Patient behaviour
1. Explain the concepts of normal and abnormal human behaviour, specifically as these relate to
beliefs, thought process and behaviour.
Psychopathology is the study of the nature and development of abnormal behaviour, feelings and
thoughts. So what is abnormal behaviour as defined typical psychological style, is behaviour that is not
normal. These parameters of normal defined by a variety of things such as society, beliefs etc. Below I
will proceed to describe what is abnormal.
Definitions of Abnormal Behaviour 1 - Statistical Infrequency
Abnormal behaviour is thought to be infrequent. No matter what the media would have us believe,
there are not that many murders and psychopaths out there. It is statistically infrequent. This model
therefore states that few people fall into the extremes of behaviour, so anything that is extreme, is
therefore abnormal behaviour. For example, only 2% of the population have a very low IQ. So this is
seen as "abnormal". However, there are still value judgments attached to this. Two percent of the
population have a very high IQ. This is seen as a positive thing, having a very low IQ isn't.
Also, consider, some other "abnormal" behaviours are good things. Not many of us win gold medals in
the Olympics, but is that "abnormal"? Quite a lot of people suffer from depression and anxiety during
their lives. Depression is not considered to be a "normal" state of affairs, but if it is statistically
frequent, isn't it therefore "normal"? It's not simple is it?
Therefore, the statistical model does not actually give us much guidance in determining what is and
isn't "abnormal" or "normal".
Definitions of Abnormal Behavior 2 - Violation of Norms
When determining whether behavioru is abnormal or not, we can consider whether it violates social
norms or if it makes people observing it feel threatened or anxious. A psychopath will often display
antisocial behaviour. This violates society's norms and makes us feel threatened or uncomfortable, so
fits with the definition of violation of social norms. However, this is still too narrow a definition.
Criminals and prostitutes may violate social norms, but are they "abnormal". Also, what we view as a
cultural or social norm can vary over time. Consider homosexuality - in various cultures and during
various times, this has been accepted or at other times and cultures, illegal.
A simple example. One hundred years ago, if you had seen someone walking down the street, talking
to a little box, they would have been considered abnormal. How many times do you see a person doing
that with a mobile phone today and think nothing of it?
Definition of Abnormal Behavior 3 - Personal Distress
Personal suffering can be used to explain if a person has some form of abnormal behavior.
Behaviour can be considered abnormal if it creates a great deal of distress and torment for the person
concerned. For example, a person with severe anxiety or depression may be suffering a great deal of
distress.
But there are problems with this model (surprise, surprise). A psychopath displays "abnormal"
behaviour, but may not find that distressing. He/she may break the law without experiencing any guilt
or remorse. Also, some experiences may distress us, such as having a baby, being hungry, but these are
not "abnormal" feelings.
Definition of Abnormal Behavior 4 - Behavioural Dysfunction or Disability
Disability is defined as whether a person is impaired in some important aspect of their life, for
example, work, relationships and so on. This can be then defined as "abnormal". A phobia, for
example, can cause distress and disability. If we are scared to go out, we may be so upset, we do not
leave the house - our lives are therefore impaired. This is a complicated definition as both disability
and distress are required. For example, a transvestite is still classed as mental disorder, but the
transvestite may not find being a transvestite distressing. Another example, we may be desperate to be
a professional football player, but not be very fast or very good at it - this may cause us distress, but it
is not abnormal behaviour.
Definition of Abnormal Behaviour 5 – Unexpectedness
Not all distress or disability is abnormal behaviour. Disability and distress can be considered
"abnormal" when they are unexpected responses to an environmental stressor. Hunger can cause us
distress - this is an expected response. If we are wealthy, but are constantly worrying about money, this
is not an expected response, so can cause us psychological problems.
So, there is no key definition of abnormal behavior or psychopathology. This is why it is such a wide
and diverse topic, with so many different theories and pieces of research being conducted.
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2. Explain how different concepts for faith (or belief/spirituality) may facilitate or obstruct the
doctor-patient relationship.
Facilitate:
Spiritual and religious practices such as prayer represent the most prevalent complementary
therapies in the United States. More than twice as many U.S. adults use prayer for health
and healing than use herbal medicines. Nearly 80% of U.S. adults believe that religion,
to a large extent, helps patients and families cope with illness. And 56% of adults
state that faith has helped them recover from illness, injury, or disease. Given these facts,
it should be clear that one goal of holistic health care is to integrate the patient's spirituality
into clinical encounters.
Spirituality is subjective and therefore difficult to define or measure. As a formal definition,
spirituality is a journey toward, or experience of, connection with the source of ultimate
meaning. Spirituality includes connection with oneself, with others, with nature, and with
a higher power. Often, this connection is with a greater story that makes sense of one's life.
Spirituality may or may not involve formal religion. Spiritual concerns arise in clinical
settings when these important connections are threatened or disrupted.
Spirituality in clinical settings demands professional attention. Spiritual beliefs are
frequently important in medical decisions. Spiritual well-being is closely linked to
successful coping, faster recovery, and higher quality of life. Many patients may want
help with meaning, hope, or overcoming fears. Therefore where spirituality/beliefs are dealt with
effectively there can be a improvement in the patient doctor relationship in terms of (1) improved
diagnostic accuracy, (2) appropriately focused and directed resources, and (3) a strengthened
therapeutic alliance.
Obstruct:
However, on the flip side unmet spiritual needs are associated with despair and higher mortality.
Integrative physicians should be prepared to inquire about and engage patients in
discussions of spirituality. To ignore the patient's source of meaning, purpose, richness,
and direction places the physician at risk for providing inefficient, ineffective, and
unsatisfactory care. The challenge is to identify the best means for doing so.
Additionally the doctor patient relationship would be obstructed if the beliefs of the patient were
so strong as to cause them not to comply fully with essential treatment provided. This would cause
a strain on the relationship and further could cause deterioration of patient condition. Therefore, it
is essential the doctor does acknowledge and respect individual patients beliefs/spirituality but
further allow this not to impede in essential care.
Gregory A. Plotnikoff, MD, MTS, FACP