Normal and abnormal

I mentioned yesterday how ambivalent I am when it comes to categories like normal/abnormal in terms of mental health. I think this topic is worth exploring. At a first sight, there should be no ambivalence. “Normal” / “abnormal” are supposed to be neutral terms, after all; referring only to what is common and uncommon in a certain society. It is hard to see these terms as neutral expressions, though, given how emotionally charged they can be in everyday life communication:

Somebody might claim, for example, that it is not normal to wear black all the time. As an observation, this is correct. Most people don´t wear black all the time; wearing black all the time is part of certain life styles which are definitely not the norm and often take pride in that. But in many cases I don´t feel like the person is stating an observation. I feel like the person is making a judgment on wearing black all the time. “Not normal” seems to imply “undesirable”, or “wrong and unhealthy in some way”. Therefore, if I reply that it is perfectly normal to wear black all the time, what I mean is that it is a perfectly acceptable life choice, and not unhealthy in any way.

On the other hand, a person might state that “you goths/metalheads feel so different from everyone else, but in fact you are totally normal”. Here, “normal” does not mean “acceptable”, but “average”, “boring”, “meaningless”. In a situation like this, I might want to defend myself against such an insinuation and claim that it is not “normal” at all. Many people refrain from wearing what they want to wear for fear of “what the neighbors will say”.  Emphasizing how “unusual”/”abnormal” certain aesthetic standards are can be a source of pride in certain contexts.

Alright, but that is my problem, isn´t it? I must detach myself from these prejudices; then I will be able to embrace a categorization of people in the mentally healthy and the mentally ill by orienting myself towards what is standard behavior in my culture. No, I don´t think so. What, for example, if a therapist decided that I am mentally ill – based on the fact that I wear black all the time and that this is not the norm in the culture I live in? Most people would agree this is controversial at the very least. And why? “Because it is nobody´s business what color my clothes are, that´s why!”

On a more reflective level, I can additionally argue that said therapist would have to explain why my fashion style should be relevant for evaluating my mental health in the first place. The likely outcome is that he has made certain assumptions regarding the meaning the color or my style in general has for me, and that this meaning is somehow related to behavior more generally acknowledged as “problematic” or “unhealthy”. He could argue that I want to express “anger towards society”, or my “disdain for society”; just like he might argue that somebody who always wears neon green light bulbs on his head “is out for attention”. So, let us assume for a moment that these traits (anger, disdain, attention-seeking) are really “abnormal” in the sense of uncommon. Then, in order to not be labeled mentally ill for wearing black, I have to prove that I don´t wear black in order to express my anger/disdain towards society? Or does the therapist have to prove that I do so? Either way, even “normal” / “abnormal” as neutral terms have the potential to place unusual life styles at a disadvantage in the sense that they are likely to be stigmatized as an expression of a mental illness.

Why is that so? Because mental health professionals are still fairly free in which traits they include in their evaluation of their patients. Wearing only black is uncommon. Naming spinach as your favorite meal is uncommon. It could be a sign of masochism, mind you… Well, fetishes are more or less uncommon, too, and they get stigmatized a lot. What I´m getting at is: There are a lot of potentially uncommon features in every patient. And it is not a coincidence which of these features are included into the evaluation of his mental health and which aren´t. It is down to the professional´s…preconceptions, if not prejudices. And that´s problematic, because now “normal”/”abnormal”, despite their apparent neutrality, can be used to guise “evaluations” which are actually judgments – judgments based on the professional´s personal value system. While the question whether a trait is normal or not may be strictly objectified by determining its statistical prevalence among the population, the question which traits are relevant for a mental health evaluation in the first place appears to be highly subjective – thus opening the door for judgments, moral values, personal opinions and, yes, a potential stigmatization of subcultures and minorities.

Why do I still believe, though, that ideas of “normal”/”abnormal” and “healthy”/”unhealthy” can be useful? I already explained a bit of that yesterday, but now I´ll go into detail. I think it was Freud who said that psychoanalysis could only cure neurotic/hysterical misery, and not ordinary misery, that is, normal unhappiness. Therefore, if you are unhappy, there lies a certain hope in your unhappiness being abnormal: It is potentially curable.  Imagine you are depressive and somebody tells you that “it is normal that life is not all sunshine and unicorns” or something like that. If your depression is labeled as normal unhappiness, it seems to confirm that you will have to suffer like that for the rest of your life – and this idea is cruel enough for you to want to end it fairly quickly. Being told such a thing can be fairly invalidating, actually. It can feel like being told to “stop whining”, “shut up”, because “we don´t care”, or “you don´t deserve to feel better”. In turn, insisting that one´s suffering is not normal is also a way of protesting this suffering, and attitudes that belittle the suffering. I should not have to feel this way. I deserve to feel better.

So what else can psychiatric classifications like “normal”/”abnormal” be used for? For validation! One might expect that it is validating to be told one is normal, but this is not necessarily the case. If a professional validates that your suffering is abnormal, it might be a huge relief. It means that you are not a loser, not a whiner, and not a prisoner of a hellish world everybody else can for some reason cope with or even thrive in.  Being told one is mentally ill can be validating in some contexts. That validation can only work, though, if the patient can rely on the validity of the criteria for what is and isn´t ill. Therefore, in order to feel redeemed by the fact that what you have is an illness and not a character flaw, you need to trust the professionals´ evaluations – but, unfortunately, this also puts you at the mercy of their possible judgments.

 

Related Posts:

Dr. Psych(o) – the weird psychiatrist

The nutjob among the neurotics – a psychology lecture through the eyes of a former mental health patient, part II 

Neither here nor there – on having mental health issues, but no real diagnosis

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