Mental illness and the concept of normal

This post is in response to JT Eberhard, and his call for the skeptical community to address mental illness. If you have not yet, please go watch his talk from Skepticon IV.

What is normal, psychologically speaking? The funny thing about this question is that many people you meet who qualify as having a mental illness would probably be described as normal if you met them on the street. It’s not until extremes are hit, that people usually say that someone is abnormal. These extremes usually come with helpful labels that aid us in identifying what is “wrong” with a person, be it cancer, the flu, depression or schizophrenia. These are labels that many people receive, and are tossed about in society often with the underlying context that all of these labels are dichotomous, yes/no, you either have this label or you don’t. But how is it decided whether or not an individual receives a particular label?

With certain infections, like the flu, or chicken pox, this is an easy decision to make. A person tests positive that that particular virus is active within their body. But with organic disorders, these lines are not always so cut and dry. Take for example, diabetes, a disorder caused by the pancreas not producing sufficient quantities of insulin. It is also not uncommon in the united states for doctors to tell people that they are “borderline diabetic.” Meaning that that individual is close to meeting the diagnostic criterion for the label diabetic. There is also, however, the possibility of the body producing too much insulin (hypoglycemia/Hyperinsulinemia). While incidents of the latter are less common than that of diabetes, they do occur. I am also sure that if the blood glucose levels of a large sample were taken, what you would see would not be three categories:

  1. Not enough insulin
  2. Just the right around of insulin
  3. Too much insulin

I’m sure you would get a relatively normal distribution:

20111126-131429.jpg

What does this have to do with mental illness?
Each mental illness has diagnostic criterion that must be met before a label can be given to any particular individual. For psychiatrists and psychologists the holy bible for this is the Diagnostic and Statistical Manual for Mental Disorders (DSM-V is due out May 2013). However, for many of these disorders (for lack of a better term) there has been a test associated with them. Usually these are checklists, or long lists of statement that you select the extent to which you agree with them. What is relevant to this discussion though, is how these tests are transformed into diagnosis. In their simplest form, each item is assigned a value, and scores are totaled. So each person who takes the test is given a single score to represent where they stand. There is usually a cutoff score, so say on a test with the possible scores ranging from 10-50, individuals scoring 40 or above will be given a clinical label/diagnosis. What generally goes unseen, however, is that if plotted, a large sample of scores would most likely again give you the normal distribution seen above. So while society sees a yes or no label, psychology sees a distribution of people with varying shades of say, depression, anxiety, anorexia, etc…

Some might argue that this method of testing is a way of the past, and that the way of the future is neurology and psychobiology. I would respond that yes, with our ever growing ability to peer into the brain, the old ways of testing and categorizing will definitely be due for some updating. However, the concept I am attempting to convey remains the same. JT was dead on when he talked about the lack of serotonin flowing in the synapses in certain areas of his brain. I would venture to hypothesize though, that if you took a large enough sample, and plotted out the values for the serotonin levels for the regions associated with anorexia, you would get something that resembled that normal distribution.

Everyone stands somewhere within the normal distribution. This can be plotted for simple things like height, weight, skin color, and longevity, as well as the multitude of psychological factors associated with human behavior. Some people have more or less anxiety than others, some people are more prone to addiction, some people are generally happier, some people find feet more or less sexy, whatever psychological aspect you can think of that is attributed to human behavior, I encourage you not to think of it as black or white, yes or no, but as something that we all have some part of. Understanding this will open your eyes to the variety of human behavior, and hopefully spark within you a little bit of the fascination for it that burns within me.

But wait! What about normal?
I don’t want you to leave here thinking that normal is the mean, or one or two standard deviations from it. I want you to have an appreciation for the vast spectrum that is human behavior, and not think of it in terms of normal vs. abnormal. But if you must have something to hold onto, because it is important to be able to decide when someone should seek help, here is my personal rule of deciding when a behavior is no longer normal: when the behavior prevents, or gets in the way of the individual’s ability to function in their daily life. I know it is simplistic, but if someone is no longer eating, bathing, working, sleeping, etc… that tells me it is time for that individual to get help. They may or may not receive a label for their condition, but I don’t care, up until that point, they were what I considered to be normal. Are they now completely abnormal? No, of course not, but they displayed a behavior or thought pattern that I would call abnormal, and now they can hopefully receive treatment to help them once again function in everyday life.

Remember that normal distribution, and remember that for every mental illness/disorder, we each stand somewhere on that continuum. There are some people who are at the far ends of that continuum that could use a little help, be there for them, because statistically speaking, someday that could be you out there drifting away from the mean, and you will be forever grateful to those who came to you in your time of need. But also recognize a little bit of yourself in everyone you encounter, no matter how strange they may seem to you, you share something with them.

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