1.2.4 Personal distress
Another way of defining psychological ‘abnormality’ is to ask whether certain behaviours or styles of functioning cause distress to the individual concerned. Think about your response to what you consider to be ‘normal’ alcohol consumption. Perhaps you specified a maximum number of units per day or week? If so, why did you do this? Is it because of the health problems associated with excessive drinking, or because of its association with antisocial behaviour? Some of you may believe that any alcohol consumption is inappropriate, for medical, cultural or religious reasons. Alternatively, some of you might have specified an age criterion that reflects the legal age for alcohol consumption in your country. These are not trivial points. Many people see ‘excessive’ alcohol consumption, even if within cultural norms, as ‘abnormal’ because of the personal distress it will cause. They believe that heavy drinking can lead to alcohol dependency or health problems that have the potential to ruin a person's life.
An obvious difficulty with the criterion of personal distress is that in some cases, such as alcoholism or drug use, personal distress is not necessarily manifest. Whose distress are we considering? Are we really intervening in the interests of the person showing the behaviour, or in the interests of their family or society? Moreover, who makes the decision to intervene will vary depending on what the behaviour is. The degree to which individuals are pressurised to comply will also vary depending on whether it is a doctor or a friend who is trying to intervene. Clearly, this criterion raises some complex issues to do with the imposition of other people's values and the acceptability of setting limits to individual freedom.
Tobacco use is associated with substantial health risks and social issues, but would intervention, in the form of bans on its use, infringe personal freedom? If the answer is ‘yes’, then why does this not equally apply to behaviours such as eating disorders? Is it because of sociocultural notions of what constitutes ‘normal’ behaviour? Furthermore, does the large number of people engaging in a behaviour, such as smoking, make it somehow more ‘normal’?
Box 1: Definitions
Dimensional Used to refer to variables that lend themselves to measurement on a continuous scale (e.g. height is dimensional, but eye colour is not).
Systemic: Belonging to or affecting the system or body as a whole. For example cardiovascular disease, with origins involving many interacting subsystems, is usually seen as systemic, whereas tuberculosis, caused by a single infectious agent, is not.