Psychological Misinformation and the search for the normal
When I was perhaps 8 or 9 years old, I asked my mother, “Is anyone actually normal?” It was one of those moments where child innocence cuts through the massive weight of worldviews drilled into us by adulthood, to identify something simple but profound. It was also, perhaps, an insight crafted for the child of a psychologist, and also an avid reader.
I’m not quite sure of the context for this question – perhaps my mother may recall. But looking around me at the time, this question seems inevitable. Look at the people in my family, at the people at school, the communities I was reading about, and the stories on the news. I grew up witnessing news of the downfall of apartheid, the Rodney King beating and riots, President Clinton’s sex scandals, the bombings in Oklahoma City and the World Trade Center, the Unabomber, the Waco, TX siege, genocide in Rwanda, and civil wars coming out of the breakup of the Soviet Union. And, of course, the O.J. Simpson trial. Capped off, at the end of the century, with the shootings at Columbine, and the 9-11 WTC attacks to start the new century.
What was I going to think?
Good observation, naive assumptions…
The question was an astute one. But in retrospect, I think it shows that I had already learned some assumptions about normality. When it comes to mental health, “normal” tends to be more of judgment of character than a statistical assessment. I was already recognizing that those we might consider “normal” are few and far between, at most. But not that there may be something amiss about the underlying judgments. I was also already falling victim to defining normal by its negation – through actions and people deemed “abnormal.” Violence, hatred, abuse: these are not things that we’re generally okay with. So, we distance ourselves from them by judging them as abnormal. We leave “normal” to the standard of knowing it when we see it. Never mind that we never do.
Normal as misinformation ingrained in psychology/psychiatry
After all, not so long after, – at least, from my current, rapidly aging perspective – when studying psychology in college early in the 21st century, I took a class in “abnormal psychology.” How did it come by this name? It’s our culture’s bias, given official sanction by the psychiatric and psychological communities. Abnormal psychology is taken as the study of mental “disorders,” or mental “illnesses.” In other words, people not thinking, feeling, sensing, or acting… ‘right.’ I struggled to figure out what word to end that last sentence with, because, truthfully, there is no right word. These assessments are in fact never about the individual: they are always in relation to others.
While there are many options for how to end that sentence – as intended, as designed, functionally, etc. – all require a fictional ‘correct’ option. Intended brings a belief that evolution comes with a sense of betterment. This is the basis for Social Darwinism, and the field of eugenics, which holds that some people are biologically superior to others. Designed brings a religious understanding of cosmic intention, a la intelligent design. But then which deity or set of deities’ design is right? Or if there is no deity? This path likewise quickly leads to some groups being better than others.
The mental health field’s standard: Functionality
Functionality is the path taken by psychiatry and psychology. In its favor, it cuts out some of the pitfalls of eugenics and intelligent design. The ‘better and worse’ of those perspectives assume a system centered around the people pre-identified as better. It’s like taking a test, wherein the scores are graded on a curve, with the mean defined as the scores of those pre-identified as better. And only those at the mean get an A. The normal person, according to eugenicists and intelligent designers, is who they want it to be. After all, they are the ones who define what are the right traits or the right belief system.
Functionality, at least, does not presume a right system. By looking at functionality, there is some freedom for things to change. Society assumed it was dysfunctional to have sex with people of the same identified gender 60 years ago, and so the DSM-II (the second edition of the diagnostic manual published by psychiatry, published in 1968) agreed. The DSM was able to adapt and remove homosexuality as a diagnosis when society changed.
Functionality: however…
However, equating dysfunction with individual illness puts on blinders to the biases inherent in what society deems functional in any given moment. This dooms psychiatry to constantly have to change labels or change formulations when society acts to correct a bias. The shift is often fairly superficial. Oops – did I say hysteria? That’s sexist. What I meant is, conversion disorder. Oh wait, that’s sexist too? My bad, what I meant is, functional neurological symptom disorder. These are the label changes to the same exact diagnosis across versions of the DSM.
Also, the functional approach makes for a bad fit with individualism. Because of individualism, society gets to set the standards, and then act innocent when there are negative consequences, leaving the individual to deal with it.
Functionality and normality: Example of PTSD
Here’s a common example of this pitfall. Someone experiences a major trauma – abuse, rape, the sudden death of someone close, war or natural disaster. There are some standard responses that people tend to have. Changes to memory, feelings, thoughts about oneself and others, and reactions to new events. Something clearly not to do with the individual (the source of the trauma), is now positioned as about the individual. Hold on a minute, the DSM says. You have to give it time. When you give people time, most people will work through those changes and the effects will ease. Those are the normal! So, for those unfortunate few that receive a posttraumatic stress disorder (PTSD) diagnosis, it is about them. Right?
Centering functionality removes context
Not quite. Where do those differences come from? Studies show differences in rates of PTSD based on a variety of social marginalization. Race/ethnicity, gender, sexuality, economic/class resources, all of these lead to higher rates of trauma and higher rates of PTSD. And remember, causation requires the cause to come before the effect. Either you take the eugenic idea that someone who’s poor, for instance, is poor because they are inherently worse, and this is why they then have higher rates of PTSD. Or, you recognize that social systems that create mass poverty leave those people with fewer resources and depleted capacity to handle traumas in the way defined as normal.
Or let’s make an even more radical shift: lets leave the assumption that the features of PTSD are abnormal, which only comes in relation to viewing certain beliefs, feelings, and reactions as universally functional. If we instead center the environment of people with a PTSD diagnosis, perhaps, for many, the “symptoms” of PTSD are in fact quite functional. Perhaps, they enable people to be ready for the next trauma, soon to come around the corner. Maybe those “symptoms” are signs of a healthy, resilient system!
Concluding thoughts on functionality as defining normality
In the end, deciding based on functioning still is biased. It assumes a set of behaviors to be abnormal, based on current social standards, and neglects the environmental factors that lead to those behaviors.
Book to read exposing psychological misinformation: Am I Normal?
These issues have been on my mind recently, as I just finished reading, Am I Normal? by Sarah Chaney. Chaney goes through the history of the concept of normality (which, at least as a term of science, only goes back approximately 200 years), and all different ways it gets applied to us as individuals and communities. She used many references from the Wellcome Collection in London, UK. I recommend both the book, as a thoughtful, broad overview of a social issue we should all be aware of, as well as the museum. The Wellcome Collection examines the history of how we understand and approach health. It is where I first realized how fundamentally problematic the methods and findings of the founders of my field are.
Psychological Misinformation: The assumption of healthy normality
I’ll finish up by sharing my orienting philosophy when it comes to the idea of normality. I practice Acceptance and Commitment Therapy (ACT). One of the foundational principles, so important that it comes right away in their book explaining how to do ACT, is the “assumption of healthy normality.” Hayes, Strosahl, and Wilson write,
The mental health community has simply not adequately explained its own data on the pervasiveness of human suffering. Drawing from medical metaphors, it seems to believe that psychological health is the natural homeostatic state that is disturbed only by psychological illness or distress.
Acceptance and Commitment Therapy: An experiential approach to behavior change, 1999, p. 4
Both words are important here: health and normality. Essentially, normality has been taken to mean the absence of any disturbance and presence of success – calm thoughts and feelings, successful actions. This has always been, generally, the privilege of those who are supported by everything around them to make it so. We all feel good when things are going our way (though with some variation on what that looks like – see above about PTSD). When this is taken as the normal standard, and all bodily variation taken as related to health, we wind up with the notion of mental disorders.
Replacing healthy normality with creative hopelessness
Instead, ACT proposes “creative hopelessness.” This idea is founded in principles of evolution. Variation is the expected method for adapting to a constantly changing world. We each have different styles and different strategies. By building those, we have not built others, which may become weaknesses. Like the selection of different types of resources in some board games. If we look at our experiences not as illness or abnormality, but instead as information about ourselves in the world, we can use our capacity for change and growth. Hopelessness is using evolution to flip the assumption that negative feelings are illness on its head, and instead using them as a tool. And creative is a more exciting version of adaptive.
We can use the tools evolution has given us, to discover new ways to deal with the suffering that is our inheritance. These tools help us strive to create better communities for ourselves and each other. (Though, remember variation in what that looks like to different people!) Striving to make a better life: what is more normal than that?