Variance in Psychological Dysfunction

“Normal” comes in many shades, and the same flavor of psychological disturbance can have an wide ranging impact on the individual who experiences the disorder: from minimal impairment, to life-altering impairment.

Once we accept that the definition of a psychological disorder is “psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected” (Durand and Barlow, 2007. p.2), then all determinations related to the assessment of a disorder have to be measured on a type of continuum or quantitative measure of each of the three criteria- the severity of the psychological dysfunction, the level of distress or impaired functioning experienced by the individual, and the distance from which the atypical behavior displayed varies from the culturally expected norm.

I’ll use three examples to illustrate the wide-ranging degree to which this is possible.

I know a young man who has always lived in large cities with efficient mass transit systems, and so he has never learned to drive. He rides his bike to the train station, or takes the bus a block from his home in inclement weather. He doesn’t have any distress riding in an automobile; he just doesn’t want to own one himself or learn to drive. For a 26 year old American male, this is a deviation from the norm, but not one that causes him any distress.

One elderly woman, 93 years old, living on Staten Island overlooking more lanes of traffic than I can count is not only resistant to driving, she is uncomfortable even taking rides out of her immediate neighborhood.The Senior citizen’s free bus picks her up and takes her to her neighborhood grocery store and appointments, she volunteers at the nursing home two blocks away, and she walks to the Church down the street that she was married in. While she misses out on activities she used to participate in, and no longer socializes with life-long friends that live more than a few blocks away, the distress that she experiences is mostly personal. The fear related to being on a highway has an impact on her life, but not one that society notices, and not one that abnormal for a little old lady to the point that it impacts anyone else.

Lastly, consider the case of a man who used to be employed as a UPS driver, who suffers from extreme OCD (Obsessive Compulsive Disorder), and has been on disability for almost 8 years now. His obsessive behavior began as a nagging concern that he had hit something while driving his delivery truck, and progressed to the extent that he could drive no more than a few feet before he had to stop, get out of the truck, walk around and check under each tire, then begin the process again. He can ride in a vehicle, but he cannot drive under any circumstances- he would have to stop even if he had merged onto a highway- a dead stop, get out and check under the wheels, drive a few more feet, and continue over and over again. His inability to control the compulsion to stop and get out caused a few fender benders, and he eventually had to be placed on full disability after he could no longer even drive out of the UPS loading docks. His impairment does have a strong impact on him, and when he was still driving, he was definitely a risk to the rest of the community.

In each of the above scenarios, the impact to the individual and the view of society are considered, and they are similar, but on a wide-ranging scale of both personal distress and abnormality as compared to the rest of society. I can’t seem to come to a conclusion of which is more significant when I am comparing individual distress to the perception of society, most likely because I am so conditioned to compare individual distress to the RISK to self or other members of society. For that reason, I am most compelled to view the concept of “harmful dysfunction” (Durand and Barlow, 2007) as defined by Jerome Wakefield, as my middle-of-the-road opinion; it is the risk of harm to self by inability to function, or the risk to others that quantifies the presence of psychological illness.

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