Sociocultural Models of Abnormality

A sociocultural model of abnormality emphasizes the social and cultural
context, going so far as to suggest that abnormality is a direct function of society’s
criteria and definitions for appropriate behavior. In this model, abnormality
is social, not medical or psychological. For example, early Greeks
revered people who heard voices that no one else heard because they interpreted
this phenomenon as evidence of divine prophecy. In the Middle
Ages, people tortured or killed people who heard voices because they interpreted
this same proclivity as evidence of demonic possession or witchcraft.
Today, people treat those who hear voices with medicine and psychotherapy
because this symptom is viewed as evidence of schizophrenia.

Social and cultural context can influence the kinds of stresses people experience,
the kinds of disorders they are likely to develop, and the treatment
they are likely to receive. Particularly impressive evidence for a social perspective
are the results of a well-known study, “On Being Sane in Insane
Places” (1973), by American psychologist David Rosenhan. Rosenhan arranged
for eight normal people, including himself, to arrive at eight different
psychiatric hospitals under assumed names and to complain of hearing
voices repeating innocuous words such as “empty,” “meaningless,” and
“thud.” These pseudopatients responded truthfully to all other questions
except their names. Because of this single symptom, the hospital staff diagnosed
all eight as schizophrenic or manic-depressive and hospitalized them.

Although the pseudopatients immediately stopped reporting that they heard
voices and asked to be released, the hospitals kept them from seven to fiftytwo days, with an average of nineteen days. When discharged, seven of the
eight were diagnosed with schizophrenia “in remission,” which implies that
they were still schizophrenic but simply did not show signs of the illness at
the time of release. The hospital staff, noticing that these people took notes,
wrote hospital chart entries such as “engages in writing behaviors.” No staff
member detected that the pseudopatients were normal people, though
many regular patients suspected as much. The context in which these
pseudopatients behaved (a psychiatric hospital) controlled the way in which
others interpreted their behavior.

Particularly impressive evidence for a cultural perspective comes from
the fact that different types of disorders appear in different cultures. Anorexia
nervosa, which involves self-starvation, and bulimia nervosa, which involves
binge eating followed by purging, primarily strike middle- and upperclass
women in Westernized cultures. In Western cultures, women may feel
particular pressure to be thin and have negatively distorted images of their
own bodies. Amok, a brief period of brooding followed by a violent outburst
that often results in murder, strikes Navajo men and men in Malaysia, Papua
New Guinea, the Philippines, Polynesia, and Puerto Rico. In these cultures,
this disorder is frequently triggered by a perceived insult. Pibloqtoq, a brief
period of extreme excitement that is often followed by seizures and coma
lasting up to twelve hours, strikes people in Arctic and Subarctic Eskimo
communities. The person may tear off his or her clothing, break furniture,
shout obscenities, eat feces, and engage in other acts that are later forgotten.
As researchers examine the frequency and types of disorders that occur
in different societies, they note some sharp differences not only between societies
but also within societies as a function of the age and gender of the individuals
being studied.
The sociocultural model of abnormality points out that other models fail
to take into account cultural variations in accepted behavior patterns. Understanding
cross-cultural perspectives on abnormality helps in better framing
questions about human behavior and interpretations of data. Poverty
and discrimination can cause psychological problems. Understanding the
context of the abnormal behavior is essential.

The medical, psychological, and sociocultural models of abnormality
represent profoundly different ways of explaining and thus treating people’s
problems. They cannot be combined in a simple way because they often
contradict one another. For example, a biological model asserts that depression
is due to biochemistry. The treatment, therefore, is medicine to
correct the imbalance. In contrast, a behavioral model asserts that depression
is learned. The treatment, therefore, is changing the rewards and punishers
in the environment so that the person unlearns the old, bad habits
and learns new, healthy habits.

One attempt to integrate the different models of abnormality is called
the diathesis-stress model of abnormality. It proposes that people develop
disorders if they have a biological weakness (diathesis) that predisposes them to the disorder when they encounter certain environmental conditions
(stress). The diathesis-stress approach is often used to explain the development
of some forms of cancer: a biological predisposition coupled
with certain environmental conditions. According to this model, some people
have a predisposition that makes them vulnerable to a disorder such as
schizophrenia. They do not develop schizophrenia, however, unless they experience
particularly stressful environmental conditions.

It is unlikely that any single model can explain all disorders. It is more
probable that each of the modern perspectives explains certain disorders
and that any single abnormal behavior has multiple causes.