July 09, 2012

Redefining Normal: An Inclusive Way of Understanding Mental Health

 

 

Redefining  Normal:  An Inclusive Way of Understanding Mental Health

In our last segment, we talked about PTSD. Unfortunately we ran out of time before I was able to emphasize the point that folks who suffer from PTSD aren't crazy; they are simply normal people who have been overwhelmed by life trauma.


That word "normal" got me thinking ... after all the advances in science and technology, we still have a problem with how we think and talk about of mental illness.  There is a definite stigma attached to mental illness in a way that doesn't exist with other medical illness. For example, I have diabetes, I'm not defined by it the way mental patients often are. No one thinks twice of someone who has an appendectomy.  Words like "crazy" or abnormal, which harkens back to the dark ages of psychiatric understanding, perpetuate fear of and stigma towards those who have emotional problems. Specifically they create a false divide between normal/ healthy folks and abnormal/mentally ill.

Today I want to suggest an alternative way to understand mental health problems which is more inclusive and that doesn't stigmatize or separate people into separate classes. Instead of dividing folks into normal and abnormal categories, mental health and illness can be seen as different locations on a continuum of cognitive/affective distortions. Rather than being a fixed notion mental health needs to be understood as a dynamic reality that changes for an individual. There are times when stress is higher that we are going to be less well than at other times. The point is that all of these changes are part of the normal variations.

Historically, people with disorders were thought to be evil or possessed or to have a lack of moral character.  They were treated in frightful ways. With advances in medicine, treatment for the mentally disturbed became more humane and the model used to understand the condition was medical.

While seeing folks as ill rather than demonic or of weak character was a significant advance, the 19th medical model had a serious drawback: (and this is the tricky part), it made the distinction between normal and abnormal separate and absolute.  Mental illness was thought to be analogous to medical illness, i.e. your body was either infected by a bacterium or it wasn't. The problem was not simply conceptual but pragmatic as well. If you were determined to be mentally ill, there was virtually no effective treatment and thus fear and hopelessness surrounded the topic.

An Inclusive View of Mental Health
The most current understanding of normal is that everyone has some level of distortion in  their perception and irrationality in their responses. For example, we all know of the skinny girl who thinks she's fat or the successful person who worries he's a failure. Thus, we have come to understand that mental disorders are best understood as a matter of the degree of perceptional and emotional distortion which is present which exists as a continuum of human experience rather than being a completely separate reality. 

People who are quite normal and mentally healthy have many of the same unusual thoughts and feelings as those who are quite emotionally disturbed. Likewise, even the most severely mentally ill person is still human. No one is completely healthy or completely sick.  The question is, if everyone has the weird thoughts and feelings, how can we know the difference between normal and abnormal? While our topic is complicated, here are some guidelines.

Illness in this a relative issue of distortion. The question is not  if a person's distorts but how much.  Health exhibits relatively low levels of cognitive/emotional distortion while illness is marked by a greater degree of distortion.

The key factors for determining one degree of health or illness are functional, i.e. how severe is the distortion and how much does it interfere with a person's success on the job, in personal relationships and in regard to one's happiness.  Here are some guidelines that help you tell the differene between everyday problems and those which may benefit from professional help.
- Intensity -- When uncomfortable or irrational feelings are so strong they can't be ignored.
- Duration -- When dysfunctional moods or behaviors persist for weeks or months.
- Impairment -- When, as a result of the upset feelings or behavioral reactions, the quality of one's work performance, interpersonal relationships or overall sense of well being deteriorates.
- Resistance to Remediation -- Nothing seems to help or reduce the problematic feelings or behaviors.

When it comes to worrying about, "Am I normal ?", we all need to take a deep breath and remember, that the very word comes from a time when psychology was not understood. Besides, having a weird thought or being different may also be a seen as creativity and thinking or living outside the box. If we were all alike ... and were unable to have an original thought, that would be very sad.

The point is that we are all human and we all struggle to be accurate and reasonable in our perceptions and responses to life's challenges. Some struggle more than others. Nonetheless we are all in it together as members of the human species and must strive to understand and support each other. Having a more inclusive model of mental health will help get rid of the stigma associated with mental illness once and for all.     

     

The Reverend Michael Heath prepared these remarks for Bridge Street 7 9 2012  www.revmichaelheath.com/

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