An example of someone we may diagnose with a mental health disorder using the ‘failure to function adequately’ determination is an adult with depression. For instance, they may say that they experience very low mood, alongside extreme fatigue, equating to them struggling to get out of bed. This may cause them to feel too tired to shower, cook, eat, and even go to work. If this continues and they isolate themselves by ringing in sick to work and staying in bed throughout the day, they are no longer conforming to interpersonal rules because they’re avoiding people at all costs.
They also, presumably, will be experiencing severe personal distress, perhaps in the morning when their work start time is approaching, or when they have to go to the shop. If the person’s depression is severe, they may experience suicidal thoughts, being a risk to themselves, or they may not be feeding themselves properly and put themselves at risk accidently. If a doctor was faced with a person like in the example, they would draw the conclusion that this person is failing to function adequately, since they’re not maintaining personal hygiene, or nutrition, and they are not able to attend work.
Although this method has advantages like the fact it accounts for the patient’s perspective, by drawing information from the patient’s subjective experience, there are issues with using this method of diagnosis, one of which is that the question Is raised of ‘is it simply a deviation from social norms?’. Some critics of this method have speculated that lots of things we would consider abnormal, from our society, and based on our social norms, are actually simply a difference in culture. For example, if someone cannot hold a job down, this can be a sign of failing to function, however, a new age traveller may go from job to job and constantly move accommodation, this isn’t them failing to function, this is simply a difference is culture, and people just leading different life styles. Or another example of this is, an extreme sportsman, he is at risk to himself, however this isn’t him failing to function, it’s simply a man who deviates from social norms.
The point being that sometimes it is hard to differentiate between failing to function and deviating from social norms. Additionally, these methods should be able to be used worldwide, however this definition requires a subjective judgement, unlike statistical deviation, which can be hard to globalise to make diagnosis’s. However the principle does remain that a psychiatrist ultimately has an educated judgement. Another method of defining abnormality is about the deviation from ideal mental health. The idea is that we look at what is considered a psychologically healthy person or mind, then we can compare this to others and see how they deviate from this, and to what extent.
This ideal mental health ‘checklist’ was proposed by Mary Jahoda, and she proposed that people that meet her criteria have ideal and health psychological health. Some of these criteria are, ‘we self-actualise’ and that we ‘can cope with stress’ and another is that ‘we have good self-esteem’. There is undoubtedly a cross over area between Rosenhan/Seligman and Jahoda’s proposals; however the main difference is that failure to function adequately focuses on physical well-being more that deviation from ideal mental health. Jahoda’s criteria are very specific to our personal, internal thoughts and feelings, whereas failure to function looks at how these feelings and thoughts affect our day-to-day lives.
By looking at people’s deviation from ideal mental health to assess their psychological well-being we get comprehensive results, this criteria covers a wide variety and range of mental disorders, therefore is an advantage for the patient and the psychiatrist because it encourages talking about our mental health, this can be a useful tool for psychiatrists for getting information out of a patient. It can also be helpful for patients to realise and see that they may gain benefits from seeking treatment or counselling, if perhaps they previously thought they didn’t require any. However there are disadvantages to this method, one of which being that Jahoda’s criteria is culture-bound, by this we mean that it’s specific to a Western European and Northern American culture.
For example, the criteria regarding that we must self-actualise would not be considered a healthy thing in other cultures. For instance in an rural, pastoral based family, the sons are generally expected to stay within the family business (farming or shop keeping), and to go off to a university and reach their ‘full-potential’ would be considered abnormal in their individualist-culture. Another criticism of these definition/criteria is that it can be seen to set an unrealistically high expectation of mental health. What we mean by this is that it would be pretty rare for someone to meet ad maintain all of these criteria at the same time, and surely not most of the population is psychologically unhealthy?
For example, the criteria of us all having ‘good self-esteem’, this is an extremely rare quality to attain, particularly in our culture with social media being a huge part of our everyday lives-(for example; fashion models, and diet hacks persuading us to become the better version of ourselves, therefore giving us the message that we constantly need to change ourselves to be loved and valued in society). With all of these things happening in today’s society, using this criteria can be seen to label the majority of the population psychologically unhealthy and abnormal, which in fact this is likely not the case.
