Theme 3
Normality and Abnormality
Learning goals:
Vignette 1
▪ What is the difference between normal and abnormal?
▪ Are the concepts stable over time?
▪ What is the model about?
▪ What is the best way to categorize psychopathology?
Helman (2010). Culture Health and Illness.
Cross-cultural psychiatry is the study and comparison of mental illness, and its treatment, in
different cultures and social groups. Research into the subject has been carries out by two different
types of investigator:
1. Western-trained psychiatrists who have encountered unfamiliar, and what seemed to them
bizarre, syndromes of psychological disturbance in parts of the non-Western world, and who
have tried to understand these syndromes in terms of their own Western categories of mental
illness, such as ‘schizophrenia’ or ‘manic depressive psychosis’.
2. Social and cultural anthropologists, whose main interest have been the definitions of
normality and abnormality in different cultures, the role of culture in shaping personality
structure, and cultural influences on the cause, presentation and treatment of mental illness.
These two approaches share a concern with two types of clinical problem:
1. The diagnosis and treatment of mental illness where health professional and patient come from
different cultural backgrounds.
2. The effect on mental health of migration, urbanization and other forms of social change, as well
as of poverty and deprivation.
The focus of cross-cultural psychiatry is mainly on mental illness rather than on mental disease. It is
less concerned with the organic aspects of psychological disorders than with the psychological,
behavioural and socio-cultural dimensions associated with them. Anthropologist are more interested
in how cultural factors affect the patient’s perceptions and behaviour, the content of their
hallucinations or delusions, and the attitudes of other toward them. In general, relationship to
culture to mental illness can be summarized as:
- It defines ‘normality’ and ‘abnormality’ in a particular society.
- It defines the differences between ‘abnormality’ and ‘mental illness’.
- It may be part of the aetiology or cause of certain illnesses.
- It influences the clinical presentation and distribution of mental illness.
- It determines the ways that mental illness is recognized, labelled, explained and treated by other
member of that society – including by health professionals.
Normality versus Abnormality
Dimensions of Social Behaviour
The illustration below represents the range of possible perceptions – by members of a particular
society or culture – of a particular form of social behaviour: whether they see it as ‘normal’ or
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, abnormal for their society, and whether it is controlled, or not, by the norms or rules of that society.
It also reflect the fact that all human groups recognize that there are certain times and places when
people can be allowed to behave in an ‘abnormal’ way, provided that they are seen to conform to the
strict guidelines laid down by the culture for this type of situation.
Most cultures disapprove of form of public behaviour that are obviously not being controlled by the
rules of their society. The four zones, and the definitions of behaviour they encompass, are not static.
Rather, they are a series of fluid categories that are likely to change with time and circumstance and
the particular perspective of the onlooker.
Furthermore, these broad social
categories do not necessarily take into
account individual factors such as
personality. Their focus is on the
perspective of the society as a whole or a
section. In the case of A, D and B it is
assumed that the individual is at least
aware (consciously or not) of what the
social norms are, whether they conform
to them or not.
A. Normality
Normality is usually a multidimensional concept. There are two views: healthy, as in a medical
definitions, and social, which are based on shared beliefs within a group of people was what
constitutes the ideal way. Not only the individuals behaviour is important, but also their dress,
hairstyle, posture, facial expression etc, as well as their appropriateness to certain contexts and social
relationships. ‘Normality’ is a series of clusters of attributes, with each cluster being appropriate for a
particular type of context. The definition is never uniform within a population. Most cultures have a
wide range of social norms that are considered appropriate for different age groups, genders,
occupations, social ranks and cultural minorities within the society.
B. Controlled abnormality
Most societies often make provision for certain specified occasions where these codes are
deliberately flouted or inverted, and ‘abnormal’ behaviour, whether of the individual, or of the group,
becomes the temporary norm. One example of controlled abnormal behaviour is ‘rites of reversal’
or ‘symbolic inversions’, which is defined as ‘any acts of expressive behaviour that inverts,
contradicts, abrogated or in some fashion represents an alternative to commonly held cultural codes,
values and norms be they linguistic, literary or artistic, religious, or social and political.
Group behaviour
These special occasions, such as carnival, sometimes involve a collective inversion of normal
behaviour and roles, for example on Halloween. Similar alterations or inversions of normal role
behaviour are found in some of the spirit possession cults of African women, where women who seek
power and aspire to roles otherwise monopolized by men ‘act out thrusting male part with impunity
and with the full approval of the audience’. All these forms are controlled since their timing and
location are clearly defined and structured in advance.
Individual behaviour
In many cultures, especially in the non-industrialized world, individuals involved in interpersonal
conflicts, or who are experiencing feelings of unhappiness, guild, anger of helplessness, are able to
express these feeling in a standardized language of distress. To the Western-trained observer, this
may closely resemble the diagnostic entities of the Western psychiatric model (e.g., being possessed
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