Normality: The Road to Nowhere

“Normality is the great neurosis of civilization.” – Tom Robbins

There is hardly a word that comes up more often during the current pandemic than “normality.” There are tears of longing for normality, calls for returning to normality, hopes of regaining normality, and dreams of gaining “the new normal.” The everyday stress of life and busyness that were not giving us enough time to stop and think are suddenly being missed, we clutch at the straws of a once-hated routine in order to feel a sense of control.

Life came to a standstill and gave us a much-needed pause, but we seem to be overwhelmed by this gift: it provokes critical thinking about the norms and values we are used to, social injustice and inequalities. In the twinkling of an eye, we found ourselves dealing with the same fears that have always been intrusive companions of those among us who are perceived as “not normal”: discriminated, different and those suffering from a mental condition. It makes us reevaluate what normality means. 

Let’s look at normality from the psychological point of view. There is no sole definition of normality. Society and culture influence perception of normality differently in different times with their variable norms, issues, and values. As Browning wrote, “what is normal and healthy is one of the main issues psychology is facing today, and since it is an issue of psychology, it is an issue of the society, too” [3, p.22]. Psychology can prescribe the perception of what is right and wrong, normal and abnormal to the society, and thus bears a huge social responsibility.

Clinical psychology and psychiatry have strongly influenced understanding of normality in society. This understanding has been experiencing the tendency to pathologization and is linked to the increasing number of mental disorders. There are two main classification systems of mental disorders worldwide: The International Classification of Diseases (ICD) developed by the WHO since 1949 and the Diagnostic and Statistical Manual of Mental Disorders (DSM) developed by the American Psychiatric Association (APA) since 1952. Both classifications have been constantly updated throughout decades. 

On the one hand, the DSM states that it provides a direction to the definition of mental disorders and not a definition as such, as no definition can specify precise boundaries for mental disorder. But on the other hand, its direction seems to be quite dominant, and it is being criticized for creating too many diagnostic categories [7; 9]. The DSM “has spawned more and more diagnostic categories, ‘inventing’ disorders along the way and radically reducing the range of what can be construed as normal or sane.” [1]

The influence of external factors on the definition of normality, classification of mental disorders and development of psychology is not new nor solely a contemporary feature. Knowing the historical implications on the classifications provides a deeper understanding of the perception of normality and the current state of the related issues. The foundations of the DSM were laid by William C. Menninger, a famous American psychiatrist, who had worked together with his father and brother Karl, both psychiatrists as well, in their own practice and set up a Menninger Foundation, a pioneer in the field of diagnosing and treatment of behavioral disorders. In the course of the World War II, which saw the “large-scale involvement of the US psychiatrists in the selection, processing, and treatment of soldiers” [6, p.138], Menninger was invited to lead the Army Medical Corps psychiatric division, and worked there together with Adolf Meyer, professor of psychiatry, who understood mental illness as individual’s incapacity to adapt to their environment caused by their life history [8]. Reflecting its high social, economic and political implications, anxiety was the main characteristic of psychoneurotic disorders. Menninger, who ended up as Brigadier General, developed a new classification scheme called Medical 203 [6], which was adapted by the American Psychological Association (APA) and published 1952 as the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its first edition. During the same timeline and impacted by the war as well, the WHO issued the sixth version of the International Statistical Classification of Diseases (ICD): the new section was the one on mental disorders [6].

The first editions of the DSM were strongly influenced by the psychodynamic and psychoanalytic traditions. The main idea was to understand the meaning of the symptom and dig to its cause [8]. Later editions, beginning with the DSM-III, were impacted rather by biological psychiatry, descriptive psychopathology and clinical field tests, and mental illnesses started to be defined by their symptoms rather than by their causes. DSM became the world’s leading diagnostic reference tool. The first edition of the DSM listed 106 disorders [8]. The latest edition, DSM-5, lists around 300 disorders [2]. The first was influenced by the military, the recent editions have ties to pharmaceutical businesses [5]. Throughout the DSM development history, it could not entirely prove to be non-judgmental. As an example, the first editions discriminated homosexuality labelling it as a “sociopathic personality disturbance” [6, p.138], whereas the latter editions pathologized anxiety and invented more and more disorders.

Psychiatry, as a dominating science in treating mental disorders, was criticized as having the aim to control and discipline patients instead of helping them [4]. The influence of business and politics on the perception of normality has been strong not only in the US. In the former Soviet Union, the entire science of psychiatry and psychology, although the latter was quite underdeveloped, was aggressively misused to silence those, who did not agree with the dictatorship of the state regime and ideology. Discrimination of “abnormal” was highly widespread, and the dissidents were “treated” by psychiatrists in specialized closed hospitals, prisons and “behavioral” camps with psychotropic drugs and lobotomy until the dissidents’ will and personality was definitively broken [10]. Psychoanalysis and psychotherapies were ideologically criticized and experienced strong disaffirmation as methods that encouraged critical and individualistic thinking. 

Worldwide, the underlying will to power and money, and thus for control, have been playing a key role in exploitation of psychology and psychiatry. 

The notion of “normality” stays controversial. There is a risk of labeling everything as abnormal that does not fit into the current norms, which, in their turn, are influenced by the power and financial interests. The development of recent decades has led to “medicalization of normality” [1]. Business and financial pressure will obviously keep on increasing and has to be challenged along with the entire economic and healthcare systems, which are anything but normal. In longing for this abnormal but familiar normal, we fall into the delusion of regaining control. Psychology can play a key role in balancing the extremes if it stays independent enough, being cautious about attempts at its exploitation and manipulation for profit, power and control. So far, it has not played this role confidently enough. Now it has a once-in-a-lifetime chance to change fundamentally. We, too, have this chance.

 

References

1. Appignanesi, L. (2011, September 6). The mental illness industry is medicalising normality. The Guardian. https://ift.tt/2VuBwlk
2. Begley, S. (2013, July 17). DSM-5: Psychiatrists’ ‘Bible’ Finally Unveiled. The Huffington Post. https://ift.tt/34CyXSp
3. Browning, D. (1980). Pluralism and Personality: William James and Some Contemporary Cultures of Psychology. Lewisburg, PA: Bucknell University Press
4. Brysbaert, M. & Rastle, K. (2013). Historical and conceptual issues in psychology. Harlow, UK: Pearson.
5. Cosgrove, L., Krimsky, S., Vijayaraghavan, M., & Schneider, L. (2006). Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychotherapy and Psychosomatics, 75(3), 154–160. doi: 10.1159/000091772
6. Fadul, J. (2015). Encyclopedia of Theory & Practice in Psychotherapy & Counseling. Raleigh, NC: Lulu Press.
7. Stein, D., Phillips, K., Bolton, D., Fulford, K., Sadler, J., & Kendler, K. (2010). What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V. Psychological Medicine. 40(11), 1759–1765. doi: 10.1017/S0033291709992261
8. Tone, A. (2008). The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers. New York City: Basic Books. doi: 10.1353/jsh.0.0365
9. Van Praag, H. M. (2000). Nosologomania: A Disorder of Psychiatry. The World Journal of Biological Psychiatry 1(3), 151–8. doi: 10.3109/15622970009150584
10. Zajicek, B. (2009). Scientific psychiatry in Stalin’s Soviet Union: The politics of modern medicine and the struggle to define ‘Pavlovian’ psychiatry, 1939–1953. https://ift.tt/2XB1aay

from Psych Central https://ift.tt/2VyvP5F