Joaquín Díaz Atienza
In order to define what it is abnormal We must be very clear about what is considered as normalIf it's already difficult in biomedicine, in the field of psychiatry and clinical psychology It is a real challenge that has not yet been satisfactorily resolved.
In the interest of objectivity, and despite many other attempts, the following has prevailed: statistical model. Assessment instruments, whether questionnaires or standardized interviews, ultimately confront us with probabilities, means, or standard deviations… In short, certain statistics will carry significant weight in the diagnosis of the "normality" or "normality". Ultimately, it's about health/illness.
These difficulties, regarding the lack of sensitivity and specificity required for any diagnostic test, have led to the fact that today it acquires great importance dimension modell Regarding the statistician. However, we are at the beginning of a debate that is considered fascinating and whose end is not yet in sight.
Normal, abnormal, pathological
Ch. Scharfetter (1977) remains, despite the years, a classic of psychopathology to which systematic reference is made. He defines statistical normality as "the behavior typical of most people belonging to a certain sociocultural sphere and, in particular, what they have in common in each case with respect to a certain aspect of behavior."
But this definition of "normal," despite its purported objectivity, fails to explain it in the psychopathological sense. First, because we are forced to establish an arbitrary cutoff point from which we speak of abnormality. Individuals who fall within a certain area of the Gaussian bell curve would be considered "normal," while the rest would be considered "abnormal," which is not exactly synonymous with pathological.
This way of defining normality lends itself to multiple exceptions in the field of psychopathology, precisely because it is due to the arbitrariness with which the clinician is forced to decide when one is normal or abnormal.
They would enter within the space of abnormality Those behaviors that deviate significantly from the "norm," from the statistical average. But deviating significantly from the average in a negative sense is not the same as deviating significantly in a positive sense. Although the example may be somewhat repetitive, in the intellectual realm, we can speak of an individual with cognitive impairment or a gifted individual. Similarly, not all characteristics of the psyche or human behavior can be defined as normal or abnormal according to this criterion, especially since the word "abnormality" carries a negative connotation that is not always present.
Ultimately, this confusion and cultural relativism surrounding what we understand as normal versus abnormal in relation to pathology forces us to define what is meant by Health and illness. Healthy This would be any person who "despite sometimes, and even despite, suffering from a physical illness and/or against the pressure represented by the norms of their society, manages to get ahead in their life" (Scharfetter, 1977).
On the contrary, when we talk about diseaseTherefore, we are obliged to define the paradigm from which we define it. Thus, when we base our definition on anatomopathological and/or pathophysiological information, we are referring to the medical modelIf we use parameters of social adaptability/maladjustability, we are referring to the social model. Weighing in terms of suffering, against an ideal benchmark of adaptability, against the capacity to experience pleasure, etc., we are employing the psychological model. Another very important approach is when we talk in terms of responsibility for their actions and/or imputability. In this case, we are referring to forensic model.
The epistemological evolution that psychopathology has undergone has led to talk, during the last few decades, of bio-psycho-social paradigm, due to the realization that in the genesis of what we call pathological, multiple aspects converge, and if we take only one of the models, we would not give a satisfactory answer.
Precisely because of the ongoing difficulties in defining normal versus abnormal, and health versus illness, concepts such as the one that have emerged have arisen absolute health, relative health, positive mental health y relative mental health.
- Absolute health: It would be the absence of symptoms and a subjective feeling of well-being.
- Relative health: the balance between states of absolute health and transient presence of symptoms or disease.
- positive mental health: It would be the equivalent of absolute health.
- Relative mental health: the equivalent of relative health.
This first chapter aims only to highlight the difficulties clinicians face in objectively diagnosing the pathology of the behaviors, cognitions, and emotions they encounter in clinical practice. I would be satisfied if, ultimately, we were left wondering whether our assessment of human behavior is accurate or not. This is especially true when the results of our decisions, unintentionally, contribute to the stigmatization of our patients.
Bibliography:
Ch. Scharfetter. Introduction to general psychopathology. 1st ed. Madrid: Morata Editions, 1977. p: 28-32.
Eguiluz I, Segarra R. Introduction to psychopathology. An updated view. 3rd ed. Madrid: Editorial Médica Panamericana. 2013. p: 3-10
