Normality? types of abnormalities.

1. a person knows that his experience/ behaviour is different from the rest & se
es it as a problem. He wants to be like others. Why am I differet is his questio
n. ?experiential block ?perceptual block
2. a person who doesn't know/realize that others see him as diferent & doesn't k
now he has a problem. Why is he not able to understand is our question. ?intelle
ctual/processing defect ?perceptual block ?
3. a person who knows & understands well, but is unable to behave like others &
is upset about it --> various emotional reactions. ?because of physical defect
s ?because of life circumstances
4. every one wants to be like everyone else; esp parents want their children to
be like other kids, without understanding why it can't be in some cases. --> in
ability to even accept minor differences & trying to medically fix it. The indus
try takes full advantage of it esp.. pharmaceutics.
solution lies in realizing that people are all different & we lack some desirab
le qualities and hence the world will treat us differently, from those who have
those qualities; we can either go in pursuit of these qualities or accept our g
iven endowments & make the best out of them for a happy living and not to be los
t in -ve emotions & reactions.
-----------------------------
Kramer on normality:
Being exceptional is by definition to be out of the ordinary, not normal in some
notable ways, and according to some common standards of behavior or values.
Processing information much faster, for example, or being able to generate many
more creative and unusual ideas than most people, or being highly sensitive.
Looking in a direction other than the majority. All are abnormal.
But there is also the matter of mental health and classifying our ways of feelin
g or behaving as normal or not.
In his stimulating article What Is Normal?, psychiatrist Peter D. Kramer notes, D
iagnostic labels are proliferating, and mental disorders seem to be annexing eve
r more territory.
At the same time, many people with diagnosable conditions are forging their own o
riginal takes on what s normal.
I have been thinking a good deal about normality lately. It s a concern in the medi
cal world. The complaint is that doctors are abusing [their] privilege, to defin
e the normal.
Ordinary sadness, critics say, has been engulfed by depression. Boyishness stands
in the shadow of attention deficits. Social phobia has engineered a hostile tak
eover of shyness.
He points out there is A spate of popular books that challenge what they believe
is psychiatry s narrowing of the normal The Loss of Sadness: How Psychiatry Transf
ormed Normal Sorrow into Depressive Disorder by Allan V. Horwitz and Jerome C. W
akefield, The Last Normal Child by Lawrence H. Diller, and Shyness: How Normal B
ehavior Became a Sickness by Christopher Lane.
The National Institute of Mental Health reports that in any given year, over a qu
arter of Americans and over a lifetime, half of us suffer a mental disorder.
The fate of normality is very much in the balance.
Continued in article What Is Normal?
----------------------
Toward the end of my psychiatric residency, a friend pulled me aside to ask a qu
estion: Was he normal?
During sex, Jack's girlfriend, Ann, let her Irish setter share the bed. Since th
e dog took an interest in the proceedings, the arrangement made Jack uncomfortab
le. When Jack expressed misgivings, Ann attacked him as obsessive. Jack told Ann
that he would be seeking my opinion. Good, she said. I was just the guy.
Was Jack neurotic? Was Ann perverse? I chose not to answer; with or without diag
noses, the two would break up (presently, they did) or enter the sort of stable
relationship where the woman calls the man fussy and the man considers the woman
irrational. But I did note that my role fledgling psychiatrist now qualified me to
adjudicate: Who is normal?
I have been thinking a good deal about normality lately. It's a concern in the m
edical world. The complaint is that doctors are abusing the privilege implied in
Jack's query, to define the normal. Ordinary sadness, critics say, has been eng
ulfed by depression. Boyishness stands in the shadow of attention deficits. Soci
al phobia has engineered a hostile takeover of shyness.
A spate of popular books The Loss of Sadness: How Psychiatry Transformed Normal So
rrow into Depressive Disorder by Allan V. Horwitz and Jerome C. Wakefield, The L
ast Normal Child by Lawrence H. Diller, and Shyness: How Normal Behavior Became
a Sickness by Christopher Lane challenge what they believe is psychiatry's narrowi
ng of the normal. The National Institute of Mental Health reports that in any gi
ven year, over a quarter of Americans and over a lifetime, half of us suffer a menta
l disorder.
The fate of normality is very much in the balance. The American Psychiatric Asso
ciation is now revising its diagnostic and statistical manual the next version, DS
M-V, should preview in 2011 and become official the following year. It may, inde
ed, be that as labels proliferate, mental disorders will annex ever more territo
ry. But claims of a psychiatric power grab are overstated. The real force behind
a proliferation of labels is the increasing ability of technology to see us as
we've never been seen before. Still, the notion of a shift in the normal invites
unease: To constrain normality is to induce conformity. To expand diagnosis is
to induce anxiety. Is anyone really well?
It's a short hop from critiquing narrowed normalcy to claiming that we are an ov
ermedicated nation. As Lane writes, "We've narrowed healthy behavior so dramatic
ally that our quirks and eccentricities the normal emotional range of adolescence
and adulthood have become problems we fear and expect drugs to fix." Psychiatry's
critics also complain that doctors medicate patients who meet no diagnosis, who
practice what I have dubbed "cosmetic psychopharmacology," to move a person from
one normal, but disfavored personality state, like humility and diffidence, to
another normal, but rewarded state, like self-assertion.
Labels matter even when medication has no role in treatment. A wife complains th
at her husband lacks empathy. Does he have Asperger's syndrome, a lesser variant
of autism, or is he simply one of those guys who "don't get it," who simply don
't see social interactions as ordinarily perceptive women do?
Diagnosis, however loose, can bring relief, along with a plan for addressing the
problem at hand. Parents who might have once thought of a child as slow or ecce
ntric now see him as having dyslexia or Asperger's syndrome and then notice simila
r tendencies in themselves. But there's no evidence that the proliferation of di
agnoses has done harm to our identity. Is dyslexia worse than what it replaced:
the accusation, say, that a child is stupid and lazy?
The question of normality creates strange paradoxes in the consulting room. Ofte
n it is relatively healthy people who feel defective. In psychotherapy, patients
may perseverate over vague complaints, feeling off-balance and out of sync. The
worriers may believe that they have too much or, more often, too little ambitio
n, desire, confidence, spontaneity, or sociability. Their keen social awareness
(a strength), when tinctured with obsessionality, causes them to fuss over glitc
hes in the self. For them, a sense of abnormality precedes any diagnosis and may
persist even when none is proffered.
In contrast, seriously ill patients may have no such concern. Those who manifest
frank paranoia will insist on their normality; anyone would be vigilant in the
face of plots directed at them. Anorexics and alcoholics may profess certainty t
hat they're fine; the degree of "denial" is something of a marker for severity o
f disorder.
People afflicted by disabling panic or depression may fully embrace the disease
model. A diagnosis can restore a sense of wholeness by naming, and confining, an
ailment. That mood disorders are common and largely treatable makes them more a
cceptable; to suffer them is painful but not strange.
In other words, in the clinical setting, the proliferation of diagnoses has dive
rse effects, making some people feel more normal, some less so, and touching oth
ers not at all. There is no automatic link between a label and a sense of abnorm
ality.
Still, diagnosis can seem to confer stigma. I recall a patient, Roberta, who con
sulted me because her marriage was in trouble. Her husband resisted couples ther
apy. Might she see me alone?
In my office, Roberta was listless and slow of thought. Her memory was vague. Wa
s the problem thyroid disease or an occult cancer? Roberta willingly submitted to
a workup by an internist. She was devastated when she was referred back for trea
tment of depression.
To Roberta, the mood disorder label confirmed her husband's complaint that somet
hing was wrong with her as a person. To be called depressed rather than, say, an
emic constituted double jeopardy: She was in pain and she was flawed, in judgmen
t and in character. She was unloved and, now, abnormal.
Despite her misgivings, I asked Roberta to consider psychotherapy, exercise, bri
ght lights (for winter in New England), and medication. I wanted her to be funct
ioning well quickly, before she made irreversible decisions about her marriage.
The case had a memorable outcome. Only when she was better did Roberta reveal th
at at her low point she had contemplated suicide. Her summary comment was, "The
fights with my husband saved my life." They caused her to be diagnosed and treated
.
When she first spoke with me, Roberta seemed to display normal sadness, that is,
emotional disruption in the face of a life crisis. Psychiatry's critics are rig
ht: Roberta experienced the diagnosis as stigmatizing, and it led to her taking
medication. But the case also illustrates why, for doctors, making diagnoses and
educating patients about them is not a matter of choice; diagnosis can be lifes
aving.
Just where does the impetus to expand diagnosis originate? A recent public flap
highlights how categories proliferate. Raymond DiGiuseppe, a psychologist who re
searches anger, made headlines last spring when, at a scientific meeting, he arg
ued that the DSM should add anger disorders, to parallel depression and anxiety
disorders. There is a point at which anger becomes harmful, he contends. When sc
holars immerse themselves in an area carefully observing research subjects, making
note of differences and attendant harm new sets of diagnosis seem obvious and ine
vitable. It doesn't matter whether treatment for the condition is medication or
psychotherapy, or indeed, any treatment at all.
Clinicians respond to such academic findings often by focusing on the risk of ha
rm. Their concern drives the expansion of diagnosis and, reciprocally, the contr
action of the sphere of the normal. Research ranging from genetics to epidemiolo
gy, for example, now associates depressive episodes with harm to the brain, hear
t, blood vessels, hormonal glands, and bones as well as to careers and marriages.
The more closely researchers look, the more they find that risk attaches to even
minor depressive episodes. Such evidence helps shape the diagnostic manual.
Critics of psychiatry complain that many patients fit no clear category and, at
least on insurance forms, are given labels like "anxiety disorder not otherwise
specified." Such patients nevertheless often remain at risk for an array of bad
outcomes, studies indicate findings that tend to broaden diagnostic categories.
Research technology is transforming understanding of mental disorders. New, more
finely grained ways of looking at brains, neurons, and even cell connections, a
s well as powerful computer models, correlate many observed variations in functi
on with disease and disability. The nerve connections you form, the neurotransmi
tters you elaborate, the symptoms you suffer each may be linked to vulnerability t
o disorder.
One way psychiatry has responded to expansionist pressures is to turn to the con
cept of dimensions. Imagine compiling a list of all the factors ever associated
with depression: irritability, a metallic taste in the mouth, a variant of a rel
evant gene, a change in size of a part of the brain. The list grows to 300 facto
rs symptoms, personality styles, gene variants, gene configurations, family histor
ies, protein elaboration, and anatomical differences. Say, you rate a person on
each of them.
Then you identify clusters of factors (extreme irritability, mild complaints of
"off" taste, moderate levels of brain abnormality) that predict recurring episod
es of mood disruption. A computer could identify varying degrees of severity for
each of the hundreds of factors, with differing prognoses and treatment options
. And then at some point, it becomes logical to dispense with the discrete, cate
gorical have-it-or-don't-have-it view of depression.
In time, and in future manuals, dimensions may push categories aside. If for man
y of the factors, difference confers some degree of vulnerability to dysfunction
, then we will find that we are all defective in one fashion or another. DSM-V m
ay turn out to be conservative and postpone the inevitable, but it is hard to im
agine a future in which abnormality is not much more prevalent than it is today.
The shift in perception may become more marked as researchers identify subtle n
euron- or gene-based variations with modest psychological consequences increased r
isk for one or another condition in the way that high blood pressure signals incre
ased risk for stroke.
How will it feel to live in a culture in which few people are free of psychologi
cal defect? Well, we've been there before, and we can gain some clues from the p
ast. The high-water mark for diagnosis occurred in the heyday of psychoanalysis.
The Midtown Manhattan Study, the premier mental health survey of the 1950s, fou
nd that over 80 percent of respondents more than triple our own abnormality rate wer
e not normal. "Only 18.5 percent of those investigated were 'free enough of emot
ional symptoms to be considered well,'" the New York Times reported. It even cit
ed a psychiatrist who reasoned that, since health includes awareness of conflict
, subjects who express no neurotic anxiety must also be abnormal.
In a forthcoming book, Perfectly Average: The Pursuit of Normality in Postwar Am
erica, American Studies scholar Anna Creadick reports that the U.S. hungered for
 a return to normality in the wake of World War II. Articles asking, "Is Your Ch
ild Normal?" appeared regularly in the press.
But being deemed neurotic was hardly a cause for distress. If anything, the affl
iction seemed to signal opposition to mass culture, as if emotional sensitivity
were a protest against Eisenhower-era dullness and conformity. Popular essays an
d books such as The Man in the Gray Flannel Suit made normal men and women out a
s saps.
The lesson of mid-century is clear: When everyone is abnormal, diagnosis loses i
ts sting. I suspect that we are entering a similar period in which diagnosis (or
dimensional defect) spreads while its gravity, in terms of social stigma, diminis
hes. Or else we will redefine normal to include broad ranges of difference.
To some degree, that is already happening. The deaf, anorexics, people with Aspe
rger's syndrome groups whose members might otherwise be considered impaired or dev
iant have made vigorous claims to represent "the new normal." The Hearing Voices N
etwork advocates liberation, not cure, for those who hallucinate. Where once peo
ple pursued normality through efforts at self-reform, now they proudly redraw th
e map to include themselves. In this context, diagnostic labels confer inclusion
in a community. Today, an emotional or behavioral state can be understood both
as a disorder and a unique perspective.

As the experience of mid-century shows, we can hold two forms of normality in mi

nd normal as free of defect, and normal as sharing the human condition, which alwa
ys includes variation and vulnerability. We may be entering a similar period of
dissociation, in which risk and pathology become separated from abnormality or an
era in which abnormality is universal and unremarkable.
We are used to the concept of medical shortcomings; we face disappointing realiz
ations that our triglyceride levels and our stress tolerance are not what we would
wish. Normality may be a myth we have allowed ourselves to enjoy for decades, s
acrificed now to the increasing recognition of differences. The awareness that w
e all bear flaws is humbling. But it could lead us to a new sense of inclusivene
ss and tolerance, recognition that imperfection is the condition of every life. Pe
ter Kramer
Redefining "Normal"
Albert Rizzi, 45, woke from a months-long coma brought on by meningitis and disc
overed he was blind. He didn't panic; events in the "'tween state" had somehow p
repared him. It helped that his father told him, "Accept it; be the best blind p
erson you can be." He did have to come to terms with a whole new way of living.
"I look at my blindness as a characteristic. I focus on my ability. Disability i
s imposed on me," largely, he says, by society's fear of blindness. "There are t
echnologies that allow us to do things. They tell me, for example, what color my
clothes are. I'm angry they're not more available and that businesses don't under
stand how able we are. The blind are great problem-solvers, for example, because
we always have to assess our environment to keep from falling down stairs." Wha
t's normal? "I'm an overachiever; I want to believe I can do anything I want. I
may have to do it differently, with more planning, but do it I will." Rizzi now
runs his own educational organization, My Blind Spot "because we all have blind sp
ots."
Donna Flagg, 45, is founder and CEO of the Krysalis Group, New York-based busine
ss consultants whose motto is "Business NOT as usual." "Everything we do challen
ges the status quo," says Flagg, who early on dyslexic and labeled retarded was sens
itized to looking at everything in novel ways. "Most people think there's only o
ne way of doing things." The only time she ever struggled, she says, was in grad
es K-12. "Once I got out of the system, I was free; paths opened." Trained to be
a dancer, she took a side job doing makeup at Chanel and discovered she loved the
 business world. After starting her own beauty company, she opted for a second c
hance at school and got straight As on a master's degree at New York University.
"I have two businesses, two master's degrees, I wrote a book. How do you call m
e disabled? What's not normal about what I've been able to do?" Flagg thinks "pe
ople confuse normal with average. Why would anyone want to be average?" She beli
eves our society "creates a lot of things that don't fit." What makes her differ
ent, she insists, is that she has chosen not to work from a "platform of inadequ
acy."
Matt Kailey, 54, grew up female. Being an atheist in Christian Middle America "the
re were parents who didn't want their kids playing with me" was more of a "big dea
l" than the "gender thing" that surfaced at age 10 and waxed and waned thereafte
r. "I believed a mistake had been made and I was supposed to be male." Matt, né Je
nnifer, went on to become "very feminine" high heels, makeup, big hair, breast imp
lants. She dated males and married twice, drawn to men "that I wanted to be, not
that I was attracted to. It was almost a vampirish thing; 'I'll suck the identi
ty out of you'; not 'you add to me.'" He didn't know his feelings had a name unt
il he was 40 and saw a therapist for other reasons. "I thought I was a normal fe
male with one quirk." But once he learned about transsexualiity, he felt "compel
led" to transition. His marriage broke up, and he "entered a whole new world of
gays, lesbians, transsexuals." His attraction to men continued. "Gender identity
disorder is in the DSM," he says. "I don't believe the transgendered are mental
ly ill. We have jobs, we shop, we eat, we pay taxes. We function. I consider mys
elf normal. To me normal is whatever exists in nature."
Kathleen Fasanella, 48, was diagnosed with autism only 11 years ago, although fr
om age 10 she "knew there was something different about me and my family." She c
ould reel off all the zip codes in the U.S. She hated labels in clothes; they ir
ritated her and she ripped them out. She dropped out of high school, but a lifel
ong sewer, she eventually studied pattern-making. "It's a hybrid of three types
of engineering product design and materials and industrial engineering." She has w
ritten manuals on starting a clothing manufacturing business and on pattern-maki
ng, but "I'm very dicey living on my own. I couldn't navigate all the executive
functioning." She manages in business because "I have strategies" and "I control
my own environment." She contends that "normal isn't what it's cracked up to be
. Many 'normal' people seem abnormal to me. The fascination with celebrities is
bizarre, to want to be like them. Normal people are obsessed with social conform
ity." Autistic people, she says, are more rational than "normal" people, more di
rect, less ambiguous, "less swayed by social trappings and presumed authority."