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Illusion and reality: psychology and normality

Updated: Dec 17, 2019


Normality is the great neurosis of civilisation. Tom Robbins

Public interest in psychology has been increasing in the recent decades directly affecting its development. Brysbaert and Rastle (2013) state the tendency of “psychologisation of society”: psychology hugely impacts society, is one of the most popular study areas, both major and minor, and shows a tremendous amount of publications.

“More than ever before, here is a growing appreciation for psychologists’ expertise, including the research they do to illuminate human behaviour and the treatment and insights they provide to improve health and well-being” (Monitor on Psychology, 2017, p.43).

Research on the brain, diversity, mindfulness, emotional, and somatic awareness is booming on the one hand, so as overregulation and profit making of psychology by pharmaceutical business are ever increasing. In addition, contemporary society is nurturing behavioural and well-being imbalance giving fertile soil to the development of disorders. In this context, normality is becoming a critical notion in psychology as the latter, being a social science, has responsibility to contribute to human well-being. At the same time, the notion of normality is facing a huge potential and risk of misuse for the purpose of profit.

Normality is an illusion: what is normal for the spider is chaos for the fly.

Morticia Addams

Public interest in psychology has always been high. On the one hand, due to the increased research of the last centuries and internet as a powerful multiplier of scientific data publication, and on the other hand, due to increased psychological awareness and issues of society, public interest in psychology is being nurtured and remains high. As Browning (1980, pp.20–21) writes:

“scientific findings seldom remain as simply cold, neutral and impersonal facts, but get interpreted. Some psychological data and theories are so stimulating to the human imagination that the general population reworks them and assigns them a broader meaning”.

In such a way, psychology can become culture, which can be identified as a system of symbols and norms that defines and guides a society (Browning, 1980). He identifies four contemporary cultures of psychology: the culture of detachment (represented by orthodox psychoanalysis and Freud), the culture of joy (represented by humanistic psychology), the culture of control (i.e. psychology of Skinner), and the culture of care (i.e. Erikson, Fromm, May). Psychology can prescribe the perception of what is right and wrong to the society, in the understanding of culture as a system of symbols and norms that defines and guides a society and the individuals within it.

There is no sole definition of normality. Society and culture influence perceptions of normality differently in different times with their variable norms, issues, and partly values. As Browning states, “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” (Browning, 1980, p.22). As cited by Browning (1980), Offer and Sabshin have identified four distinct styles in psychological literature which define health and normality. There is normality as absence of disease, as utopia, average, and transactional systems. Normality as absence of disease is a medical-psychiatric understanding differentiating normality and pathology. Normality as average is linked to research and measurement through psychological testing. More humanistic and less measure focused, society and culture sensitive styles are normality as utopia and normality as transactional systems. Normality as utopia refers to the idea that it is a horizon-like and unachievable state of how a person should ideally be. Normality as transactional systems is connected with systems-theory and relational approach to the behavioural sciences and amplifies the importance of taking into consideration the greater field of person, as what is normal to one person in certain times and circumstances would be considered as abnormal to the completely different broader system or field.

Clinical psychology and psychiatry have strongly influenced understanding of normality in society. Myers (2011) writes about understanding of normality in analytical psychology. He states that for Jung, normality was finding one’s need being met in the situations of daily life, whereas Foucault criticized the use of normality in mainstream psychiatry, psychology and psychoanalysis. He further mentions an interesting implication of Jung’s definition of normality in the relationship between personal / individual and collective awareness, that increase of one leads to the increase of the other and vice versa. At the end, finding a balance is important for the perception of normality and well-being, and from the perspective of analytical psychology, the goal is to help find balance between individual and collective awareness.

In its Constitution, the World Health Organisation (WHO) describes health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948, p.100). With regard to what is well-being, Dodge, Daly, Huyton, and Sanders (2012) state that defining it is a challenge. There were historically two main approaches to the definition of well-being: hedonic, associated with happiness in life, and eudaimonic, linked to positive psychological functioning and human development. At the end, most researchers conclude multidimensionality of well-being. Dodge et al. (2012) present a concept which refines a lot of different researches on well-being. This concept includes a new definition of well-being as a balance point between an individual’s psychological, social and physical resources and the psychological, social, and physical challenges faced.

Being influenced by psychiatry, definitions of normality are directly linked to the definitions 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 (i.e. DSM-IV or DSM-5). In its various criteria of the definitions of mental disorders, DSM refers to:

“a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual; to the distress, disability, or a significantly increased risk of suffering death, pain, disability, or an important loss of freedom, not linked to an only one particular event; to behavioural, psychological or biological dysfunction” (Stein et al., 2010, pp.1759–1765).

On the one hand, 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 (van Praag, 2000 as cited by Stein et al., PMC, 2010). As Appignanesi (2011) states, 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.”

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 and critical understanding of how mental health professions and notion of normality have been perceived and why. 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 behavioural 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” (Fadul, 2015, p.138), Menninger was invited to lead the Army Medical Corps psychiatric division, and worked there together with a professor of psychiatry Adolf Meyer, who understood mental illness as individual’s incapacity to adapt to their environment caused by their life history (Tone, 2008). 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 (Fadul, 2015), which was adapted by the 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 published the sixth revision of the International Statistical Classification of Diseases (ICD), which included the section on mental disorders for the first time“ (Fadul, 2015, p.138).

The DSM became increasingly popular and used by the mental health professionals worldwide. The first editions of the DSM were strongly influenced by the psychodynamic and psychoanalytic traditions, same as the APA. The main idea was to understand the meaning of the symptom and dig to its cause (Tone, 2008). Later editions, beginning with the DSM-III, were impacted rather by the 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 (Tone, 2008). The latest edition, DSM-5, lists around 300 disorders (Begley, 2013). The first was highly influenced by the military, the recent editions have ties to pharmaceutical businesses (Cosgrove, Krimsky, Vijayaraghavan, & Schneider, 2006). Throughout the DSM development history, it could not entirely prove to be non-judgemental. As an example, the first editions discriminated homosexuality labelling it as a “sociopathic personality disturbance” (Fadul, 2015, p.138), whereas the latter editions overuse the notion of anxiety, invent more and more disorders, and are infamous for having too interdependent ties to pharmaceutical businesses.

Psychiatry, as a dominating science in treating mental disorders, was criticized as having the aim to control and discipline patients and not to help them (Brysbaert & Rastle, 2013). But the influence of business and politics on the perception of normality has been strong not just 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 concentration camps with psychotropic drugs and lobotomy until dissidents’ will and personality was definitively broken (Zajicek, 2009). Psychoanalysis and psychotherapies were ideologically criticised and experienced strong disaffirmation as methods that encouraged critical and individualistic thinking. Worldwide, the underlying thrive for power and nurturing of ego of those who hold the power have been playing a key role in exploitation of psychology and psychiatry.

Normality is an illusion, created by a conservative culture to control behaviour.

Merlyn Gabriel Miller

The notion of ‘normality’ stays controversial in psychological and behavioural well-being. There is a risk of labelling everything as abnormal that does not fit into the current norms, which, in their turn, are influenced by politics and business. The developments of recent decades have led to “medicalization of normality” by the mental illness industry and pharmaceutical business (Appignanesi, 2011). The need of pharmaceutical business for unstoppable growth and ever increasing sales volumes results into their subsequently growing need of market in their products, which can be achieved if there will be more officially defined disorders and their medications. This has created an issue of overregulation and ethically questionable practices of financial collaboration between medical and mental health practitioners and pharmaceutical corporations, which are legally fully conform in some countries. At the same time, as a balance act, critical public interest in the development of psychology is ever increasing, as is the research and application of humanistic implications and approaches in psychology. Business and financial pressure will obviously keep on increasing and has to be challenged by reviewing the entire economic system which is based on exponential growth. Psychology can play a key role in balancing the extremes if it stays independent enough being cautious about attempts of its exploitation for profit or other manipulative goals.

References

Appignanesi, L. (2011, September 6). The mental illness industry is medicalising normality. The Guardian. Retrieved from https://www.theguardian.com/commentisfree/2011/sep/06/mental-illness-medicalising-normality

Begley, S. (2013, July 17). DSM-5: Psychiatrists’ ‘Bible’ Finally Unveiled. The Huffington Post. Retrieved from https://www.huffingtonpost.com/2013/05/17/dsm-5-unveiled-changes-disorders-_n_3290212.html

Browning, D. (1980). Pluralism and Personality: William James and Some Contemporary Cultures of Psychology. Lewisburg, PA: Bucknell University Press

Brysbaert, M. & Rastle, K. (2013). Historical and conceptual issues in psychology. Harlow, UK: Pearson.

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

Dodge, R., Daly, A., Huyton, J., & Sanders, L. (2012). The challenge of defining wellbeing. International Journal of Wellbeing, 2(3) 222–235. doi: 10.5502/ijw.v2i3.4

Fadul, J. (2015). Encyclopedia of Theory & Practice in Psychotherapy & Counseling. Raleigh, NC: Lulu Press.

Monitor on Psychology (2017, November). 10 Trends to Watch in Psychology. Washington DC: The American Psychological Association.

Myers, S. (2011). Normality in Analytical Psychology. Behavioral Sciences, 3(4) 647–661. doi: 10.3390/bs3040647

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

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

The World Health Organization (1948). Constitution of WHO: principles. Retrieved from http://www.who.int/about/mission/en/

Zajicek, B. (2009). Scientific psychiatry in Stalin’s Soviet Union: The politics of modern medicine and the struggle to define ‘Pavlovian’ psychiatry, 1939–1953. Retrieved from https://media.proquest.com/media/pq/classic/doc/1860999961/fmt/ai/rep/NPDF?_s=YKQ5H1u3HsO7sP33%2Fb%2B0G0ezoH4%3D

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