That behaviour is not normal! But how do you prove it?
This piece relates to Dave’s piece on delusions and will be relevant to anyone who is publicly ‘into weird stuff’.
In examining the implications of defining one act as abnormal compared to another there are a multitude of ethical and practical problems. Firstly, (assuming judgments are necessary at all) who judges? And secondly, who judges the judges? Someone initially decides who is able to give an objective definition of normality; and must then decide the judges are indeed objective. In the context of this essay the judges are legal and medical experts who judge themselves. In attributing values to behaviour there is a considerable grey area. Statistically abnormal behaviour occurs infrequently, otherwise it wouldn’t be STATISTICALLY abnormal. No value judgment is made between the rare behaviours of a serial killer who uses an unusual weapon and a unique pioneering experimental surgeon, they are both abnormal so far as the numbers go. Deviation from statistical norms allows acceptability, but is still based around morality.
The late Stuart Sutherland, a psychology professor who'd also been mentally ill, had pointed out to him the folly of attempting to define abnormality at all, by a psychiatrist who said that anyone who wrote on that subject confidently would need psychiatric help. With that caveat....
One approach is to identify normality first: Jahoda (an influential 1950s psychologist) listed 8 factors:
The main critiques of Jahoda's table are that it's way too idealistic; the majority of mankind is abnormal compared to the above, but as already stated, majorities cannot be abnormal, statistically.
Normality varies with time, culture and geography; it's more likely that a patient will be diagnosed schizophrenic in the USA than with the same symptoms in the UK. It's disconcerting that a "cure" for the diagnosis of schizophrenia could be a journey abroad. This issue of category reliability and standardisation is important; under current medical guidelines it's possible for patients with no symptoms in common to be diagnosed with the same disorder; i.e. a schizophrenic may have no symptoms that another with "the same illness" presents with. This situation doesn't exist in physical medicine; similar diagnoses have commonality of symptoms; i.e. pulse, blood count, temperature, ECG etc. Schmidt and Fonda, two more 1950s psychologists, had over 400 patients checked by different psychiatrists and found wide variances in diagnoses based on the same information. Rosenhan conducted a famous study in the 1970s where 8 sane volunteers were sent into mental hospitals under instructions to act out particular, but bogus, symptoms. Seven of these were diagnosed as schizophrenics; and it took them a while to achieve their release. Subsequently to publication of his results and the resulting discussion of the study in professional circles, Rosenhan informed one large hospital that he would be sending actors in for assessment, and asked them to assess each new patient as to likelihood of them faking their illnesses. From 193 patients in the study period, 41 were assumed false by at least one member of staff, 23 of which were assessments by one psychiatrist, and two medics assessed 19 of these. Rosenhan had sent in no actors- NONE of the patients were impostors; which casts huge doubts as to the objectivity of judgments made in the mental health field, and emphasises the power of expectation and labeling.
Abnormality is a comparison against flexible cultural norms without absolute rules; 50 years ago it would have been abnormal for a woman to be a priest, today there are many women entering the priesthood. Adrian Boshier was an anthropologist in Africa; to the natives he was a powerful and respected mystic, in touch with spirits. To white men he was a nutty scientist, regularly epileptic and to be avoided because he was weird; a vastly different perception of "normality" relating to the same person (for the rest of this fascinating and ultimately very sad story, see Lyall Watson’s ‘Lightning Bird’, link below).
Social class also affects definition: "eccentricity" in one class may be decried in a lower class. The context of behaviour is important; a child playing with toys in the home is normal; an adult playing alone with children's toys may be labeled abnormal; doubly so if this took place in the middle of a busy street, as the situation would also be inappropriate.
The great psychiatry-reform crusader Szasz believed health should only be judged biologically, pointing out that moral philosophy isn't brought to bear on physical illnesses, such as blame for catching ‘flu- and so shouldn't be aimed at "mental illness" either. Psychiatric diagnosis was often a relative moral-cultural process, not a medical one; and it has a stigma as if there were some personal blame attached. A life-threatening heart attack prompts no shame, not so mental illness. The patient becomes a bad marriage, job and credit risk; facing a double blow: disease and social stigma. Labeling is impersonal; a patient will be labeled as ‘a manic depressive’ - an object; rather than "a person with manic depression", which is dehumanising. Reinforcement of the label on a regular basis may be sufficient to create or prolong health problems.
Mental health is a matter of public ignorance and fear; in a 1993 UK Gallup survey, one-third of the sample endorsed the statement that: "the mentally ill are likely to be violent, and all murderers insane"…. (but they might have been unlucky with their sample group- see my separate article on Occult e-books; it’s not gone online at the time of writing, called ‘The non-average WoMan in the Street- anarcho-magick and street surveys’)
It has been suggested that personal distress at one's own behaviour could indicate abnormality; this links with the autonomy-control axis of Jahoda (above) however not all subjects show distress, i.e. psychotic patients without insight into feelings, or manic patients, whose grandiose behaviour may be pleasurable to them. Those considered to be dangerous to themselves and/or others (or
POTENTIALLY dangerous; another subjectivity! But one on which the UK is about to create a whole new law….) are liable to physical removal to secure hospitals for psychiatric evaluation and/or treatment. Other patients arrive voluntarily; and the means of initial assessment seem rather subjective. A visual appraisal of clothing is made, covering suitability, cleanliness, "appropriate fashion" and state of repair, plus general physical hygiene. This imposes discrimination: a patient with any illness may be unemployed, perhaps also be homeless and unable to afford clothes or washing facilities; but be mentally well. And you thought that ‘fashion police’ was a metaphor….
Similarly, deliberate vagrancy is not a mental illness. As Shakespeare said "clothes maketh not the man"… and subjective fashion can also be viewed as just another signal in the ongoing class war; oh, so you can’t afford Gucci? You’re one step nearer to the looney bin……
Only after a visual appraisal is the partly-prejudged patient talked to. The following anecdote (taken from Quantum Psychology by Robert Anton Wilson, link below) from psychiatrist Paul Watzlavick illustrates problems inherent in conversation. Dr Watzlavick, arriving at a mental hospital as a new consultant entered the administration area, and spoke to a woman he assumed was a member of staff, since she was sat at a desk:
PW (assuming his name to be in the diary in front of the woman) "I'm Watzlavick"
Woman (looking up, startled) "I didn't say you were"
PW (cautiously) "But I AM…"
Woman (very politely, while reaching for an alarm button) "Then why did you deny it?"
At this stage Watzlavick realised she'd misheard him saying, "I am NOT Slavic", and immediately assumed he was a wandering paranoid patient (unprompted denials of self-evident facts are common in paranoia. As one may expect from his surname, Watzlavick appears and sounds Slavic, which compounded the problem). Her denial made Watzlavick assume she wasn't a staff member, but a wandering paranoid who'd sneaked into the offices. His confusing assertion of what he had seemingly denied ("But I am") made him a schizophrenic in her eyes, so she tried to placate him while reaching for the alarm to call for muscular help. This exchange could have had unfortunate consequences, but Watzlavick produced some identification. That two mental health professionals show such confusion via one misheard phrase seems discouraging when you consider that it is by conversation that patients are assessed.
Action against "abnormal" persons causes immense practical problems when it conflicts with civil and legal rights (sanity is largely a legal term); psychiatric patients have been defined as those who'd broken no laws but had lost their rights, and there is gradual regression in scope of privilege of an individual as they become enveloped in the mental health system. The general rule seems to be the right of society to protection from potential harm takes precedence over individual rights.
A celebrated case of the civil rights of the "abnormal" individual versus society was that of a street person called Joyce Brown, who was compulsorily hospitalized by the State in New York in 1987 as schizophrenic. Her case was taken up by the American Civil Liberties Union, whose own psychiatrists did not diagnose her as schizophrenic. In a very ambiguous case it would seem that her removal from life on the streets was primarily for aesthetic purposes, as she frequented the streets of a plush neighbourhood, and it was ‘lowering the tone’. The argument eventually came down to her individual rights to choose a lifestyle under US constitution versus the aims of the local authority. Oh yeah, she was African-American as well as female, so she stood less of a chance in the first place….
For a long time in the UK mental patients could not vote, and the former USSR was notorious for using the mental label as a means of "losing" dissidents in asylums. It's important to differentiate abnormality from politically unwelcome acts, which attract labels as means of social control. The USSR was not alone in this; the poet Ezra Pound was imprisoned in the US for 13 years for treason (being pro-fascist) but wasn't tried due to a diagnosed incurable insanity; among his "symptoms" were his politics and habitual writing activity (of poems). It is useful to note that many "heretics" and madmen of the past have later been found to make great discoveries, such as Copernicus.
One minor abnormal act of Joyce Brown (mentioned above) was to burn welfare money given to her. Similarly, Bill Drummond and Jimmy Cauty, two "confrontational artists" (and members of the band The KLF, see link below) burned money as an artistic statement which led them to greater notoriety. The difference between Ms Brown and the two artists? She burned small sums of donated money, while they allegedly burned £1 million UK of their own money. The latter act could seem to be the more abnormal to many people; it's probably the rarer of the two. As has been observed, psychiatry is based upon white male middle class values, even if it is practiced on other groups- Joyce Brown is a poor black female street-person, Drummond and Cauty are white, rich and were already feted by middle-class art lovers.
Treatment of the abnormal person varies from incarceration to release into care of the family. In cases where there has been mis-diagnosis and drugs are prescribed there is the chance of an iatrogenic reaction; in the case of many drugs used they may simulate, or actually produce mental disorders when given to "normal" people; via their designed purpose of altering the balance of neuro-chemicals in the brain, but in this case changing a healthy state to an unbalanced one. Often these created illnesses are indistinguishable from natural disease…. And the treatment for the illness is…… keep taking the tablets…….
As an addendum: recently a fashion for "designer" mental health drugs, such as "Prozac" has arisen; which is now seemingly being abused by GPs in the USA. Many people, initially Americans but the trend has spread, are given drugs to effect minor mood elevations or "improve personality", where there was previously no significant mental problem, to; in the words of the marketing slogan, be "better than well". It's unusual in itself to have slogans for drugs licensed as anti-depressants. Only long-term monitoring will indicate whether this practice leads to any mental problems, but one high-flying UK Academic Psychiatrist has already lost a major research job because he spoke out about Prozac’s side-effects (– see news story linked below).
Abnormality has been highlighted in the UK with the dismally-ineffective "Care In The Community" initiative, whereby many patients who might formerly have been institutionalised are now within "normal" society under medical supervision. There are approximately 12 highly-publicised murders per year by such people, compared to approx 700 murders nationally by all persons, "normal" or otherwise per year. But it’s the ‘Nutters with knives’ who get most of the alliterative bold headlines on the tabloids……
While it is worrying that murders have been committed, the majority of released patients haven't acted dangerously and hence aren't newsworthy due to reporting bias. The majority of offences are by schizophrenics who have evaded medical supervision; in almost 60% of murders by psychiatric patients this followed release from hospital combined with lapsed medication. Sadly, when these acts occur they become criminalised, rather than a health issue. In former times the plea of insanity was a convenient "get-out" clause for many crimes, the situation now seems to be reversed.
In conclusion; any definition of abnormality is extremely problematic, unusual behaviour attracts ethical value judgments often based on moral or philosophical grounds without relevance to medicine or psychology, and the practical applications of such judgments cause great dispute.
There are major social, cultural and class issues affecting judgment of normality.
There is disparity in methods for diagnosis of specific conditions; lending credence to the feeling that mental health issues are presently almost entirely subjective. However this great scope for improvement in categorisation of mental health diagnoses may simply await both further advances in medical science and advances in how we all behave towards eachother….
Great social power exists in labeling, as abnormalities attract stigma, which often far outlast any illness. Abuse of this procedure has been a means of social control and suppression of dissent. Public ignorance of mental health only serves the efficacy of such abuses; along with creating problems with the patient's reintegration into society, even if their ‘abnormality’ was nothing much in the first place. Overcoming the label can often be harder than overcoming any ‘disease’.
And in any case, you’re not normal, nor am I.
Let’s enjoy that ?
These three are great reading:
Robert A Wilson: Quantum Psychology; Falcon 1990
Buy it at Amazon US
Stuart Sutherland: Breakdown; Weidenfeld 1989
Buy it at Amazon US
Lyall Watson: Lightning Bird (Sphere 1977) is out of print- look for it in your local second hand bookshop or on www.abe.com
Psychiatry and the image of Prozac news story
Info on The KLF is here and at about 1000 sites on the web
Joyce Brown does not have her own website…