etiology of child psy-
chopathology is concerned with the family and, in particular, with parental rear-
ing practices. In the context of abnormal behavior, two important dimensions in
parental rearing behaviors can be discerned. The first dimension is parental care
and has two opposite poles: an accepting and warm rearing style on one side and
a rejecting and cold rearing attitude on the other side. The second dimension is
concerned with parental control and actually opposes an autonomy-promoting and
About the Origins of Abnormal Behavior 5
an overprotective rearing style to each other (Rapee, 1997). Various studies have
found that specific types of abnormal behavior in children are associated with
particular types of parental rearing. For example, anxiety symptoms in youths are
generally linked to high levels of parental control (i.e., overprotection), depressive
symptoms are related to low levels of parental care (i.e., lack of emotional warmth
and rejection), whereas behavioral problems are associated with high levels of
control as well as low levels of care (Muris, Bögels, Meesters, Van der Kamp, &
Van Oosten, 1996; Muris, Meesters, Merckelbach, & Hülsenbeck, 2000; Muris,
Meesters, Schouten, & Hoge, 2004; Muris, Meesters, & Van den Berg, 2003). As
an aside, it should be mentioned that it is difficult to find out what is cause and what
is effect in the relation between parental rearing behavior and child psychopathol-
ogy. It may well be that negative rearing behaviors contribute to the development
of abnormal behavior. Otherwise, it is also possible that children who display
abnormal behavior elicit negative rearing behaviors in their parents. Currently,
researchers assume that both scenarios are applicable, which means that parental
rearing behaviors are thought to play a role in the etiology and maintenance of
psychopathology in youths.
More specific parental rearing behaviors also seem to be involved in the
origins of psychological problems in children. For example, it is a common fact
that children learn by observing and imitating the behaviors of their parents, a
phenomenon that is known as modeling. Experimental research has convincingly
demonstrated that modeling is involved in the acquisition of fear in children. In
a study by Gerull and Rapee (2002), toddlers were shown a rubber snake and
spider, which were alternately paired with either a negative or a positive facial
expression by their mother. Next, both stimuli were presented again after a brief
delay, and fear and avoidance reactions were assessed. Results clearly indicated
that children displayed less fear and more approach behavior when their mothers
had responded positively to the stimuli. Conversely, children showed more fear
and avoidance following negative reactions from their mother. Other examples
that suggest a link between modeling and child psychopathology are numerous
and can be observed inside as well as outside the clinic: obese children often have
fat parents, aggressive children frequently have antisocial parents, and children
with developing personality problems tend to have weird parents (Adshead, 2003;
Bandura, 1976; Gable & Lutz, 2000). Of course, modeling is not the only factor
that contributes to these phenomena but at least seems to play a significant role.
Life Events and Negative Information
A third group of factors that is relevant in the context of the genesis of
abnormal behavior in children is concerned with negative learning experiences.
Obviously, children who experience aversive life events run greater risk for devel-
oping psychopathology (Cuffe, McKeown, Addy, & Garrison, 2005; Tiet et al.,
2001). Maltreatment, abuse, parental divorce, being teased at school, or the death
of a significant person are all negative life events that may give rise to abnor-
mal behavior in children, and especially in those characterized by a vulnerable
temperament. However, there are also more subtle forms of learning experiences
that may promote the development of psychopathology. For example, research has
demonstrated that negative information promotes children’s fear (Field, Argyrus,
& Knowles, 2001). Seven- to 9-year-old children received either negative or pos-
itive information about an unknown monster doll. Results showed that negative
information significantly increased children’s fear ratings, whereas after positive
information fear ratings slightly decreased. These results were replicated by Muris,
Bodden, Merckelbach, Ollendick, and King (2003) who provided children with
either negative or positive information about an unknown, doglike animal, called
“the beast.” This study demonstrated that information-induced fear effects endured
over a 1-week follow-up period and generalized to other stimuli; that is, children
who became more fearful of the beast after receiving negative information also
became more apprehensive of other dogs and predators.
It is good to keep in mind that children are confronted with negative infor-
mation in various ways: they may hear things from adults or other children, but
they may also see things on television or come across certain information while
surfing on the internet. These learning experiences not only play a role in anxiety
phenomena, but also seem to contribute to other forms of abnormal behavior in
youths. For instance, Greenfield (2004) studied the effects of inadvertent exposure
to pornographic material on the internet, and noted that children who regularly
come across such information are more likely to develop different sexual attitudes,
and even engage in age-inappropriate sexual activity and sexual violent behaviors.
Society and Culture
The fourth and final group of factors that is involved in the etiology of
abnormal behavior in youths is operating at a societal and cultural level. For
example, research on the prevalence of anxiety symptoms in South African chil-
dren has consistently demonstrated that black and colored youths in this country
display higher anxiety levels than their white counterparts (Burkhardt, Loxton,
& Muris, 2003; Muris, Schmidt, Engelbrecht, & Perold, 2002). This difference
was almost completely explained by the socio-economic background of the chil-
dren (Muris, Loxton, Neumann, & Du Plessis, in press). That is, in the after-
math of the Apartheid regime black and colored children still live in poor and
threatening neighborhoods, whereas white children are raised under rich and safe
living conditions. While such marked differences in socio-economic background
are seldom seen in Western countries, this example illustrates that a societal
factor can make a significant contribution to the psychological (dys)functioning of
About the Origins of Abnormal Behavior 7
Further evidence for a link between society and anxiety comes from a meta-
analytic study by Twenge (2000) who compared children’s scores on a commonly
employed anxiety questionnaire for various birth cohorts between 1952 and 1993.
Results indicated that youths in the 1990s displayed considerably higher anxiety
levels as compared to youths in the 1950s. To put it even stronger, the mean
score of the normal children in the 1990s was even higher than the mean score
of clinically referred children in the 1950s. Interestingly, this increase in anxiety
across various age cohorts was significantly related to a variety of social parameters
(e.g., divorce rate, number of violent crimes), which made Twenge (2000) conclude
that a decrease in social connectedness and an increase in environmental danger
may be responsible for the rise in anxiety among youths.
Another example illustrating the role of society in the etiology of child psy-
chopathology is concerned with culturally determined body ideals. In Western
countries, children and adolescents are attracted by good-looking idols of whom
women look slim and men look slender and muscular. It has been demonstrated
that early adolescent youths frequently engage in body change strategies, with
girls engaging in dieting in order to lose weight and boys doing exercises in or-
der to develop their muscles (Ricciardelli & McGabe, 2001). Further research
indicates that culturally determined body ideals have a substantial impact on the
development of abnormal manifestations of body change strategies, and this influ-
ence remains statistically significant when controlling for various biological (e.g.,
Body Mass Index) and psychological factors (e.g., self-esteem; Muris, Meesters,
Van de Blom, & Mayer, 2005).
In sum, it can be concluded that psychopathology is highly prevalent among
youths, and there are clear indications that a substantial proportion of these psy-
chological problems will continue into adulthood. Various child, family, environ-
mental, and societal factors have been discussed that are thought to be involved
in the etiology of abnormal behavior in youths. Two additional remarks should
be made with regard to the role of these factors. First, it should be kept in mind
that in reality factors frequently interact with each other (Wenar & Kerig, 2000).
For example, a child is particularly vulnerable if he/she is characterized by an
emotional temperament and is raised by parents who are rejective and show little
emotional warmth. Thus, it should be kept in mind that it is often the combination
of vulnerability factors and/or the lack of protective variables that are responsible
for the emergence of abnormal behavior. Second, when studying factors that are
involved in the etiology of child psychopathology, one should adopt a developmen-
tal perspective. For example, when raising a 2-year-old child it may be perfectly
adequate for parents to rely on a controlling rearing style. However, this style
may be totally inappropriate for a 16-year-old who generally fares better with an
autonomy-granting attitude of his parents.
The general impression is that contemporary youths run greater risk for
developing psychopathology. Changes in society (increased individualization) and
family (increased divorce rate) and increased confrontation with the negative and
even dark sides of life (not only via television and internet, but also in the direct
environment) put children under greater pressure and will result in an increase of
Fortunately, there is also good news. In the past decade, researchers in the
field of clinical psychology have developed effective intervention methods for
treating the most prevalent psychological problems among youths (Barrett &
Ollendick, 2004). When detected in good time, disruptive behavior disorders can
be treated effectively by training parental rearing skills (Barkley, 1997). Depres-
sion can be successfully handled with cognitive-behavioral therapy (CBT) of the
child (Lewinsohn, Clarke, Hops, & Andrews, 1990). Impressive progress has also
been made with the treatment of childhood anxiety disorders (Kendall, 1994),
which also respond well to CBT-based interventions. For example, in a study by
our research group (Muris, Meesters, & Van Melick, 2002), children with anxi-
ety disorders were randomly assigned to three conditions: CBT, a psychological
placebo intervention (i.e., emotional disclosure), or a no-treatment control con-
dition. Therapy outcome measures were obtained three months before treatment,
at pretreatment, and at posttreatment. Results showed that levels of psychopatho-
logical symptoms remained relatively stable during the three months preceding
treatment. Most importantly, pretreatment-posttreatment comparisons indicated
that CBT was superior to psychological placebo and no-treatment control. That
is, only in the CBT condition significant reductions of anxiety symptoms were
observed. Recently, research has demonstrated that these positive effects of CBT
in anxious children are maintained over very long time periods (Barrett, Duffy,
Dadds, & Rapee, 2001).
In spite of this positive news, there are also a number of problems. The first
problem has to do with the dissemination and implementation of the intervention
methods that have been developed by scientists (Weisz, Jensen, & McLeod, 2005).
Effective programs frequently remain in the research institute and, as a result, they
are not used by clinicians who actually work with disordered youths. A second
problem pertains to the late detection of abnormal behavior in youths (Angold,
Costello, Farmer, Burns, & Erkanli, 1999; Champion, Goodall, & Rutter, 1995).
This is not only true for disruptive behavior problems which either elicit shame
in parents or are not seen as a serious problem (because parents show antisocial
behavior themselves) but also for emotional problems such as anxiety disorders
About the Origins of Abnormal Behavior 9
and depression that are less clearly visible to the outside world. As a result,
many children already suffer from their problem for many years. When they are
eventually referred to the clinic the problem has become so severe that effective
treatment is difficult. A third and final problem concerns the organization and
quality of the mental health service system. Even in such a civilized and well-
organized country as the Netherlands, it is still surprising to note that not all
clinicians are using empirically validated, effective treatment methods. Further, it
is far from clear for children and their parents where they can get the most optimal
treatment for psychological problems.
WAS FREUD RIGHT?
Was Freud right in his ideas on the origins of abnormal behavior? Formally,
the answer to this question is of course negative, as Freud developed an almost
unreal theory about the etiology of psychopathology in which constructs such
as Id-Ego-Superego, repression, and Oedipus complex play a prominent role. It
has become clear that such constructs are difficult to validate empirically and as
such a firm scientific basis for Freud’s theory is still lacking. However, there is
at least one important issue on which Freud was right: that is, human abnormal
behavior frequently has its origins in childhood. Researchers and clinicians seem
to have accepted this idea, but it is time that politicians and other policy makers
also become convinced of this notion, so that they put more effort in tackling the
problems that hinder the effective detection and intervention of disordered youths.
This paper is based on the academic lecture given by the author on February
18, 2005 when accepting his position as full professor in Clinical and Health
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PERSONALITY DISORDER IS DISEASE
DAVID P. AUSUBEL
Bureau of Educational Research, University of Illinois
IN two recent articles in the American Psycholo-
gist, Szasz (1960) and Mowrer (1960) have
argued the case for discarding the concept of
mental illness. The essence of Mowrer’s position
is that since medical science lacks “demonstrated
competence . . . in psychiatry,” psychology would
be wise to “get out” from “under the penumbra of
medicine,” and to regard the behavior disorders as
manifestations of sin rather than of disease (p.
302). Szasz’ position, as we shall see shortly, is
somewhat more complex than Mowrer’s, but agrees
with the latter in emphasizing the moral as op-
posed to the psychopathological basis of abnormal
For a long time now, clinical psychology has
both repudiated the relevance of moral judgment
and accountability for assessing behavioral acts and
choices, and has chafed under medical (psychiatric)
control and authority in diagnosing and treating
the personality disorders. One can readily appreci-
ate, therefore, Mowrer’s eagerness to sever the
historical and professional ties that bind clinical
psychology to medicine, even if this means denying
that psychological disturbances constitute a form of
illness, and even if psychology’s close working
relationship with psychiatry must be replaced by a
new rapprochement with sin and theology, as “the
lesser of two evils” (pp. 302-303). One can also
sympathize with Mowrer’s and Szasz’ dissatisfac-
tion with prevailing amoral and nonjudgmental
trends in clinical psychology and with their entirely
commendable efforts to restore moral judgment and
accountability to a respectable place among the
criteria used in evaluating human behavior, both
normal and abnormal.
Opposition to these two trends in the handling
of the behavior disorders (i.e., to medical control
and to nonjudgmental therapeutic attitudes), how-
ever, does not necessarily imply abandonment of
the concept of mental illness. There is no incon-
sistency whatsoever in maintaining, on the one
hand, that most purposeful human activity has a
moral aspect the reality of which psychologists
cannot afford to ignore (Austibel, 1952, p. 462),
that man is morally accountable for the majority
of his misdeeds (Ausubel, 1952, p. 4
), and that
psychological rather than medical training and
sophistication are basic to competence in the per-
sonality disorders (Ausubel, 1956, p. 101), and
affirming, on the other hand, that the latter dis-
orders are genuine manifestations of illness. In
recent years psychology has been steadily moving
away from the formerly fashionable stance of
ethical neutrality in the behavioral sciences; and
in spite of strident medical claims regarding superior
professional qualifications and preclusive legal re-
sponsibility for treating psychiatric patients, and
notwithstanding the nominally restrictive provisions
of medical practice acts, clinical psychologists have
been assuming an increasingly more important,
independent, and responsible role in treating the
mentally ill population of the United States.
It would be instructive at this point to examine
the tactics of certain other medically allied profes-
sions in freeing themselves from medical control
and in acquiring independent, legally recognized
professional status. In no instance have they
resorted to the devious stratagem of denying that
they were treating diseases, in the hope of mollify-
ing medical opposition and legitimizing their own
professional activities. They took the position in-
stead that simply because a given condition is de-
nned as a disease, its treatment need not necessarily
be turned over to doctors of medicine if other
equally competent professional specialists were
available. That this position is legally and politi-
cally tenable is demonstrated by the fact that an
impressively large number of recognized diseases
are legally treated today by both medical and non-
medical specialists (e.g., diseases of the mouth, face,
jaws, teeth, eyes, and feet). And there are few
convincing reasons for believing that psychiatrists
wield that much more political power than physi-
cians, maxillofacial surgeons, ophthalmologists, and
orthopedic surgeons, that they could be successful
where these latter specialists have failed, in legally
restricting practice in their particular area of com-
petence to holders of the medical degree. Hence,
even if psychologists were not currently managing
to hold their own vis-a-vis psychiatrists, it would
be far less dangerous and much more forthright to
press for the necessary ameliorative legislation than
to seek cover behind an outmoded and thoroughly
discredited conception of the behavior disorders.
THE SZASZ-MOWRER POSITION
Szasz’ (1960) contention that the concept of
mental illness “now functions merely as a conven-
ient myth” (p. 118) is grounded on four unsub-
stantiated and logically untenable propositions,
which can be fairly summarized as follows:
1. Only symptoms resulting from demonstrable
physical lesions qualify as legitimate manifestations
of disease. Brain pathology is a type of physical
lesion, but its symptoms properly speaking, are
neurological rather than psychological in nature.
Under no circumstances, therefore, can mental
symptoms be considered a form of illness.
2. A basic dichotomy exists between mental
symptoms, on the one hand, which are subjective
in nature, dependent on subjective judgment and
personal involvement of the observer, and referable
to cultural-ethical norms, and physical symptoms,
on the other hand, which are allegedly objective in
nature, ascertainable without personal involvement
of the observer, and independent of cultural norms
and ethical standards. Only symptoms possessing
the latter set of characteristics are genuinely reflec-
tive of illness and amenable to medical treatment.
3. Mental symptoms are merely expressions of
problems of living and, hence, cannot be regarded
as manifestations of a pathological condition. The
concept of mental illness is misleading and demon-
ological because it seeks to explain psychological
disturbance in particular and human disharmony in
general in terms of a metaphorical but nonexistent
disease entity, instead of attributing them to inher-
ent difficulties in coming to grips with elusive
problems of choice and responsibility.
4. Personality disorders, therefore, can be most
fruitfully conceptualized as products of moral
conflict, confusion, and aberration. Mowrer (1960)
extends this latter proposition to include the dictum
that psychiatric symptoms are primarily reflective
of unacknowledged sin, and that individuals mani-
festing these symptoms are responsible for and
deserve their suffering, both because of their original
transgressions and because they refuse to avow and
expiate their guilt (pp. 301, 304).
Widespread adoption of the Szasz-Mowrer view
of the personality disorders would, in my opinion,
turn back the psychiatric clock twenty-five hundred
years. The most significant and perhaps the only
real advance registered by mankind in evolving a
rational and humane method of handling behavioral
aberrations has been in substituting a concept of
disease for the demonological and retributional doc-
trines regarding their nature and etiology that
flourished until comparatively recent times. Con-
ceptualized as illness, the symptoms of personality
disorders can be interpreted in the light of under-
lying stresses and resistances, both genie and en-
vironmental, and can be evaluated in relation to
specifiable quantitative and qualitative norms of
appropriately adaptive behavior, both cross-cultur-
ally and within a particular cultural context. It
would behoove us, therefore, before we abandon the
concept of mental illness and return to the medieval
doctrine of unexpiated sin or adopt Szasz’ ambigu-
ous criterion of difficulty in ethical choice and
responsibility, to subject the foregoing propositions
to careful and detailed study.
Mental Symptoms and Brain Pathology
Although I agree with Szasz in rejecting the doc-
trine that ultimately some neuroanatomic or neuro-
physiologic defect will be discovered in all cases of
personality disorder, I disagree with his reasons for
not accepting this proposition.. Notwithstanding
Szasz’ straw man presentation of their position, the
proponents of the extreme somatic view do not
really assert that the particular nature of a patient’s
disordered beliefs can be correlated with “certain
definite lesions in the nervous system” (Szasz, 1960,
p. 113). They hold rather that normal cognitive
and behavioral functioning depends on the anatomic
and physiologic integrity of certain key areas of
the brain, and that impairment of this substrate
integrity, therefore, provides a physical basis for
disturbed ideation and behavior, but does not ex-
plain, except in a very gross way, the particular
kinds of symptoms involved. In fact, they are
generally inclined to attribute the specific character
of the patient’s symptoms to the nature of his pre-
illness personality structure, the substrate integrity
of which is impaired by the lesion or metabolic
defect in question.
PERSONALITY DISORDER Is DISEASE 71
Nevertheless, even though this type of reasoning
plausibly accounts for the psychological symptoms
found in general paresis, various toxic deleria, and
other comparable conditions, it is an extremely im-
probable explanation of all instances of personality
disorder. Unlike the tissues of any other organ,
brain tissue possesses the unique property of making
possible awareness of and adjustment to the world
of sensory, social, and symbolic stimulation. Hence
by virtue of this unique relationship of the nervous
system to the environment, diseases of behavior and
personality may reflect abnormalities in personal
and social adjustment, quite apart from any struc-
tural or metabolic disturbance in the underlying
neural substrate. I would conclude, therefore, that
although brain pathology is probably not the most
important cause of behavior disorder, it is un-
doubtedly responsible for the incidence of some
psychological abnormalities as well as for various
neurological signs and symptoms.
But even if we completely accepted Szasz’ view
that brain pathology does not account for any
symptoms of personality disorder, it would still be
unnecessary to accept his assertion that to qualify
as a genuine manifestation of disease a given
symptom must be caused by a physical lesion.
Adoption of such a criterion would be arbitrary and
inconsistent both with medical and lay connotations
of the term “disease,” which in current usage is
generally regarded as including any marked devia-
tion, physical, mental, or behavioral, from normally
desirable standards of structural and functional
Mental versus Physical Symptoms
Szasz contends that since the analogy between
physical and mental symptoms is patently fal-
lacious, the postulated parallelism between physical
and mental disease is logically untenable. This
line of reasoning is based on the assumption that
the two categories of symptoms can be sharply
dichotomized with respect to such basic dimensions
as objectivity-subjectivity, the relevance of cultural
norms, and the need for personal involvement of
the observer. In my opinion, the existence of such
a dichotomy cannot be empirically demonstrated in
Practically all symptoms of bodily disease involve
some elements of subjective judgment—both on the
part of the patient and of the physician. Pain is
perhaps the most important and commonly used
criterion of physical illness. Yet, any evaluation
of its reported locus, intensity, character, and dura-
tion is dependent upon the patient’s subjective
appraisal of his own sensations and on the physi-
cian’s assessment of the latter’s pain threshold,
intelligence, and personality structure. It is also
a medical commonplace that the severity of pain
in most instances of bodily illness may be mitigated
by the administration of a placebo. Furthermore,
in taking a meaningful history the physician must
not only serve as a participant observer but also
as a skilled interpreter of human behavior. It is
the rare patient who does not react psychologically
to the signs of physical illness; and hence physicians
are constantly called upon to decide, for example,
to what extent precordial pain and reported tight-
ness in the chest are manifestations of coronary
insufficiency, of fear of cardiac disease and impend-
ing death, or of combinations of both conditions.
Even such allegedly objective signs as pulse rate,
BMR, blood pressure, and blood cholesterol have
their subjective and relativistic aspects. Pulse rate
and blood pressure are notoriously susceptible to
emotional influences, and BMR and blood choles-
terol fluctuate widely from one cultural environment
to another (Dreyfuss & Czaczkes, 1959). And
anyone who believes that ethical norms have no
relevance for physical illness has obviously failed
to consider the problems confronting Catholic pa-
tients and/or physicians when issues of contracep-
tion, abortion, and preferential saving of the
mother’s as against the fetus’ life must be faced
in the context of various obstetrical emergencies and
medical contraindications to pregnancy.
It should now be clear, therefore, that symptoms
not only do not need a physical basis to qualify as
manifestations of illness, but also that the evalua-
tion of all symptoms, physical as well as mental,
is dependent in large measure on subjective judg-
ment, emotional factors, cultural-ethical norms, and
personal involvement on the part of the observer.
These considerations alone render no longer tenable
Szasz’ contention (1960, p. 114) that there is an
inherent contradiction between using cultural and
ethical norms as criteria of mental disease, on the
one hand, and of employing medical measures of
treatment on the other. But even if the postulated
dichotomy between mental and physical symptoms
were valid, the use of physical measures in treat-
ing subjective and relativisitic psychological symp-
toms would still be warranted. Once we accept the
72 AMERICAN PSYCHOLOGIST
proposition that impairment of the neutral substrate
of personality can result in behavior disorder, it is
logically consistent to accept the corollary proposi-
tion that other kinds of manipulation of the same
neutral substrate can conceivably have therapeutic
effects, irrespective of whether the underlying cause
of the mental symptoms is physical or psychological.
Mental Illness and Problems of Living
“The phenomena now called mental illness,”
argues Szasz (1960), can be regarded more forth-
rightly and simply as “expressions of man’s struggle
with the problem of how he should live” (p. 117).
This statement undoubtedly oversimplifies the
nature of personality disorders; but even if it were
adequately inclusive it would not be inconsistent
with the position that these disorders are a mani-
festation of illness. There is no valid reason why
a particular symptom cannot both reflect a problem
in living and constitute a manifestation of disease.
The notion of mental illness, conceived in this way,
would not “obscure the everyday fact that life for
most people is a continuous struggle . . . for a
‘place in the sun,’ ‘peace of mind,’ or some other
human value” (p. 118). It is quite true, as Szasz
points out, that “human relations are inherently
fraught with difficulties” (p. 117), and that most
people manage to cope with such difficulties without
becoming mentally ill. But conceding this fact
hardly precludes the possibility that some indi-
viduals, either because of the magnitude of the
stress involved, or because of genically or environ-
mentally induced susceptibility to ordinary degrees
of stress, respond to the problems of living with
behavior that is either seriously distorted or suf-
ficiently unadaptive to prevent normal interpersonal
relations and vocational functioning. The latter
outcome—gross deviation from a designated range
of desirable behavioral variability—conforms to the
generally understood meaning of mental illness.
The plausibility of subsuming abnormal be-
havioral reactions to stress under the general rubric
of disease is further enhanced by the fact that
these reactions include the same three principal
categories of symptoms found in physical illness.
Depression and catastrophic impairment of self-
esteem, for example, are manifestations of person-
ality disorder which are symptomologically com-
parable to edema in cardiac failure or to heart
murmurs in valvular disease. They are indicative
of underlying pathology but are neither adaptive
nor adjustive. Symptoms such as hypomanic over-
activity and compulsive striving toward unrealisti-
cally high achievement goals, on the other hand,
are both adaptive and adjustive, and constitute a
type of compensatory response to basic feelings of
inadequacy, which is not unlike cardiac hyper-
trophy in hypertensive heart disease or elevated
white blood cell count in acute infections. And
finally, distortive psychological defenses that have
some adjustive value but are generally maladaptive
(e.g., phobias, delusions, autistic fantasies) are
analogous to the pathological situation found in
conditions like pneumonia, in which the excessive
outpouring of serum and phagocytes in defensive
response to pathogenic bacteria literally causes the
patient to drown in his own fluids.
Within the context of this same general proposi-
tion, Szasz repudiates the concept of mental illness
as demonological in nature, i.e., as the “true heir
to religious myths in general and to the belief in
witchcraft in particular” (p. 118) because it al-
legedly employs a reined abstraction (“a deformity
of personality”) to account in causal terms both
for “human disharmony” and for symptoms of
behavior disorder (p. 114). But again he appears
to be demolishing a straw man. Modern students
of personality disorder do not regard mental illness
as a cause of human disharmony, but as a co-
manifestation with it of inherent difficulties in
personal adjustment and interpersonal relations;
and in so far as I can accurately interpret the
literature, psychopathologists do not conceive of
mental illness as a cause of particular behavioral
symptoms but as a generic term under which these
symptoms can be subsumed.
Mental Illness and Moral Responsibility
Szasz’ final reason for regarding mental illness
as a myth is really a corollary of his previously
considered more general proposition that mental
symptoms are essentially reflective of problems of
living and hence do not legitimately qualify as
manifestations of disease. It focuses on difficulties
of ethical choice and responsibility as the particular
life problems most likely to be productive of per-
sonality disorder. Mowrer (1960) further extends
this corollary by asserting that neurotic and psy-
chotic individuals are responsible for their suffer-
ing (p. 301), and that unacknowledged and un-
expiated sin, in turn, is the basic cause of this
suffering (p. 304). As previously suggested, how-
PERSONALITY DISORDER fs DISEASE 73
ever, one can plausibly accept the proposition that
psychiatrists and clinical psychologists have erred in
trying to divorce behavioral evaluation from ethical
considerations, in conducting psychotherapy in an
amoral setting, and in confusing the psychological
explanation of unethical behavior with absolution
from accountability for same, without necessarily
endorsing the view that personality disorders are
basically a reflection of sin, and that victims of
these disorders are less ill than responsible for
their symptoms (Ausubel, 1952, pp. 392-397, 465-
In the first place, it is possible in most instances
(although admittedly difficult in some) to distin-
guish quite unambiguously between mental illness
and ordinary cases of immorality. The vast
majority of persons who are guilty of moral lapses
knowingly violate their own ethical precepts for
expediential reasons—despite being volitionally
capable at the time, both of choosing the more
moral alternative and of exercising the necessary
inhibitory control (Ausubel, 1952, pp. 465-471).
Such persons, also, usually do not exhibit any signs
of behavior disorder. At crucial choice points in
facing the problems of living they simply choose
the opportunistic instead of the moral alternative.
They are not mentally ill, but they are clearly
accountable for their misconduct. Hence, since
personality disorder and immorality are neither
coextensive nor mutually exclusive conditions, the
concept of mental illness need not necessarily
obscure the issue of moral accountability.
Second, guilt may be a contributory factor in
behavior disorder, but is by no means the only or
principal cause thereof. Feelings of guilt may give
rise to anxiety and depression; but in the absence
of catastrophic impairment of self-esteem induced
by other factors, these symptoms tend to be transi-
tory and peripheral in nature (Ausubel, 1952, pp.
362-363). Repression of guilt, is more a conse-
quence than a cause of anxiety. Guilt is repressed
in order to avoid the anxiety producing trauma to
self-esteem that would otherwise result if it were
acknowledged. Repression per se enters the causal
picture in anxiety only secondarily—by obviating
“the possibility of punishment, confession, expia-
tion, and other guilt reduction mechanisms”
(Ausubel, 1952, p. 456). Furthermore, in most
types of personality disorder other than anxiety,
depression, and various complications of anxiety
such as phobias, obsessions, and compulsion, guilt
feelings are either not particularly prominent
(schizophrenic reactions), or are conspicuously
absent (e.g., classical cases of inadequate or ag-
gressive, antisocial psychopathy).
Third, it is just as unreasonable to hold an
individual responsible for symptoms of behavior
disorder as to deem him accountable for symptoms
of physical illness. He is no more culpable for his
inability to cope with sociopsychological stress than
he would be for his inability to resist the spread of
infectious organisms. In those instances where
warranted guilt feelings do contribute to personality
disorder, the patient is accountable for the mis-
deeds underlying his guilt, but is hardly responsible
for the symptoms brought on by the guilt feelings
or for unlawful acts committed during his illness.
Acknowledgment of guilt may be therapeutically
beneficial under these circumstances, but punish-
ment for the original misconduct should obviously
be deferred until after recovery.
Lastly, even if it were true that all personality
disorder is a reflection of sin and that people are
accountable for their behavioral symptoms, it would
still be unnecessary to deny that these symptoms
are manifestations of disease. Illness is no less real
because the victim happens to be culpable for his
illness. A glutton with hypertensive heart disease
undoubtedly aggravates his condition by overeat-
ing, and is culpable in part for the often fatal
symptoms of his disease, but what reasonable
person would claim that for this reason he is not
P’our propositions in support of the argument
for discarding the concept of mental illness were
carefully examined, and the following conclusions
First, although brain pathology is probably not
the major cause of personality disorder, it does
account for some psychological symptoms by im-
pairing the neural substrate of personality. In any
case, however, a symptom need not reflect a physical
lesion in order to qualify as a genuine manifestation
Second, S/asz’ postulated dichotomy between
mental and physical symptoms is untenable because
the assessment of all symptoms is dependent to some
extent on subjective judgment, emotional factors,
cultural-ethical norms, and personal involvement of
the observer. Furthermore, the use of medical
measures in treating behavior disorders- -irrespec-
tive of whether the underlying causes are neural
or psychological—is defensible on the grounds that
if inadvertent impairment of the neural substrate
of personality can have distortive effects on be-
havior, directed manipulation of the same substrate
may have therapeutic effects.
Third, there is no inherent contradiction in re-
garding mental symptoms both as expressions of
problems in living and as manifestations of illness.
The latter situation results when individuals are
for various reasons unable to cope with such prob-
lems, and react with seriously distorted or mal-
adaptive behavior. The three principal categories
of behavioral symptoms—manifestations of im-
paired functioning, adaptive compensation, and de-
fensive overreaction—are also found in bodily
disease. The concept of mental illness has never
been advanced as a demonological cause of human
disharmony, but only as a co-manifestation with it
of certain inescapable difficulties and hazards in
personal and social adjustment. The same concept
is also generally accepted as a generic term for all
behavioral symptoms rather than as a reified cause
of these symptoms.
Fourth, the view that personality disorder is
less a manifestation of illness than of sin, i.e., of
culpable inadequacy in meeting problems of ethical
choice and responsibility, and that victims of be-
havior disorder are therefore morally accountable
for their symptoms, is neither logically nor empiri-
cally tenable. In most instances immoral behavior
and mental illness are clearly distinguishable con-
ditions. Guilt is only a secondary etiological factor
in anxiety and depression, and in other personality
disorders is either not prominent or conspicuously
absent. The issue of culpability for symptoms is
largely irrelevant in handling the behavior disorders,
and in any case docs not detract from the reality
of the illness.
In general, it is both unnecessary and potentially
dangerous to discard the concept of mental illness
on the grounds that only in this way can clinical
psychology escape from the professional domination
of medicine. Dentists, podiatrists, optometrists, and
osteopaths have managed to acquire an independent
professional status without rejecting the concept of
disease. It is equally unnecessary and dangerous
to substitute the doctrine of sin for illness in order
to counteract prevailing amoral and nonjudgmental
trends in psychotherapy. The hypothesis of re-
pressed guilt does not adequately explain most
kinds and instances of personality disorder, and the
concept of mental illness does not preclude judg-
ments of moral accountability where warranted.
Definition of behavior disorder in terms of sin or
of difficulties associated with ethical choice and
responsibility would substitute theological disputa-
tion and philosophical wrangling about values for
specifiable quantitative and qualitative criteria of
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orders. New York: Grunc & Straiten, 1952.
AtrsuBEt, D. P. Relationships between psychology and
psychiatry: The hidden issues. Amer. Psychologist, 1956,
DREYEUSS, F., & CZACZKES, J. W. Blood cholesterol and
uric acid of healthy medical students under the stress
of an examination. AMA Arch, intern. Med., 1959, 103,
MOWRER, O. H. “Sin,” the lesser of two evils. Amer.
Psychologist, 1960, 15, 301-304.
SZASZ, T. S. The myth of mental illness. Amer. Psycholo-
gist 1960, 15, 113-118.
IS “ABNORMAL PSYCHOLOGY” REALLY ALL THAT ABNORMAL?
Is “Abnormal Psychology” Really all that Abnormal –
a blog post by Jonathan D. Schaefer, a doctoral student of Clinical Psychology at Duke University
An assumption held by many—including many mental health professionals—is that people who suffer from one or more mental disorders constitute a small, troubled minority. This assumption is reflected in both the way we talk about mental illness (e.g., “abnormal psychology”), and in the stigmatization of individuals who suffer from mental illness. Stigma, in turn, represents a major impediment to the effective treatment of these conditions, contributing to both low treatment uptake as well as medication non-adherence among people struggling with mental health problems (Gulliver et al., 2010).
Research from the Dunedin Multidisciplinary Health and Development Study, however, suggests that mental disorders may not be as uncommon as previously thought. The Dunedin Study has followed a population-representative cohort of about 1000 New Zealanders since the early 1970s, conducting in-person interviews assessing them for a variety of common mental disorders every few years. In a recent paper, my colleagues and I used diagnostic data aggregated across six mental health assessments to determine how many Study members made it from age 11 (the age of the first mental health assessment) to age 38 (the age of the most recent assessment) without ever being diagnosed with a mental disorder by research staff.
Surprisingly, of the roughly 1000 Dunedin Study participants, we found that only 17% failed to meet criteria for one or more common mental disorders across all six assessment waves. Of the remaining 83%, roughly half met criteria for one or more diagnoses at 1 or 2 assessment waves, whereas the remainder met criteria at 3 or more assessment waves. This pattern suggests that the “typical” human experience is one characterized by at least one brush with a diagnosable disorder, and that those who avoid these conditions entirely—people with enduring mental health—are actually quite rare.
Although the proportion of Dunedin Study members diagnosed with at least one mental disorder may strike some readers as unusually high, these numbers are consistent with findings from several other longitudinal studies of mental health, conducted in locations as diverse as North Carolina (Copeland et al., 2011), Oregon (Farmer et al., 2013), and Switzerland (Angst et al., 2015). Indeed, systematic comparison of these studies reveals a relatively straightforward pattern: The studies reporting the highest rates of disorder tend to be those with the most frequent assessments and lengthiest follow-up periods. In other words, the more carefully we measure psychiatric disorders across the life course, the more likely we are to find that they affect almost everyone, at least for a little while.
With accumulating evidence suggesting that at least one episode of a diagnosable mental disorder is the norm—not the exception—we next wondered how the few individuals with enduring mental health came to be. We reasoned that they may have avoided mental disorder, in part, by being exceptionally advantaged as children. For example, we expected them to come largely from well-to-do families, and to enjoy both high intelligence and robust physical health, as each of these characteristics have previously been linked to a lower likelihood of developing mental disorders. These expectations, however, were not supported by our data. Instead, we found that the Dunedin Study members who avoided mental illness tended to possess a suite of advantageous personality traits, which could be observed as early as childhood. Specifically, as children, study members with enduring mental health showed little evidence of strong negative emotions, were less socially isolated, and displayed higher levels of self-control. They also had fewer first- and second-degree relatives with mental health issues.
Interestingly, we found some evidence suggesting that these never-diagnosed study members may have benefitted from their lack of mental disorder as adults. When interviewed at age 38, most people with enduring mental health reported higher-quality relationships, greater life satisfaction, and superior educational and occupational attainment relative to their “typical-mental-health” peers. However, lasting mental health did not appear to guarantee an exceptional sense of well-being, as close to 1 in 4 Study members with enduring mental health scored below the cohort mean on life satisfaction.
The observation that mental disorders affect the overwhelming majority of persons at some point in life has implications for both research and clinical practice. First, it indicates that any mention of “abnormal psychology” should acknowledge that “normality” refers to the absence of a diagnosable disturbance in emotional or behavioral functioning
at the present time—not across the life course. Clinically, this distinction may be of benefit to both patients and mental health professionals. For example, the knowledge that many people who have experienced at least one bout of mental disorder have nevertheless gone on to experience relatively happy, healthy, and productive lives may help to bolster self-efficacy and self-esteem among those currently struggling with a mental health problem, potentially leading to higher treatment uptake and better clinical outcomes. Similarly, it is possible that acquainting healthcare professionals with the high lifetime prevalence of mental disorder will help these individuals to identify and confront their own biases towards mental illness in a way that promotes better clinical care.
Second, these findings add additional weight to calls for increased funding of mental illness research, training, treatment, and prevention. The World Health Organization (WHO) has already reported that mental illnesses are the leading cause of disability worldwide (Whiteford et al., 2013). A similar report for the World Economic Forum indicated that the global cost of mental illness is nearly $2.5 trillion, with a projected increase to over $6 trillion by 2030 (Bloom et al., 2012). Our study adds to these reports by showing that the burden of mental disorder is not limited to an unfortunate few, but instead felt by the majority of the population. In addition to reducing stigma, it is our hope that increased recognition of this fact will lead to better screening for these conditions as well as improved access to effective treatment.
Schaefer, J.D., Caspi, A., Belsky, D.W., Harrington, H., Houts, R., Horwood, J., Hussong, A., Ramrakha, S., Poulton, R., Moffitt, T.E. (2017).
Enduring mental health: Prevalence and prediction
Journal of Abnormal Psychology, 126(2), 212-224. doi: 10.1037/abn0000232
· Some may be inclined to interpret the high lifetime rates of mental disorder reported here as evidence that mental disorders are over-diagnosed, and/or that psychiatry pathologizes “normal” aspects of the human experience. Others, however, point to physical conditions with equally high lifetime prevalence rates, arguing that the ubiquity of a condition has little bearing on whether or not it is perceived as impairing or deserving of treatment. What implications, if any, do you believe the present research has for the current diagnostic system?
· Does the fact that mental disorders are a “normal” part of the human experience have clinical utility? How might this information best be used or conveyed in a treatment setting?
Jonathan D. Schaefer, B.A.
is a doctoral student in the Clinical Psychology program at Duke University and a predoctoral fellow at both the Duke Population Research Institute (DuPRI) and the University of North Carolina Center for Developmental Science (CDS). Jon uses population-representative, longitudinal datasets to examine the prevalence and antecedents of both common mental disorders and the enduring absence of such conditions. He hopes that his research will enhance scientific understanding of how individual characteristics and life experiences interact across the life course to produce either mental disorder or enduring mental health, as well as inform the development of more effective interventions targeting vulnerable individuals.