The Challenge of Defining Abnormality: Subjectivity and Context

Ask most people whether they can recognize “abnormal” behavior, and they will say yes – confidently. But ask them to define it, and the certainty quickly fades. What counts as abnormal? Who decides? And what happens when those decisions are wrong? These are not just academic questions. The answers shape how people are diagnosed, treated, and perceived in society. Two of the most unsettling challenges to the way we define abnormality come from an iconoclastic psychiatrist named Thomas Szasz and a landmark experiment that exposed the fragility of psychiatric diagnosis. Together, they reveal just how elusive – and consequential – the concept of abnormality really is.

The problem with “abnormal”: more than a definition
Szasz’s critique: mental illness as a social construct
Psychiatry as social control
Criticisms of Szasz
The Rosenhan experiment: when diagnosis fails in practice
The power of labels
False positives and the reversal test
Limitations of the experiment
What context does to diagnosis
Where this leaves us

The problem with “abnormal”: more than a definition

Defining abnormality in psychology is not like measuring blood pressure or identifying a broken bone. Psychological abnormality deals with thoughts, emotions, and behaviors that exist on complex continua, with no obvious cut-off points and no universal standard. What appears abnormal in one context – talking to oneself, refusing to eat certain foods, avoiding eye contact – may be completely unremarkable in another. Cultural norms, historical period, and social expectations all shape what gets labeled as a disorder.

This is not a minor technical problem. It is a deep conceptual one. And it has led some thinkers to question not just how we measure abnormality, but whether the very category of mental illness makes sense at all.

In 1961, psychiatrist Thomas Szasz published The Myth of Mental Illness, one of the most provocative works in the history of psychiatry. His central argument was straightforward but radical: mental illness, as a category, does not exist in the same way physical illness does. For Szasz, a disease requires a demonstrable physical lesion – some identifiable abnormality in the body. Because no such lesion could be found for most psychiatric conditions, he argued that labeling someone mentally ill was not a medical act but a social and moral judgment.

Szasz did not deny that people suffered or that their behavior was sometimes deeply unusual. What he rejected was the medical framing of that suffering. In his view, what psychiatrists actually dealt with were personal, social, and ethical problems in living – conflicts, dilemmas, and struggles that called for understanding, not diagnosis. Calling these problems “illnesses” did not illuminate them; it obscured them behind a medical veneer.

Szasz went further. He argued that the construal of behaviors as pathological entities perpetuates the assumption that the individual’s actions are devoid of motivation and occur outside the orbit of their control. By medicalizing deviance, psychiatry effectively handed responsibility for troublesome behavior away from the individual – and handed power to the state and the medical establishment.

In Szasz’s analysis, psychiatry served its social function through state-sanctioned power to label certain forms of deviant or undesirable conduct as illness, and through the mechanism of involuntary commitment – detaining individuals without trial, in the name of mental health. He pointed to historical examples like drapetomania (a fictitious “disorder” invented in the 19th century to pathologize enslaved people who tried to escape) and sluggish schizophrenia (a Soviet-era diagnosis used against political dissidents) as evidence that psychiatric labels have historically been deployed in the service of social and political control.

For Szasz, the concept of “mental illness” was not a neutral scientific term – it was a tool. And like any tool, it could be used to harm as well as help.

Criticisms of Szasz

Szasz’s ideas were widely discussed but also widely challenged. Most psychiatrists and mental health professionals reject the view that psychiatric diagnoses serve purely as tools of social control. Critics argue that his framework was rooted in the psychoanalytic psychiatry of the 1950s and does not account for the substantial body of neuroscientific evidence that has emerged since. Brain imaging, genetics, and pharmacological research have all demonstrated that conditions like schizophrenia and major depression involve genuine biological processes – not merely problems in living.

As one clinical psychiatrist noted in a peer-reviewed commentary, insisting that conditions involving disruptions to thought, emotion, impulse control, and perception should be exempt from the rubric of illness seems entirely unjustified. Szasz may have been right that psychiatric diagnosis carries social and political weight. He was on shakier ground when he denied that psychopathology itself was real.

Nevertheless, Szasz’s core provocation retains its value. It pushes us to ask: when we call something abnormal, are we making a scientific observation – or a social judgment?

The Rosenhan experiment: when diagnosis fails in practice

If Szasz attacked the concept of mental illness from a philosophical angle, psychologist David Rosenhan attacked it from the empirical one. In 1973, he published a study in the journal Science titled “On Being Sane in Insane Places” – and it sent shockwaves through psychiatry.

The premise was deceptively simple. Rosenhan, along with eight other people, entered 12 hospitals in five states and feigned auditory hallucinations to gain admission – but acted entirely normally from that point onward. All were admitted. All were diagnosed with psychiatric disorders, most commonly schizophrenia. Not one was identified as a pseudopatient by the clinical staff, though real patients sometimes suspected the ruse.

The power of labels

What happened after admission was just as revealing as the admission itself. Once a person was diagnosed, the label shaped how every subsequent behavior was interpreted. A pseudopatient calmly taking notes was recorded in their chart as exhibiting “writing behavior” – a supposed symptom. Normal interactions with family were filtered through the lens of schizophrenia and interpreted as evidence of pathology. The diagnosis had become self-fulfilling.

Even when the pseudopatients stopped feigning symptoms and behaved completely normally, the doctors clung to the initial assessment and continued to treat the patients as mentally ill. They were eventually discharged – not as “sane,” but as schizophrenic “in remission.”

False positives and the reversal test

Rosenhan then set up a second phase of the study. He informed a teaching hospital – aware of his earlier findings – that during the next three months, pseudopatients would attempt to gain admission. Staff were asked to rate each new patient’s likelihood of being an impostor. Of 193 patients, 41 were identified as likely impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients at all. Every patient flagged was a genuine one.

The conclusion was damning: the same system that had failed to detect healthy people pretending to be ill now readily suspected real patients of faking. As Rosenhan put it, any diagnostic process that yields so readily to massive errors of this sort cannot be a very reliable one.

Rosenhan himself identified the key flaw: the diagnostic leap made between a single presenting symptom – hallucination – and the sweeping diagnosis of schizophrenia was the heart of the matter. A single symptom, reported in a single context, was being used to affix a label that then colored everything else.

Limitations of the experiment

The Rosenhan experiment is not without its critics. Psychiatrist Robert Spitzer argued that deceiving clinicians into admission does not invalidate the diagnostic system itself – and that psychiatrists are more likely to make a type two error – calling a healthy person sick – than a type one error, because the consequences of prematurely discharging a genuinely ill patient can be severe. Later investigation also raised questions about methodological inconsistencies in Rosenhan’s original data.

Still, the study’s broader point stands. Psychiatric diagnoses continue to be made largely on the basis of inferences drawn from patient self-reports and practitioners’ observations of behavior – evidence that is, by its nature, more ambiguous than a blood test or a scan. This leaves significant room for context, expectation, and bias to shape what clinicians see.

What context does to diagnosis

Both Szasz and Rosenhan, in very different ways, point to the same underlying problem: the meaning of behavior is deeply context-dependent. A person who hears voices in a clinical intake setting is likely to be diagnosed very differently from a person who reports the same experience during a religious retreat. A woman who refuses to eat in the context of a famine is not the same as one who refuses to eat in the context of an eating disorder – even if their behavior is outwardly identical.

Cultural context, historical period, and situational factors all influence judgments about psychological normality. This is not a reason to abandon diagnosis, but it is a reason to approach it with humility. The history of psychiatry contains genuine examples of normal behavior being pathologized – from women who challenged gender norms being diagnosed with “hysteria” in the 19th century, to homosexuality being classified as a mental disorder in the DSM until 1973.

Cultural relativism theory holds that there are no universal standards to judge behavior as abnormal – only prevailing cultural norms. But this view has its own dangers: if cultural norms alone determine what is sick, then societies can use that power to pathologize anyone who deviates from the dominant order. The challenge is to find an approach that is both culturally sensitive and grounded in genuine evidence of suffering and impairment.

Where this leaves us

The critiques raised by Szasz and demonstrated by Rosenhan do not mean that mental illness is a fiction or that psychiatric diagnosis is worthless. They mean that defining abnormality is an exercise that must be approached with intellectual honesty. Modern diagnostic frameworks have evolved significantly since Rosenhan’s era – the DSM was substantially revised partly in response to his findings, with greater emphasis on specific, observable criteria. Defining abnormality involves considering cultural context, personal distress, functional impairment, and potential danger to self or others. No single criterion is sufficient on its own.

What neither framework fully resolves is the subjective element at the heart of every clinical judgment. The clinician brings their training, their cultural assumptions, and their institutional context into every assessment. The task of defining abnormal psychology demands a dynamic and flexible approach, one that can adapt to changing societal views and scientific advancements. Recognizing the elusive nature of abnormality is not a weakness in the field – it is a sign of intellectual maturity.

What do you think? If the line between normal and abnormal is so dependent on context and culture, is it possible to diagnose mental illness in a way that is truly objective? And given what Rosenhan found, how much trust should we place in a single diagnostic label?

References

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Table of Contents

The problem with “abnormal”: more than a definition 🔗

Szasz’s critique: mental illness as a social construct 🔗

Psychiatry as social control 🔗

Criticisms of Szasz 🔗

The Rosenhan experiment: when diagnosis fails in practice 🔗

The power of labels 🔗

False positives and the reversal test 🔗

Limitations of the experiment 🔗

What context does to diagnosis 🔗

Where this leaves us 🔗

References

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