Should the field drop the term "abnormal psychology"?

[cara susanna]

Hi all,

I may regret starting this thread at some point, but I've seen some very interesting discussions around changing the title "abnormal psychology" because of concerns that it's pejorative and stigmatizing.

Here is a proposed letter on the topic, for instance:



What do you all think?

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[WisNeuro]

From a purely pragmatic view, did I miss it, or did the author not suggest an alternative. I mean, we could just call it psychopathology, which we already use in a similar sense.

 

[erg923]

Learning the difference between normative behavior variations/responses and abnormal behavior is at the heart of this field. Thats kinda the whole thing of what we do here.

 

[cara susanna]

I prefer psychopathology but some people feel that's also stigmatizing.

Not sure what the alternatives would be. Some people suggest mental distress or something like that. I worry that if we do that, we risk sending the message that these aren't real disorders in need of real treatment.

 

[WisNeuro]

Learning the difference between normative behavior variations and responses and abnormal behavior is at the heart of this field. Thats kinda the whole thing of what we do here.

True, but the taxonomy/abnormal debate has been going on for quite some time, this is hardly new. Abnormal is something of a charged word. There are ways in which we describe disorders that are still descriptive, and less charged. The psychopathology term, for instance, which is already in teh vernacular, and encompasses temporary and chronic conditions.

 

[WisNeuro]

I prefer psychopathology but some people feel that's also stigmatizing.

Not sure what the alternatives would be. Some people suggest mental distress or something like that. I worry that if we do that, we risk sending the message that these aren't real disorders in need of real treatment.

I have to imagine no matter what the term is, a group of people are not going to be happy. I'd be curious to hear what term people would prefer that carries little to no subjective stigmatizing value, but is descriptive and accurate enough to be meaningful. Otherwise, I feel like we're just playing whack-a-mole and will be having the same discussion in several years about whatever the replacement term is.

 

[Fan_of_Meehl]

I have to imagine no matter what the term is, a group of people are not going to be happy. I'd be curious to hear what term people would prefer that carries little to no subjective stigmatizing value, but is descriptive and accurate enough to be meaningful. Otherwise, I feel like we're just playing whack-a-mole and will be having the same discussion in several years about whatever the replacement term is.

Agreed. I'm tired of having to relearn the 'proper' terms..., e.g., multidisciplinary begat interdisciplinary which begat interprofessional, etc. But I'm just getting curmudgeony, probably.

On the stigma issue, I tend to accept the view that self-deception is the root of most (all?) psychopathology as well as the adage, "where there is truth, there is health."

 

[WisNeuro]

Agreed. I'm tired of having to relearn the 'proper' terms..., e.g., multidisciplinary begat interdisciplinary which begat interprofessional, etc. But I'm just getting curmudgeony, probably.

 

[Mindfulpsych22]

Coming from a third-wave perspective, I see a lot of value in dropping the "abnormal" from the name. I would love to go with a label such as "Biopsychosocial Conditions" or something that clearly delineates that these are serious problems that need treatment but also gets away from the "disease" model. I think this name would also shift the culture to adopt broader ranges of interventions for these problems that are also evidence based.

 

[SomeGreatNotion]

I'll note that the Journal of Abnormal Psychology is changing their name to the Journal of Psychopathology and Clinical Science beginning in 2022.

 

[WisNeuro]

Looks like Psychopathology is the current front runner. Works for me.

 

[PsyDr]

The last time our profession moved away from the medical model, hospitals replaced us with social workers, we lost E/M codes, and we almost totally lost the ability to bill insurance. Great job.

Looks like we are in for another run of this. Tell insurance to pay us, but refuse to use the required terms. Tell courts stuff, without understanding the required terms.

 

[WisNeuro]

The last time our profession moved away from the medical model, hospitals replaced us with social workers, we lost E/M codes, and we almost totally lost the ability to bill insurance. Great job.

Looks like we are in for another run of this. Tell insurance to pay us, but refuse to use the required terms. Tell courts stuff, without understanding the required terms.

That's only accelerating in these parts.

 

[erg923]

that clearly delineates that these are serious problems that need treatment but also gets away from the "disease" model.

Thats not how healthcare works.

 

[AcronymAllergy]

That's only accelerating in these parts.

Hit or miss here, but I agree that we don't do ourselves any favors when we purposefully try to be at odds with the extant/dominant terminology used by the systems in which we work. Sorry psychologists, we aren't that special.

 

[WisNeuro]

Hit or miss here, but I agree that we don't do ourselves any favors when we purposefully try to be at odds with the extant/dominant terminology used by the systems in which we work. Sorry psychologists, we aren't that special.

No one gets in the way of psychology advocacy quite like psychologists themselves.

 

[Sanman]

Coming from a third-wave perspective, I see a lot of value in dropping the "abnormal" from the name. I would love to go with a label such as "Biopsychosocial Conditions" or something that clearly delineates that these are serious problems that need treatment but also gets away from the "disease" model. I think this name would also shift the culture to adopt broader ranges of interventions for these problems that are also evidence based.

Family discord, unstable housing situations, pretty much any V code in the DSM are all conditions that can be serious problems. Health insurance carriers will not reimburse counseling/ psychotherapy related to those issues. They reimburse for the treatment of diseases and disorders. So, who pays for the treatment of biopsychosocial conditions? (HINT: the biggest biopsychosocial problem in the country is poverty, who gets paid to cure that?)

 

[psych.meout]

Great, another superficial way for people to feel like they're doing something to contribute and change things for the better without effecting any practical change of real significance, because that would require actual time, money, and effort. I always wanted psychology to become like online social media politics.

 

[MCParent]

Other than the journal of abnormal psych (which is changing) and the undergrad abnormal psych textbooks (which are also changing their titles), does anyone ever use this word? I don't walk around talking about my "abnormal patients." I refer to specific things (e.g., uniquely low WMI score or whatever) as abnormal, but the initial post makes it sound like we all say this word all the time.

As @psych.meout , seems like a fun fuzzy thing to attach to that makes no real difference.

 

[WisNeuro]

Other than the journal of abnormal psych (which is changing) and the undergrad abnormal psych textbooks (which are also changing their titles), does anyone ever use this word? I don't walk around talking about my "abnormal patients." I refer to specific things (e.g., uniquely low WMI score or whatever) as abnormal, but the initial post makes it sound like we all say this word all the time.

As @psych.meout , seems like a fun fuzzy thing to attach to that makes no real difference.

Yeah, even in clinical reports I still don't see abnormal as a descriptor ever. More likely to see things like "extremely low" or "atypical." This may be more of a solution in search of a problem type of case.

 

[Fan_of_Meehl]

Other than the journal of abnormal psych (which is changing) and the undergrad abnormal psych textbooks (which are also changing their titles), does anyone ever use this word? I don't walk around talking about my "abnormal patients." I refer to specific things (e.g., uniquely low WMI score or whatever) as abnormal, but the initial post makes it sound like we all say this word all the time.

As @psych.meout , seems like a fun fuzzy thing to attach to that makes no real difference.

Good point. And it's funny, a client earlier this week in therapy used the term to describe himself (or his behavior), saying something to the effect of, 'Man...that's abnormal isn't it?' I just engaged him around the term/concept, agreed that the behavior was probably 'statistically abnormal' (in that probably few people engaged in the behavior at that frequency) but then redirected the discussion more towards the topic of was it helpful/harmful to him according to his perspective (i.e., was it 'functional/dysfunctional'). I'm sure everyone's different, but I don't particularly sense any malignant connotation to the term 'abnormal' above and beyond its replacement 'psychopathological.' In fact, I'd even think that 'abnormal' had fewer negative connotations than 'psychopathology,' especially considering the connotations of 'pathology' and 'psychopath.'

 

[SomeGreatNotion]

The words and language we use matter. Certainly much has been published on this in the motivational interviewing literature (e.g. change talk -> outcomes). While I've never heard other clinicians use the term "abnormal", my clients have voiced concerns about their own thoughts or behavior as "not normal".

I don't find that this shift is all that unique to psychologists as we've seen recent language shifts in medicine such as referring to someone as with diabetes versus diabetic.

 

[haRtwin]

I've recently read some exchanges over a few different listservs about changing the title of the undergraduate psychology course. Most of the exchanges came from the decision of Journal of Abnormal Psychology to change its name.

Some proposed changes were: Psychopathology, Psychological Disorders, Psychological Diagnoses, and Clinical Psychology (this one seems misleading if there is a clinical/counseling psychology course). These were some of the common names across the exchanges, but I also saw also some unique ones like "Disrupted Well-Being."

 

[psych.meout]

The words and language we use matter. Certainly much has been published on this in the motivational interviewing literature (e.g. change talk -> outcomes). While I've never heard other clinicians use the term "abnormal", my clients have voiced concerns about their own thoughts or behavior as "not normal".

I don't find that this shift is all that unique to psychologists as we've seen recent language shifts in medicine such as referring to someone as with diabetes versus diabetic.

 

[WisNeuro]

I've recently read some exchanges over a few different listservs about changing the title of the undergraduate psychology course. Most of the exchanges came from the decision of Journal of Abnormal Psychology to change its name.

Some proposed changes were: Psychopathology, Psychological Disorders, Psychological Diagnoses, and Clinical Psychology (this one seems misleading if there is a clinical/counseling psychology course). These were some of the common names across the exchanges, but I also saw also some unique ones like "Disrupted Well-Being."

Jesus Christ, we better not be the profession that emulates Dr. Oz and Goop.

 

[deleted106747]

Maybe we should start calling cancer cells a sub-optimal variant instead of pathological.

 

[Fan_of_Meehl]

Maybe we should start calling cancer cells a sub-optimal variant instead of pathological.

Maybe we should rename 'Panic Disorder' to 'Serenity Deficit Disorder'

 

[haRtwin]

Jesus Christ, we better not be the profession that emulates Dr. Oz and Goop.

Not only that, but the name "disrupted well being" is probably not recognizable to most faculty reviewing applications at clinical/counseling graduate programs. I could see faculty being confused as to what courses the applicant completed at their undergraduate institution.

 

[ccool]

I may regret starting this thread at some point

Hi, this struck me. And I noticed that you and another poster said the same thing when you contributed to the defining violence thread. I’m curious why you felt, at least when you first wrote this, that you may regret starting this thread?

 

[WisNeuro]

Not only that, but the name "disrupted well being" is probably not recognizable to most faculty reviewing applications at clinical/counseling graduate programs. I could see faculty being confused as to what courses the applicant completed at their undergraduate institution.

Well, it follows the trend of some sectors of psychology embracing pseudoscience and aggressively rejecting the scientific method, so I wouldn't be terribly surprised.

 

[cara susanna]

Hi, this struck me. And I noticed that you and another poster said the same thing when you contributed to the defining violence thread. I’m curious why you felt, at least when you first wrote this, that you may regret starting this thread?

Just, as a longtime poster, I know how these types of threads tend to go. The violence thread I said that because it was already a dumpster fire (in my humble opinion).

 

[ccool]

Just, as a longtime poster, I know how these types of threads tend to go. The violence thread I said that because it was already a dumpster fire (in my humble opinion).

Lol, I agree entirely. It absolutely was. Right, as a not longtime poster I think I have some general sense of what you may be referring to. But I’m not sure. Because I sometimes have to be really critical when deciding what, if anything, to say and when lest I have to deal with anything I wasn’t prepared to. Anyway, was just curious abt others’ perspectives and if you had any insights that I was missing. Thanks!

 

[cara susanna]

I wonder if this discussion also reflects differences in perspectives between academics and clinical practitioners. As mentioned, the terms psychological distress, disrupted well being, etc., aren't really pragmatic. That's why I like psychopathology, I tend to say that in practice whereas I almost never say abnormal (and encourage my patients not to frame things in terms of "normal" if they bring up that word).

 

[Fan_of_Meehl]

I wonder if this discussion also reflects differences in perspectives between academics and clinical practitioners. As mentioned, the terms psychological distress, disrupted well being, etc., aren't really pragmatic. That's why I like psychopathology, I tend to say that in practice whereas I almost never say abnormal (and encourage my patients not to frame things in terms of "normal" if they bring up that word).

Honestly, thank you for starting threads like this one and inviting discussion...it allows those who may have valid opinions that may be inconsistent with the new orthodoxy a place to articulate a 'counterposition' freely without threat of negative consequences...this, in my opinion, is sorely needed and actually increases the validity/credibility of the orthodox opinions in that--if they can survive substantive/real debate, they are strengthened. Sadly, academia has morphed from a place of the free exchange of ideas and vigorous debate to more of a groupthink/conformity/obedience to 'authority' paradigm.

 

[Sanman]

I wonder if this discussion also reflects differences in perspectives between academics and clinical practitioners. As mentioned, the terms psychological distress, disrupted well being, etc., aren't really pragmatic. That's why I like psychopathology, I tend to say that in practice whereas I almost never say abnormal (and encourage my patients not to frame things in terms of "normal" if they bring up that word).

The problem with terms like psychological distress and disrupted well-being, is that they don't differentiate between normal functioning and functioning indicative of clinical intervention. The entire world has been suffering through some level of psychological distress since March 2020. I suffered disrupted well-being this morning when my alarm clock woke me out of a sound sleep and indicated I need get up and get ready to work. Neither scenario means I require intervention. On the flip side, try telling a veteran suffering with severe PTSD for decades that they have a case of "disrupted well-being" and let me know if you get slapped in the face. It sounds as if you are making light of a severe condition. George Carlin would have had a field day with these terms.

 

[erg923]

The problem with terms like psychological distress and disrupted well-being, is that they don't differentiate between normal functioning and functioning indicative of clinical intervention. The entire world has been suffering through some level of psychological distress since March 2020. I suffered disrupted well-being this morning when my alarm clock woke me out of a sound sleep and indicated I need get up and get ready to work. Neither scenario means I require intervention. On the flip side, try telling a veteran suffering with severe PTSD for decades that they have a case of "disrupted well-being" and let me know if you get slapped in the face. It sounds as if you are making light of a severe condition. George Carlin would have had a field day with these terms.

Bring back "shell shock."

 

[WisNeuro]

Bring back "shell shock."

I'm more partial to Railway Spine.

 

[erg923]

I wonder if this discussion also reflects differences in perspectives between academics and clinical practitioners. As mentioned, the terms psychological distress, disrupted well being, etc., aren't really pragmatic. That's why I like psychopathology, I tend to say that in practice whereas I almost never say abnormal (and encourage my patients not to frame things in terms of "normal" if they bring up that word).

Probably. All this focus on "getting away from medicine" is likely from people who don't work in it the way many psychologists do and dont understand insurance companies. See the E&M code loss point from @PsyDr.

I also think academics overestimate how much the average practicing psychologist (or anyone else for that matter) really cares about some these types of things. I had honestly never thought about this, and really doubt alot of other psychologist did/do too.

 

[singasongofjoy]

Other than the journal of abnormal psych (which is changing) and the undergrad abnormal psych textbooks (which are also changing their titles), does anyone ever use this word? I don't walk around talking about my "abnormal patients." I refer to specific things (e.g., uniquely low WMI score or whatever) as abnormal, but the initial post makes it sound like we all say this word all the time.

As @psych.meout , seems like a fun fuzzy thing to attach to that makes no real difference.

Good point- I don't think I've ever heard or used the term outside of referring to a class with that title & related textbook. Or maybe when referencing the journal which is apparently changing its name soon so that'll be a moot point.

 

[AcronymAllergy]

Probably. All this focus on "getting away from medicine" is likely from people who don't work in it the way many psychologists do and dont understand insurance companies. See the E&M code loss point from @PsyDr. I also think academics overestimate how much the average practicing psychologist cares about some these types of things. I had honestly never thought about this, and really doubt alot of other people did/do too.

A related key point: the more economic/financial "power" psychologists have in the healthcare marketplace (e.g., in terms of billing/reimbursement for our services), the better situated we can be to effect change. If we still had E/M codes, we'd probably have always had a bigger seat at the Medicare/CMS and health insurance tables.

 

[DynamicDidactic]

I recently brought up this topic in my university. Though, the non-clinical faculty seemed to have much more interest in the topic. A few things:
1) Do we have any evidence that the term "abnormal" is indeed stigmatizing? Or psychopathology? What about disorder?
2) I like either Psychopathology, Clinical Science, or the combo
3) The term abnormal is just old and likely needs to be updated. That is the reason I'd like to change it.

 

[MCParent]

Although "psychopathology" is fine with me, I think it might be a problem for laypeople. I've seen a substantial number of people think
psychopathology = psychopath = serial killer tendencies!
Not people in the profession but undergrads and patients. I'd never write "comorbid psychopathologies" in a report.

 

[WisNeuro]

Although "psychopathology" is fine with me, I think it might be a problem for laypeople. I've seen a substantial number of people think
psychopathology = psychopath = serial killer tendencies!
Not people in the profession but undergrads and patients. I'd never write "comorbid psychopathologies" in a report.

Perhaps regional and/or specialty specific, but I see the term psychopathology quite often in reports.

 

[MCParent]

Perhaps regional and/or specialty specific, but I see the term psychopathology quite often in reports.

Do people ever ask if that means the same thing as psychopathy/psychopath? Maybe it is linked strongly to my area.

Yes, probably specialty diffs, my reports usually go up to an SSD university office or MCAT etc. accommodations people, so read by non-psychs very often.

 

[WisNeuro]

Do people ever ask if that means the same thing as psychopathy/psychopath? Maybe it is linked strongly to my area.

Yes, probably specialty diffs, my reports usually go up to an SSD university office or MCAT etc. accommodations people, so read by non-psychs very often.

I've honestly never had anyone ask.

 

[bcliff]

I'm also a fan of clinical science and/or psychopathology -- To @MCParent 's point, I once recommended psychotherapy to a parent re: their child, and they thought I was diagnosing their child with psychopathy

 

[MCParent]

I'm also a fan of clinical science and/or psychopathology -- To @MCParent 's point, I once recommended psychotherapy to a parent re: their child, and they thought I was diagnosing their child with psychopathy

Oh lol. Psychotherapy = therapy for psychos.
I'll probably continue to not use psychopathology in my reports given my report readers but doesn't seem like the specific misunderstanding I encounter sometimes is widespread.

 

[DynamicDidactic]

Although "psychopathology" is fine with me, I think it might be a problem for laypeople. I've seen a substantial number of people think
psychopathology = psychopath = serial killer tendencies!
Not people in the profession but undergrads and patients. I'd never write "comorbid psychopathologies" in a report.

My thoughts:
A) Most undergrads, in my experience, do not even think about the name too much (Abnormal Psych). They take the course b/c it fits an undergrad requirement. If they are already interested in the subject, they likely wont be dissuaded by the course name.
B) The variability of how people misunderstand terms is wide. More importantly, when they take the course they should be educated on the term. That, in itself, should reduce any potential stigma (though, I have not seen evidence that the term abnormal or psychopathology is stigmatizing to the average person).
C) For course names, it is less important what laypeople - outside of the university - think and feel about the name.
D) There is no perfect name for a course like this.

 

[calimich]

Changing the name of our dept's course from "abnormal psychology" to "psychopathology" was one of the first small changes I advocated for when I was hired as the psych dept's first licensed psychologist on the tenure track. Glad to say the dept and admin took my recommendation.

 

[cara susanna]

My concern about clinical science is that a lot of universities have clinical psych introduction courses that are more about counseling and therapy. That could get confusing.