By Cassie Hazell
Universities have a duty to provide quality education and training to those who want it, and create a community that reflects all the best parts of society. Consequently, universities and their students have worked hard to stamp out prejudice and discrimination. Although, unfortunately instances of sexism, racism and homophobia may still occur within our higher education institutions, the wider community agrees that this is unacceptable. University policies are clear as to the seriousness of such actions, and firm (I hope?) about the consequences. But, what about mental health discrimination?
Yes, I am sure many universities will argue their discrimination policies cover this – yet the linguistic norms used to teach students about mental health demonstrate otherwise. While universities are generally places where the boundaries of current knowledge are questioned and challenged, this is one domain where they are more than a little ‘behind the times’.
I invite you to enter the phrase ‘university and abnormal psychology’ into a search engine; now scroll through the pages that it returns. You will see just how many institutions offer modules, courses, and degrees labelled ‘abnormal psychology’. Some of the world’s most prestigious universities are on that list. But what even is ‘abnormal psychology’? If you take a deeper look at the course content, you will find that they purport to teach their students about mental health (also more sympathetically known as clinical psychology). How can these courses teach their students about the latest research, when the course title is stigmatising and fundamentally wrong?
The dictionary defines abnormal as: “deviating from what is normal or usual, typically in a way that is undesirable or worrying”. The suggested synonyms are rare, freak, deviant, weird, unexpected… as well as a host of other offensive terms. Ignoring the issue of stigma for a moment (although I believe this is the most important issue), I hope to prove to you that the use of this term to describe mental health is inaccurate.
Abnormal could be taken to mean that mental health problems are rare or unusual. This is false. The Time to Change campaign in the UK reports that 1 in 4 people will experience mental health issues. I would argue this figure is actually far too small. The ‘1 in 4’ figure is based on the results of the 2009 UK National Household survey; but only those with a recognised disorder were included in this analysis. Many people experience mental health difficulties without a clinical diagnosis (Baumeister & Morar, 2008) – so it is highly likely that there will be a lot of people experiencing mental health problems that were not counted. Also the effects of the recent economic crisis on mental health (Karanikolos et al., 2013) is likely to inflate this figure even more. Consequently it is probable that more than 25% of the UK population will experience mental health difficulties. So, are mental health problems rare? I don’t think so.
Another understanding of abnormal could be that those with mental health problems are somehow different from the rest of the ‘normal’ population. The flaw with this assumption relies on the understanding that mental health issues can be reduced to a dichotomous entity – you are either ‘abnormal’ or ‘normal’, you are either a ‘freak’ or ‘ordinary’. This does not reflect reality. For example, taking the dichotomous approach, we could describe someone as being either happy or unhappy. But in practice people can be just a little bit happy, or their happiness could fluctuate over the day. In line with this thinking, the most recent understandings of mental health argue that mental health can be best understood as part of a spectrum or continuum (e.g. Cuijpers, de Graaf, & van Dorsselaer, 2004; Tylka & Subich, 1999; van Os, Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2009). Everyone has a place on the continuum, with the potential to move either up or down the scale. If we all have the capacity to be at both the most and least extreme points on the continuum, then how can mental health be viewed as ‘them and us’? Either we are all freaks or none of us are.
A final possible implication from the term ‘abnormal’ is that the development of mental health problems is an anomaly. In fact, there is strong evidence to suggest that mental health problems can be interpreted as a reaction to stressful or traumatic life events. This is supported by an overwhelming pool of evidence demonstrating the link between stressful life events and the development of mental health difficulties (e.g. Carr, Martins, Stingel, Lemgruber, & Juruena, 2013; Kraan, Velthorst, Smit, de Haan, & van der Gaag, 2015; Lindert et al., 2014; Nielsen, Tangen, Idsoe, Matthiesen, & Magerøy, 2015). Evolution has taught us the value of reacting to extreme stress on a cognitive, emotional and physical level so that we can learn about ourselves, and the world (Baldwin, 2013). As many people will experience a trauma at some point their life (Lukaschek et al., 2013), it is then plausible that the event will trigger mental health difficulties for some people. What is so surprising about that?
The most pertinent problem with the term ‘abnormal psychology’ is its inherent stigma. Mental health stigma can stop people from seeking help or support (Corrigan, 2004), cause feelings of shame (Corrigan & Miller, 2004), worsen mental health symptoms, and reduce treatment adherence (Livingston & Boyd, 2010). I believe using the term ‘abnormal psychology’ within universities is discriminatory. Its continued use will teach students that prejudice is acceptable, and increase self-stigma amongst those students experiencing mental health problems.
I am aware that I have been predominantly negative thus far – I hope I can reassure you that change is possible. At the University of Sussex (where I study), as recent as last year the Psychology department offered an elective called ‘Abnormal Psychology’. However, lecturers and students challenged this, and the course title has now been changed to something that is more accurate and less stigmatising (the course is now called ‘Clinical Psychology and Mental Health’).
The aim of this blog is somewhat a ‘call to arms’. If you are part of a university that still uses the term ‘abnormal psychology’, why not challenge it? You may be able to see through the fallacy of this terminology, but I can assure you there will be others who won’t. The continued use of the term ‘abnormal psychology’ will only reinforce the lie that people experiencing mental health difficulties are to be feared. This is not an issue of political correctness; it is an issue of social responsibility.
If you are able to bring about change in your university I would love to hear about it. Please feel free to tweet me @MissCHazell. For more information, the British Psychological Society has a great resource on language in relation to mental health: http://www.bps.org.uk/system/files/Public%20files/guidelines_on_language_web.pdf
Also I am a big supporter of the Only Us campaign. They embody everything I have tried to say here – they believe “there is no them and us; there is only us”. Check them out on twitter: @OnlyUsCampaign
Cassie Hazell is currently in the final year of her PhD with the University of Sussex, supervised by Dr Clara Strauss, Dr Mark Hayward, and Dr Kate Cavanagh. Her PhD looks at the effects of a guided self-help cognitive behaviour therapy (CBT) for people who hear distressing voices (also known as verbal auditory hallucinations).