FAILURE TO FUNCTION ADEQUATELY
Failure to function adequately is a definition of abnormality where a person is considered abnormal if they are unable to cope with the demands of everyday life, or experience personal distress.
As a definition of abnormality, failure to function adequately refers to an individual's incapacity to perform daily activities and roles expected by society, leading to significant distress or discomfort. This concept evaluates a person's ability to maintain basic self-care, work, engage in healthy relationships, and participate in community activities. When someone struggles to meet these fundamental requirements due to psychological distress or other mental health issues, they may be considered to be experiencing a state of abnormality. This definition emphasizes the practical aspects of mental health, focusing on observable behaviours and their impact on an individual's ability to live a fulfilling and independent life. Importantly, the consideration of distress signals that not only the subjective experience of the individual matters but also the effects of their condition on those around them. Thus, failure to function adequately encompasses both the personal and social dimensions of abnormality, highlighting the importance of adaptability and coping mechanisms in everyday life.
Rosenhan et al. (1989) suggested certain features which would help diagnose abnormality based on their failure to function adequately. These include:
Personal distress: The individual may display personal suffering and distress.
Suffering: Experiencing distress or discomfort without a reasonable cause.
Maladaptiveness: Engaging in behaviours that hinder personal well-being or ability to adapt to life’s demands, such as self-harm or substance abuse.
Vividness and Unconventionality: Displaying behaviours or thinking patterns significantly different from the societal norm.
Unpredictability and Loss of Control: Exhibiting erratic behaviours or reactions that are unexpected by others or uncontrollable by the individual.
Irrationality: Demonstrating an inability to communicate or behave in ways that are understandable to others.
Observer Discomfort: Acting in a way that causes discomfort or distress to others.
Violation of Moral and Ideal Standards: Behaving in ways that significantly deviate from society’s moral or ideal standards
GLOBAL ASSESSMENT OF FUNCTIONING SCALE
The Global Assessment of Functioning (GAF) Scale is a diagnostic tool clinicians use to assess adults' overall functioning and psychological well-being. It is especially useful in understanding the impact of mental illness on an individual's daily life. The GAF Scale serves as an indirect measure of abnormality or mental illness by evaluating symptoms and how those symptoms affect a person's day-to-day activities, responsibilities, and social interactions. It rates functioning on a scale from 0 to 100, with higher scores indicating better functioning.
Typical questions or considerations used in determining a GAF score might include:
High Scores (81-100): Can the individual maintain a good relationship with family and friends? Does the person perform well in their job or schooling without significant stress?
High Average Scores (61-80): Does the person occasionally feel overwhelmed by stress but generally manage their daily responsibilities effectively? Are social relationships stable despite occasional conflicts?
Middle Scores (41-60): Is the individual struggling with certain social roles or responsibilities due to mental health issues? Are symptoms like occasional panic attacks or depressive episodes affecting work or social life?
Low Average Scores (21-40): Does the person have difficulty maintaining personal hygiene or living independently due to mental illness? Are there frequent conflicts in relationships or substantial neglect of personal responsibilities?
Low Scores (1-20): Is the individual at risk of harming themselves or others, e.g., Is the person suicidal or homicidal?? Is there a persistent inability to maintain minimal personal hygiene, or is the person constantly confused?
Considering the extent of positive support, does the individual have access to and utilize a support system that helps him or her cope with daily stressors?
Assessing occupational functioning: Can the person maintain employment or perform consistently in a school setting?
Evaluating psychological symptoms: How severe are symptoms like hallucinations, delusions, severe depression, or anxiety, and how do they impact functioning?
Social interaction: Can the person form and maintain close relationships with others, or do mental health issues severely limit social interactions?
Daily living activities: Can the individual carry out daily tasks such as shopping, cleaning, and cooking, or does mental illness significantly impair these abilities?
The GAF Scale is a numeric (0 through 100) instrument used by mental health clinicians and physicians to subjectively rate adults' social, occupational, and psychological functioning, e.g., how well or adaptively one is meeting various problems in life. Scores range from 100 (extremely high functioning) to 1 (severely impaired).
For example, a score between 51 and 60 might indicate moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A clinician would analyse this score by comparing it to the individual's baseline functioning and considering it within their life situation and symptoms.
The GAF Scale allows mental health professionals to consider a broad range of factors when assessing an individual's mental health status, making it a comprehensive tool for evaluating functioning and guiding treatment planning.
FAILURE TO FUNCTION ADEQUATELY EVALUATION
*For AQA psychology students, mastering the four definitions of abnormality is essential. However, it's important to recognize that none alone would constitute a complete essay, particularly those worth 16 marks; it's unlikely that a question would focus exclusively on one definition. Instead, broader essay prompts such as “Discuss definitions of abnormality” are designed to encourage students to explore multiple definitions. This approach allows for a fuller essay response and enables students to compare and contrast the different perspectives on abnormality, providing a comprehensive overview. Preparing for these kinds of questions by understanding the strengths and limitations of each definition can help students develop well-rounded and detailed answers.
A significant advantage of the failure to function adequately definition is its acknowledgement of the individual's subjective experience, particularly for those struggling to cope with daily life and seeking help. This approach is patient-centred, considering mental disorders from the sufferers' perspective. It highlights the importance of understanding mental health issues not just through observable symptoms or behaviours but through the impact on an individual's ability to navigate day-to-day activities and their desire for intervention. This inclusivity ensures that mental health assessments can accommodate a broad range of experiences, potentially leading to more effective and tailored treatment plans.
Another advantage of the failure to function adequately definition is that it enables those close to the sufferer—such as family, friends, or colleagues—to be the first to recognize when something is not right, prompting them to either approach the person directly or seek help from relevant authorities. This early detection can be crucial for timely intervention and support. However, it's important to acknowledge that perceptions of normality and the capacity to function vary significantly across individuals and societies, influenced by political, religious, or personal beliefs. Consequently, judgments about an individual's ability to function normally may differ based on these factors. For example, some may view the challenge of meeting financial obligations or maintaining employment as a sign of abnormality. In contrast, others may regard it as a common hurdle of adult life. This discrepancy underscores that the definition may inadvertently set idealized standards for normalcy, posing a risk that individuals could be unfairly labelled as abnormal based on subjective judgments rather than objective assessments.
However, more objective methods are available for assessing failure to function adequately, such as clinical interviews or diagnostic tests, including the Global Assessment of Functioning (GAF) scale. The advantage of using such tools is their standardized and scientific nature, which allows for a more uniform and unbiased evaluation of an individual's ability to cope with daily life. These measures provide a structured framework that can help mitigate the subjectivity in judging someone's functionality, offering a more reliable and consistent basis for diagnosis.
However, definitions like “failure to function adequately”, while useful, may lack ecological validity in diagnosing mental illness per se. In certain instances, the abnormality may not manifest through observable dysfunctional traits. For instance, individuals with psychopathy or dangerous personality disorders can inflict significant harm on others while maintaining an appearance of normalcy. A notable example is Harold Shipman, an English doctor who was responsible for the deaths of over 200 patients. Despite his abnormal behaviour, Shipman exhibited no outward signs of dysfunctional behaviour or incapacity to function in daily life. Consequently, relying solely on the criterion of dysfunctional behaviour to define abnormality does not provide a comprehensive understanding, failing to account for cases where individuals can conceal their harmful tendencies effectively.
A significant limitation of defining abnormality based on the inability to function adequately lies in its vulnerability to cultural bias. This approach is heavily influenced by societal norms and expectations about how individuals should conduct their daily lives. As such, an inability to function adequately in one culture may be deemed normal in another, leading to discrepancies in diagnoses across different cultures and socio-economic backgrounds. For instance, individuals from lower socio-economic or non-white backgrounds are often disproportionately diagnosed with mental disorders, possibly due to differences in lifestyles and values that deviate from the prevailing cultural norms of the diagnosing culture.
Moreover, the existence of culture-bound syndromes illustrates the impact of cultural context on understanding what constitutes abnormal behaviour. Culture-bound syndromes are mental disorders or afflictions recognized only within specific cultures or societies. Examples include:
Amok: Primarily observed in Southeast Asia, amok involves a sudden outburst of uncontrollable aggression or violence, often followed by amnesia.
Hikikomori: Found in Japan, this condition is characterized by extreme social withdrawal, with individuals isolating themselves in their homes for months or even years.
Susto: Seen in some Latin American communities, susto is believed to be a condition caused by a frightening event that leads to the soul leaving the body, resulting in anxiety, insomnia, and depression.
These examples underscore the challenge of applying a one-size-fits-all definition of abnormality across diverse cultural contexts. They highlight the necessity for mental health professionals to adopt a culturally sensitive approach when assessing and diagnosing mental disorders.
Certain behaviours perceived as dysfunctional by observers may serve a functional purpose, particularly in individuals with ADHD or autism. For instance, repetitive actions or intense focus on specific interests, often associated with autism, can provide a sense of security, predictability, and satisfaction. Similarly, the high energy and impulsivity seen in ADHD may foster creativity and rapid problem-solving. These behaviours, while possibly challenging in conventional settings, may not constitute a failure to function but instead represent alternative ways of interacting with the world that are adaptive and meaningful for the individual.