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 fifty-
two 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 upper-class 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 pun-ishers 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.
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