D: What qualifies as normal versus abnormal when it comes to the mental health or behavior of an individual? This information explores the flaws in our definitions of mental illness.
“I worry about the line we draw between people who are OK and people who aren’t.” -Winnie Dunn, Chair of the Department of Occupational Therapy Education at the University of Kansas and author of Living Sensationally (Wallis, 2007)
Even when checkmarks are followed precisely in order to accurately assess a client’s behavioral symptoms, this doesn’t mean the diagnosis is correct. There could be many different reasons for those boxes to be checked, many of which have nothing to do with mental illness.
Psychiatrist Arthur Kleinman (1988, p. 11) gives an example of this problem by illustrating how skewed perspectives can lead to an errant diagnosis.
Let’s say you took ten American psychiatrists, all trained in similar ways and armed with the same diagnostic tools, and had them assess an American Indian who was mourning the recent death of a spouse. In this state of mind, the man reports hearing his dead wife’s voice calling out to him from the spirit world.
Nine out of ten doctors might concur that the patient reported hearing the voice of a dead person, a respectable 90% accuracy rate. Nine out of ten might also agree that this is a symptom of psychosis. Is it really valid to say that hearing voices under this condition is a sign of psychosis? After all, American Indians believe it is normal to hear the voices of the dead as they pass into the spirit world. This idea is deeply ingrained into their culture. In fact, among these tribes it might be seen as abnormal +not+ to hear the voices of your dead loved ones after they passed. Nor is this phenomenon restricted to native Americans–Around 3/4 of bereaved adults will say they have heard, seen, or otherwise sensed their departed partners. (Bower, 4-7-2012)
Expanding on this concept further, each person might have a different definition of what “hearing voices” means. After all, each and every one of us is running dialogue through our heads and carrying on conversations with ourselves on a daily basis. Does this qualify as hearing voices? What if for some reason this internal dialogue is perceived as more auditory to one person than another. This might happen because of slight differences in brain functioning or sensory systems that have nothing to do with being crazy. In fact, studies have found that about 10-15% of us will sometimes hear voices or have moments where we engage in magical thinking without being the least bit distressed. (Jabr, 2012; Bower, 4-7-2012) There is reliability in the symptoms for diagnosis, but that doesn’t mean the condition being diagnosed is valid.
Or take something like schizophrenia. African American men are more likely to be misdiagnosed with schizophrenia, and this is largely due to the fact that they’re less trusting of the government and more paranoid in general, which leads to more symptom boxes being checked. But is this really a sign of mental illness? I wouldn’t trust the U.S. government to lick a postage stamp, and it’s not because I’m schizophrenic, it’s because every day I investigate stories revolving around the shady and downright sinister things they do. Some of the things the United States has been caught doing in the past (programs to sterilize populations, secret overseas torture prisons, assassination of civil rights leaders, funding terrorists, etc.) might sound like a schizophrenics craziness had they not been documented. And all the horrible things they’re doing today are classified – kept under lock and seal for 100 years so that by the time anyone knows about them, it’s already a quaint talking point in ancient history.
Personally, given their history, I think it’s far more delusional to trust ANY government to do the right thing than it is to be suspicious of them. And Black men have plenty of reasons to be more distrustful of police or government or their environment in general. So what a clinician might see as a sign of mental illness is really just a product of the environment one inhabits. This is a crucial point to keep in mind, since children, too, are masters at adapting to their environment and changing their behavior accordingly.
Who Gets To Define Normal?
“What kind of country will we have if we attempt to ‘cure’ various odd behaviors and quirky traits – qualities that can sometimes look like symptoms of a coming illness and at other times look like evidence of a lively mind?”
– John Cloud (6-22-2009, p. 74)
All of these issues are rooted in a much deeper problem: The push to define a range of “normal” behavior while suggesting anyone outside of that range is in need of corrective action. Campaigns to define normal are almost always misguided attempts to push conformity masquerading as a helping hand. There’s a great deal of danger involved whenever experts (or anyone else) tries to delineate a script for what constitutes normal thoughts or behavior, because it usually mean grinding down many an odd-shaped peg in order to stuff them into round holes. Helping someone who’s struggling is one thing. Making people feel abnormal for their differences is quite another.
Historian Michael Foucault has argued that the history of psychiatry and the constitution of the normal/abnormal dichotomy is really just a history of state control over bodies and human affairs. We can see evidence of this in past practices. The fact that homosexuality was once considered a mental illness is one such example. ADHD is another – the condition owes its very existence to our educational bureaucracy. It’s hard to fathom the construct of ADHD in an indigenous setting. The contrasts in the “disorder” only begin to show in light of the government’s need to subject children to rigorous amounts of rote education.
The normal/abnormal dichotomy can be pushed to absurd degrees in everyday practice. In his book Doctoring the Mind, Richard Bentall describes one case in which a man, ‘Andrew,’ was brought into a facility for psychiatric evaluation. Presumably in an attempt to find behaviors that fit the diagnosis, staff at the facility focused on the fact that Andrew seemed “excessively polite.” One of the reasons for keeping him in the institution then became to work out whether this politeness was “part of his normal personality or his illness.” (Bentall, 2009)
Different Isn’t Bad: The Positive Aspect of Differential Thinking
It’s a little bit puzzling why human beings struggle so much with diversity. In our personal lives we like different things to eat, different clothes to wear, different flavors of ice cream, different sexual experiences with different partners, different colors and different scenery to gaze upon. But when it comes to each other, we’re only comfortable with everyone being some degree of the same. It’s an attitude that gets us in trouble.
Life itself is built upon the principle of diversity. Think about the genome. It’s good to have diversity in genetics, which is why it’s not a good idea to inbreed for more than one generation. When two people with similar genomes breed, they lose out on the chance for genetic diversity. This diversity provides flexibility and variability. It means the opportunity to combine the best from two different worlds. What many people don’t realize is that this principle of genetics is true to all of life. It’s true in caring for children (the more actively involved caretakers a child has the more they are protected against any one parent’s particularly pathology or bad habits); and it’s also true in society (the more diversity exists in a group, the more creative and adaptive that group becomes).
Diversity can be equally beneficial when it comes to psychology and behavior. Steve Silberman, author of Neurotribes, gives a good analogy when he compares mental diversity to a computer’s operating system, saying that “just because a computer isn’t running windows does not mean it’s broken.” And just because a child’s behavior may seem off or unusual, that doesn’t mean they are disturbed. Many of the traits society seeks to treat (a wandering mind, introversion, hyperness, restlessness, disinterest in traditional learning or typical activities, unusual optimism, unusual pessimism, and so on) can be seen as flaws or weaknesses in one area, but strengths in another.
Astrophysicist Mathew H. Schneps touches upon this subject in writing about his own struggles with dyslexia: “In physics we know that heat engines such as those in automobiles or power systems, can only transform energy into mechanical work by making use of differences in temperature, hot versus cold. Nothing productive takes place when everything is the same. Neurological differences similarly drive the engine of society and create the contrasts between hot and cold that generate new ideas. Impairments in one area can lead to advantages in others, and it is these differences that drive progress.” (Scheps, 2015)
For the best illustration of this principle we can look to none other than Einstein himself. As a child, Albert Einstein was a lad whom today we would label as “developmentally delayed” or possibly even borderline retarded. He was slow to walk, slow to talk…he didn’t even start communicating through speech until age three or four. He sludged his way through grade school, irritated by the drudgery work and teachers who seemed more like drill sergeants. “I preferred to endure all sorts of punishment rather than learn to gabble by rote,” he recalls. (Sagan, 1979)
Things didn’t get much better in the later grades. As Carl Sagan recounts, “Not one of this teachers seems to have recognized his talents. At the Munich Gymnasium, the city’s leading secondary school, one of the teachers told him, ‘You’ll never amount to anything, Einstein.’ At age fifteen it was strongly suggested that he leave school. The teacher observed, ‘Your very presence spoils the respect of the class for me.’ He accepted this suggestion with gusto and spent many months wandering through Northern Italy, a high school dropout in the 1890s.” (ibid, p. 29): 24)
He applied to the Federal Institute of Technology in Zurich for college, but failed the entrance examination. After enrolling himself in Swiss high school to catch up, he made it the following year. Yet he remained a mediocre student, graduating only because his close friend Marcel Grossman shared his notes with Einstein. Einstein says the experience of cramming for final exams “had such a deterring effect on me that…I found the consideration of any scientific problem distasteful to me for an entire year… It is little short of a miracle that modern methods of instruction have not already completely strangled the holy curiosity of inquiry…” (ibid, p. 25) It’s enough to make you wonder how many other Einstein’s out there might have gotten discouraged and given up.
Of course we all know how it turned out in the end. But how could so many people be so wrong about Einstein? Is it even possible to be more wrong than that teacher who predicted he would never amount to anything? Therapists can be every bit as wrong in their own assessments of children.
Einstein was certainly a peg that didn’t fit well within the cogs of traditional social structure. But that hardly meant he was broken. His mind didn’t operate in the same way as everyone else, and that turned out to be a wonderful thing. But imagine what might have happened if Einstein had spent his childhood doped up on Ritalin. What if they had succeeded in hammering away at his eccentricities until he started thinking and behaving just like everyone else? Would he still have become the Einstein we know and love today?
His story provides a sobering reality check, and it’s something we all should remember before getting too carried away with our preoccupations about “normal.”