Sometimes it is a straight-forward matter, and we can all agree on who is normal or abnormal; other times it is difficult.

BAD criteria for distinguishing normal from abnormal behavior:

1. The behavior is unusual - the fact that behavior is unusual does not necessarily mean that it is undesirable, or a sign of mental illness. It is unusual, for example, to be an Olympic caliber athlete; yet most of us would not think that this was a sign that an athlete is mentally ill.
2. The behavior is culturally deviant - if people deviate from the cultural standards of their own culture, this may be a sign that they are mentally ill OR it may just mean that they are eccentric or non-conformist.

More USEFUL criteria for distinguishing normal from abnormal behavior:

1. The person exhibits behavior that is inappropriate or maladaptive- Inappropriate behavior refers to behavior that deviates from accepted cultural standards. As explained above, this criterion can be dicey to use. However, there are some cases that are fairly clear-cut. For example, an elderly person jogging down the street completely naked in the middle of the winter is clearly deviating from the accepted cultural standard, and the reason for this abnormal behavior probably has to do with some form of mental illness.

Maladaptive behavior refers to behavior that goes against a persons' own goals or best interests. For example, if you are hoping to keep your job and get promoted, it is maladaptive to miss work frequently and come in late on the days that you do show up. On the other hand, if your goal in life is to get fired and collect unemployment, this same behavior is much less maladaptive. Maladaptive behavior is often a clue that there is an underlying mental illness.

2. The person's behavior or thoughts reflect a distorted perception of reality- There are varying degrees of reality distortion. However, any significant distortion of reality is likely to reflect some sort of underlying mental illness.

Hallucinations - false sensory perceptions, where people see or hear things that are not there - probably reflect the most severe form of reality distortion.

Delusions - false beliefs about reality, such as thinking that you are the Queen of England, or that the CIA and FBI are out to get you - represent another form of reality distortion. Some delusions, such as thinking you are the Queen of England (unless you really are) or that the CIA and FBI are out to get you (unless you are an international criminal) are very flagrant, and are strongly associated with severe mental illness. Other delusions are more subtle, but may also indicate underlying mental illness. People who have anorexia (a form of eating disorder in which people essentially starve themselves to death) seem themselves as unattractively fat, whereas other people see them as unattractively thin. People who are depressed are likely to view themselves as worthless, unlikeable people; while others typically do not see depressed people in so harsh a light.

3. The person is experiencing psychological distress or discomfort - This typically means that the person is anxious or depressed, without obvious cause. (If you are anxious because someone is holding a gun to your head, that is not a sign of mental illness. However, if you worry about every little thing for no apparent reason, that may be a sign that you have a psychological disorder.) The distress or discomfort associated with anxiety and depression are what cause people to see treatment, most often.
4. The person's behavior poses a danger to self or others - This refers to the likelihood that a person will attempt to harm himself/herself or someone else. It refers to physical harm (including suicide, homicide, self-mutilation, or assault on others), NOT to psychological harm. There are some people who are mentally ill that do not fit the first three criteria, but have a form of mental illness. Use of this criterion helps us to identify those people. For example, while the behavior of mass murderers is obviously inappropriate, it is typically carried out in secret, so this criterion is not very helpful. Mass murderers may not have any distortion of reality (that is, they may see the world pretty much as we do, even if we find what they do abhorrent). Typically, they do not experience distress or discomfort (which is why they are often referred to as "cold-blooded" killers). However, once we know that a person's behavior is dangerous to others, this may provide a clue to underlying mental illness.

A person who meets any of these criteria may be considered to have abnormal behavior, indicating a psychological disorder. It is not necessary to meet all of the criteria to be diagnosed with a disorder.

Now that I've made distinguishing between normal and abnormal behavior sound easy, I need to remind you that it is not always that easy. In fact, the study performed by Donald Rosenhan, in 1973, tells us that under some circumstances even trained mental health professionals have difficulty in distinguishing normal people from those who are mentally ill. You might think that this study no longer applies because it was done nearly 30 years ago, but I think that Rosenhan would have similar findings if he repeated his study today. In fact, his observations of mental hospitals in the early 70s are very similar to my own observations in a public mental hospital in the early 90s. (I was a volunteer, not a patient!)

If you have not already done so, read the paper "On being sane in insane places" by Donald Rosenhan.

Now let's apply what you have learned to a real-life case, that of Dr. Rosemary Rodgers, a former U.S. Army physician who has been diagnosed as a paranoid schizophrenic. (Schizophrenia was the diagnosis received by all of the pseudopatients in Rosenhan's study.) She does not agree with this diagnosis. Read about her, read her letters, then post your opinions about Rosemary Rodgers on the WebCT Discussion Area. (Respond to the posting with subject heading: Dr. Rosemary Rodgers - Victim of persecution or mental illness?)