Sunday, August 05, 2012

Revisiting Normal

A couple of years ago, I wrote a post about how patients often ask me if they...or something they are feeling...or something they are Normal.  I went on to ramble about how Normal is Boring, and why would anyone want to be Normal.  IQ = 100, tuna fish for lunch, you name it.  

People still ask me if they are normal. I've taken to responding: "I have no idea what 'normal' means."  I still have no idea why anyone would want to be normal. 

 In psychiatry, we often ask "Why now?"   Why are you seeking help for your problem today?  You may want to know why I'm blogging about Normal today.  Ah, the answer to that is easy.  My friend Patty put the above cartoon on her Facebook Page and what better graphic for a Shrink Rap post?  Is it normal to blog about Facebook cartoons?


Anonymous said...

Not too many people want to be abnormal, although if one takes your examples there is a decent chance most would choose if they could, to test at IQ of 135 instead of IQ of 65 and most would choose oysters and champagne over bread and water for lunch. You know by now what people mean when they ask if they are normal.
You would probably let them know in some way if you truly felt they were not normal and your entire profession revolves around dividing the world into people who are and people who are not normal.Now I will take my chill pill.

Sarebear said...

Normal is a bit of a sensitive word for me, because I don't want my daughter with high functioning autism (not defines her, but it is part of her) feel abnormal. I tell her she is different than many children, but there are alot who also have autism, nowadays.

I know some parents of the autistic use the term "neurotypical" to refer to "normal" children/people, but I find that too . . . cold.

So I use autistic and non-autistic, though I try to not talk about her autism with other people when she's in hearing. It comes up sometimes though and this is a small apartment.

Also, while knowing that genius level IQ is around 180? I don't know the specifics, and had to assume that my psychiatrist, a month or two ago, was giving me a compliment when she told me she figured I was around a 130 IQ.

Maybe I'm really uneducated/uninformed on the matter. She gave it in a complentary way, so I assumed it was. Anyway, if I was normal I'd be boring, although I wish there were many aspects of me that were a little less . . . . difficult. I work on em but it's sloooww going.

RobotRobot said...

It's a very real and important question to ask a psychiatrist, given all the joking we all do about being marked as unacceptably "crazy". Asking whether it's normal to think/feel a certain way - am operating within acceptable parameters? Do you accept me as a human being even though I've got this unusual, atypical symptom/trait/thought pattern? People like your friend, who presumably don't have grounds to doubt that they'll be accepted as human beings, get to joke about not being "normal". But if you start to worry that your interior life marks you as less-than, then wanting your doc to acknowledge you as 'worthy of dignity, etc' means quite a lot. We may joke about not wanting to be 'normal' but there are plenty of not-normal behaviors that ARE very very deeply stigmatized by even very accepting communities.

Robot Robot (An Anon Gains A Name)

Anonymous said...

First anon hit the nail on the head and handled the issue already.

There is a very real qualitative difference between being abnormal like a creative genius, or being abnormal like a schizophrenic. The fact both aren't normal doesn't mean these conditions are the same as quality of life is concerned.

If I went to a psychiatrist and asked him or her if my behavior was "normal" and they responded by saying "normal is boring" I would feel patronized and be pretty upset. We're talking about my life and future and potential disease, not whether or not my socks have funky pin stripes on them. I want a normal brain that doesn't devolve into psychosis, and I don't want my healthcare provider to trivialize my concerns that I might be mad as a hatter. Tell me I am healthy or tell me I might not be but don't make jokes about what it means to be mentally ill, as if it was some flavor of ice cream; different but fun, more interesting than boring vanilla.

rob lindeman said...

Wow. Learned way more about CCSVI than I ever wanted to know!

The category 'normal' is shrinking. My bias, at the risk of boring those who are familiar with my point of views and STILL read my comments, is to broaden, rather than contract the category 'normal'. For reasons that baffle me, my doing so has made me unpopular. Or abnormal.

Sam said...

Perhaps what your patients mean to ask is not "is this normal" but "is this healthy".

Oh and freshly baked bread and champagne please. Oysters? Blech!

Anonymous said...

When it comes down to it, most people are not totally "normal." If they were, we would all be the same, and everyone has unique characteristics. As the first anon suggested, it's about the type of abnormal and whether it is accepted in society.

Having been to the depths of major depression and back again several times, I no longer seek "normal." I'm not at all confident that true "normal" exists for me. Our lives are defined by our experiences and the vast majority of people (thankfully) do not have my experience in their repertoire.

When I gave up being "normal", seeking "happy" that I thought most "normal" people have, a lot of my angst went away. I'm OK with melancholy...seeing the world through blue glasses. I believe my brain just doesn't have the chemistry to do what others do.

I question (bringing back an old topic) if children brought up on anti-depressants will be normal. Having deprived their brains of some of the spectrum of emotion that people experience during development, is the end result a "normal" brain.

Yup, it's all a setting on the dryer and nothing more. BTW, what is "normal dry" as opposed to "high dry." Isn't dry, dry?

Anonymous said...

Rob, I do not know what measure you have been using to determine that normal is shrinking. That may be your perspective. Mine is that it is holding pretty steady but we just choose different people and behaviors or states to categorize as normal or as abnormal. Many places have normalized same sex marriages or unions. Statistically, these may occur less often than heterosexual marriages or unions, but greater acceptance has made made it no longer abnormal. It was once abnormal for women to wear pants.Now it is normal.You can think of other examples. Of course, these represent social mores, what is acceptable as opposed to what is normal, but people do confuse the two ideas. At the same time, within psychiatry, it has become normal to prescribe anti psychotics off label for so many conditions that it has become normal to take them, a fact which I believe is alarming and I have not decided whether the trend adds to the ranks of the "abnormal"or normalizes the ingestion of APs. Far more children have a diagnosis of an emotional or a learning disability. Has the system put more of these kids into the abnormal group or is it just now normal to have a diagnosis? Question is far too complex to be answered here. I am familiar with these issues, having taken anti psychotics since the days they were not atypical in terms of the names by which they were called, but it was very atypical to be taking them. I now take them and so do a lot of other people I know. The big difference is that they take them for up to now,"normal" things like insomnia and I take them for something that is still not talked about very openly unless one is a star of movie or rock, take your pick.I do remember when there were one or two kids with an LD dx. I remember when there were one or two kids considered to be gifted,not that we called it by that name then.Now,it is very difficult for a teacher to teach a class in which so many kids have been "identified" with a range of learning needs and styles. Every second parent I speak with has a child who is exceptional or even twice exceptional. Of course, the kids have not changed much if looking at a classroom of forty years ago vs today. Our views of them have changed. We label everyone, not always to good effect.
So, it really seems to me that we keep shifting the goalposts but that the net result, pardon the pun, is that the same number of people end up being considered fro inclusion into the category normal.

If you have not seen this,please take a listen. Most likely, you have seen it. It does not relate to the question your patients ask but it does address the question of why people seem to think they are all gifted and talented and entitled. As I posted above,most people would choose to be special to the upside. Very few would choose to below average and you seem to believe that normal or average is in itself a tragic outcome.


It sounds like you are a very good mother. I am sure you are bright but if you really want to know your own IQ, know that a psychiatrist cannot guess at this.No one can guess at your IQ and your IQ is not always a great indicator of what you will or can achieve in life. Your psychiatrist may have wanted to pay you a compliment but I would be careful about professionals who throw out numbers in such an offhand fashion. I have never met a psychiatrist who did psychometric testing.

rob lindeman said...

Thank you, Anon, I should clarify: I'm speaking about children, the group I see in my daily work. Here, with respect to behavioral or mental health measures, the data are irrefutable. The normal group is shrinking. The evidence is the logarithmic growth in the prevalence of children taking psychoactive medications. I report with sadness that with children, the goalposts are both shifting and shrinking

Sarebear said...

I didn't think she could literally give me a specific number, I took it as a general compliment that she thought I was smart.

I think she's quite sharp herself, on the medical side of things anyway.

My first psychiatrist was quite intelligent as well (you'd think that most doctors would be, to get thru med school, but I'm talking about just . . . well it's hard to define right now, and I gotta go to therapy in a minute! He told me that he thought I was more intelligant than he; I thought that a nice compliment, since he was usually pretty darn hard on me.

Maybe I sound conceited here, lol, but . . . growing up as miserable as I did, my "smarts" as it were were the only thing I could count on, and it would many of the kids in class asking me fr help/explanation. It's the only area I've ever had any confidence in, so to have that acknowledged, by doctors, and by ones who were usually either loathe to compliment me or were/are rather hard on me, well, it was a nice compliment/validation. I'm probably not putting this very good, being in a rush.

Anonymous said...

I once asked my therapist if my response to a very abnormal situation was "normal." It was helpful for the therapist to tell me that my behavior made a lot of sense considering what I been through and that my response to that situation was not uncommon. I felt a lot of relief from her answer. It helped to know that there were other people out there who responded to a similar situation in a similar way. I felt like less of a freak.

But, then I'm...


Anonymous said...

It is probably hard to know what to say, sometimes. There are so many things that I've shared with a therapist, and searched for whether it's "normal" (or at least not cause for mental health concern), and she gave me so much relief (without directly getting into the label of "normal" or not). The word "normal", or some equivalent description thereof, is exactly was what I wanted to hear to ease my mind.

But, I also got fascinated with this idea of "normal" or "not normal" and started asking folks if they felt x, y, or z about something, or to rank their emotional response to a shared experience, etc. I got a quick (albeit small sample size) feel for "normal" outside of asking my therapist about it. I discovered through this polling that I was the only person in my group that had bad nightmares about 90+% of the time (verses 0-20% of the time). That was news to me that I wasn't "normal" in this area, and it became something very much worth sharing and exploring in therapy.

Sometimes you just wanna know, and "normal" is the answer you're hoping for! And if you're not "normal", it's something you deserve to know and hope to better understand.

Anonymous said...

Sigh. It feels as though Dinah does not understand the reality that many people in therapy truly believe they are abnormal or freaks when they are actually very normal in their sane reactions to impossible situations. How many people who suffered abuse were told growing up that they were crazy? A whole lot. How many end up with partners where the whole scenario is repeated? A lot. Even if not in a violent relationship, a lot of people who were brought up this way attach themselves to people who are happy to reinforce their sense that they are crazy.Therapy may be the first chance to hear that they are normal. The only definition of normal for them is not crazy and it would be a great thing for them t hear and learn to believe. If no has ever mistreated you and then told you that you were crazy, maybe that is hard to grasp. Many patients would do better with a therapist who listened closely for what normal means to a given patient
and responded appropriately.If my therapist had written this post and I had read it, I would be hurt. Is that normal? To me it is normal since my therapist has been working with me to help me see how my view of myself was shaped by experiences that were crazy.
Who knows what could have been had I spent fewer years doped up and more years hearing something that validated my feelings. Not all of my perceptions should be validated, some are not all that normal, but until a therapist tries to understand where they come from or why I perceive things the way I do, they would not be a very helpful person to be seeing.

Anonymous said...

Love this one, I always am asking my doctor that question. I suffer from trichotillamania and horrible, scary intrusive thoughts. My outward appearance is quite normal ( in fact, voted prettiest girl in high school.No one knew I had a bald spot the size of a softball on the top of my head and had persistent thoughts of death) and have always had a job, friends, etc. For the last 40 years, I have fought trich and intrusive thoughts everyday. Pulling ones hair out is not normal behavior. Having random, frightening thoughts pop up unexpectedly does not feel normal. I get the, you are artistic, you are creative, you are funny , you're not boring, etc Shrinks, dosn't work for me always. Instead I walk around as the great pretender.

Dinah said...

This was meant as a quick, light-hearted post, mostly because I wanted to use my friend's cartoon. I also got the attribution wrong: Patty took it from Joan's facebook page. Both high school friends of mine.

Clearly, the question can be asked in contexts which are different-- and here is where knowing the patient, their lives/illness/symptoms/past and their body language, tone, etc. have meaning. Of course I don't give a light-hearted pat response to someone in distress.

Anonymous said...

"I still have no idea why anyone would want to be normal."

That pretty much sums up your point so why backpedal? You spoke in relation to your patients, not random people asking you this question at a cocktail party. How distressed does the person have to be?

"I still have no idea why anyone would want to be normal."

That is not something one ever wants to hear from a shrink. It shows a lack of understanding.

Anonymous said...

I see what Dinah means, but it is a sensitive subject to those in therapy trying (like me) to get a grasp on normal. I often tell my therapist that when it comes to mental heath, I do not want to be extraordinary in any way. But yes, in a light hearted way, normal is boring. I think we all can relate to that, too. Hard to remember to be light hearted on a therapy blog, though.

Anonymous said...

Last Anon,

Dinah is clear that this is not a therapy blog.It is a blog by psychiatrists, for psychiatrists, even though only a handful of psychiatrists pass this way. Please also remember that stirring things up brings attention, on which one blogger seems to thrive.

Anonymous said...

I don't feel that way about Dinah. I should have said -- a blog that deals with issues related to and including therapy.

Anonymous said...

I find it very interesting how people confuse "depression" as just another setting on the emotion spectrum. I would have expected that from someone who's never suffered depression, but go figure. My antidepressants allowed my emotions to come back and are pretty much the only thing between me and suicide. People wanting to kill themselves is not normal. A lot of children are put on antidepressants because they voice suicidal intent or plans. So while I'm sure you mean well, think twice before judging whether someone elses' medication as necessary.