What is Normal?

Psychologists, psychiatrists, and other mental health professionals have pretty well cornered the market on abnormal. It has been defined and codified in a dizzying number of ways and indeed, each edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published between 1952 and 2014 has added dozens of new mental illnesses. These diagnostic labels are used to categorize symptoms that are outside the bounds of normal human affect, cognition, and behaviour and there is no doubt that these different ways of classifying abnormality carry immense weight for individuals and society.

But what does normal*  look like? Is it the absence of mental illness? Is it perfect mental health? Is it feeling great all the time, or merely good enough? For that matter what is abnormal? What separates normal states of distress from mental health disorders? Indeed, these questions form the basis for all study of human behaviour. 

During my training I learned that one way of defining mental disorder was through the concept of 'harmful dysfunction'. Wakefield (1992) used this term in the following way: 'harmful' can be considered a value judgment referring to the consequences that the person bears because of the dysfunction and that are deemed negative by sociocultural standards. 'Dysfunction' is a scientific term based in evolutionary biology that refers to the failure of an internal mechanism to perform a natural function for which it was designed. This latter portion of Wakefield's definition has been criticized for being vague, difficult or impossible to assess, and frankly unnecessary.   

A more practical approach to defining mental disorder draws upon concepts of distress, disability, and 'expectable response'. For instance, if it does not cause significant distress, and does not interfere with social, occupational, or other important areas of functioning, it is not a mental disorder. Likewise if it is an expectable response to a particular event within a culture, it is not a mental disorder. So then, is the absence of these criteria the definition of normality? Does a lack of distress or disability really sum up the complexity of normal human emotional function? Interestingly, I was not taught a definition of what 'normal' mental health looked like. So I decided to create my own. 

So, here goes: normal  is being more or less aware of (and in control of) thoughts, feelings, and behaviours, and not being particularly distressed by them. Of course, no one is ever fully aware of each and every one of their thoughts, feelings, and actions. However, normal means having a reasonable access to these features of human consciousness and the ability to identify a continuity to our mental and behavioural experience. Similarly, though we all feel out of control sometimes, people with average mental health feel more like drivers than they do passengers when it comes to their mental experiences and personal actions. Expressions of emotion are not typically random, overwhelming, or frightening. Thoughts are generally not intrusive or disturbing. Behaviours are not usually compulsively repeated, and difficult or impossible to control.

Normal involves the use of healthy (or at least neutral) ways of coping with stress and other problems that are a part of everyday life. When stress (i.e., change - good or bad) builds and our personal resources are drawn down, how do we recharge? Normal means drawing on inner resources and the use of various forms of mental and physical relaxation, socialization and support seeking, and leisure activities to re-energize. Of course, everyone is drawn to unhealthy ways of coping with stress at one time or another: alcohol or drug use, avoidance, blame or otherwise trying to stay afloat by dragging others down. Individuals with compromised mental health may have fewer inner resources to draw upon and may feel locked into these more passive approaches to solving problems of everyday living.   

Finally, normal tends to be associated with reasonably healthy relationships with oneself and with others. A healthy relationship to self can be characterized by a self-image that is more often neutral or positive than it is negative, with a level of trust in oneself, and reasonably firm values and convictions. Healthy relationships with others are never ever perfect, but they do tend to involve some degree of personal boundaries, a mutual respect, and reciprocal benefit. 

So, what is normal? To me, normal is feeling good enough, most of the time. It is definitely not feeling great all the time but it is more than the absence of mental disorder. Normal as feeling good enough most of the time recognizes that mental health is a dynamic process and not a static ideal for which to strive. It recognizes that average people can experience significant declines and improvements in their mental health. Which is why mental health exists in the domain of the everyday, whether we care to admit it or not. 

 

*I use the term normal in the psychological sense (i.e., approximately average) and not corresponding to any particular standard or expectation that might be implied by its use.