What is normal?

Society takes it as a given. We teach it implicitly in psychology degrees in terms of our unquestioning acceptance of psychiatric diagnostic categories. Like porn, we just know it when we see it. The mental health charities are even trying to educate us to spot it when it goes wonky.

But what do we mean by ‘normal’?

Normal is a statistical concept that is in reference to the mean and standard deviations. If you are one SD from the norm you are less typical, two and you’re definitely not typical, three and you’re just plain weird.

We might be able to make some kind of reasonable claim about normal in reference to some physiological factors, like weight, or population incidences of disease, but what does it mean in terms of behaviour? Thoughts? Feelings?

Is there actually any evidence to it?

And who is making this judgement? Who decides what is ‘normal’ and ‘abnormal’?

In psychiatric diagnostic categories, the whole thing is based on abnormality. Of course, you say, why would it be otherwise? But if you have textbooks and handbooks telling you what is abnormal why don’t we have one that actually tells us explicitly what ‘normal’ behaviour is? I suppose the burning question there is ‘is there any money in it?’ and given that the majority of clinicians involved in the new DSM 5 have had funding from big pharma I suspect that such a textbook is unlikely to arrive soon.

But, I’m digressing (is this normal?).

When psychiatrists make a diagnosis of abnormal behaviour they are not making a medical judgment. There is very little evidence for a biological cause of abnormal behaviour, so given this evidence, it can’t be a medical judgement. But they are making a moral one. They are telling you, and us, what is acceptable and not acceptable behaviour. They are telling us what behaviours will be tolerated in society.

But are they qualified to make such a decision? If you think that psychological illnesses are medical diseases with underlying disease processes at work, then they clearly are.

But what if the causes are psychological or sociological or even spiritual?

What makes psychiatrists so qualified to make moral judgments on us?

The evidence suggests that clinicians – both psychiatric and medical – are woefully out of touch with the general populations waynof thinking and behaving. For example, they are likely to be atheists, but their clients are likely not to be. Belief in the paranormal is rampant in society despite science telling us that there is little evidence to support these thoughts. Medical doctor’s have higher drug and alcohol problems than the general population. They are more educated, richer, ambitious, male, married, white and western. Clearly, their view of the world is very different to the rest of us, especially given that psychiatric service users are likely to be poor, socially isolated, have family problems and a trauma history, and less educated.

Isn’t it not possible that psychiatrists, and even psychologists, view of what is ‘abnormal’ behaviour is not, in fact, correct or realistic?

For example, up to 20% of the population have had paranoid thoughts serious enough that if they were under the care of a psychiatrist they would probably get a diagnostic label. Something like 65% of the population think that you can’t trust anyone, ever. Around 10% of the population regularly hear voices, and 75% have heard a voice at least once in their life.

With hand on DSM, this suggests that the loonies are everywhere.

Psychiatry is interested in whether you have these unusual experiences, and only interested in this. Yet, clearly, the number of people having these unusual experiences is nowhere close to the number of people accessing mental health services.

Something doesn’t add up.

These people are having regular abnormal experiences yet they aren’t seeking help for it. Is it an educational problem? Are there untold millions of people suffering from serious psychiatric disorders that we don’t know about? The Tory minister for Health should be shaking in his boots around now.

The reason for this discrepancy is simple. These people are not disturbed or distressed by their experiences. They are not preoccupied by them. It doesn’t interfere with their daily lives. They are not suffering.

So, should the primary diagnostic criteria not be ‘does this experience distress you’ rather than ‘do you hear a voice?’

I propose, m’lord, that we dump labels and categories based on an assumption of normality that is not valid, not reliable, and doesn’t reflect real life behaviour.

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