1.2.3 Boundaries of ‘normality’
The origin of the ‘other’ in society is the widespread human tendency to create categories where people who don't fit in can be placed away from the mainstream. Social categories may lead to prejudice and discrimination, but may also lead to the physical separation of people to the margins of that society. Sibley (1995) traces the physical marginalisation of people in what he calls the ‘geographies of exclusion’. Part of the process of exclusion is where the ‘bad’, the ‘mad’ and the ‘imperfect’ are deemed to be ‘other’ and, often in stereotyped form, are disregarded or rejected.
Being the ‘other’ in mental health terms means being on the ‘them’ side of the normality/abnormality boundary. What does it mean to be regarded as abnormal? Indeed, what is the nature of mental distress? What does it mean to have mental health problems? It all depends on where the boundaries are drawn, and by whom. A boundary may often be drawn, for example, in a way that differentiates mental distress from ideas of what constitutes mental health and wellbeing. A person experiencing mental distress is, therefore, at least temporarily on the other side of the divide from those who are ‘normal’ or ‘sane’. Boundaries divide and define, but do they help to explain?
A recent definition of mental disorder states that ‘“Mental disorder” means any disability or disorder of mind or brain which results in an impairment or disturbance of mental functioning; and “mentally disordered” is to be read accordingly’ (Department of Health, 2002, p. 3).
So that's clear, then. Or is it? The concept of disorder suggests its counterpart – that there is some sort of mental ‘order’, an internal state where there is calm and coherence. The boundary between mental health and mental disorder is also concerned with the controversial idea of normality and what society regards as normal (Coppock and Hopton, 2000). It may be more helpful, in human terms, to think of a continuum of mental health and distress. Instead of being on one side of a social divide or the other, we are at varying points on the continuum and can move along it, back and forth, stopping and (re)starting as life changes. This is a more inclusive way of thinking about mental distress, avoiding the fixed boundary between ‘them’ and ‘us’, and allowing everyone to move between points as circumstances change and episodes of distress come and go.
This is not a view shared by everyone. In the article by Rachel Perkins (Reading 1) that you read in Activity 1, she argues against the notion of a continuum on the grounds that it disguises and diminishes real differences between people. What needs to change, in her view, is the value we give to those differences. What do you think? The next activity gives you the opportunity to reflect on what ‘normality’ means.
Activity 3: What is mental ‘normality’?
Think about what normality means to you. In what ways do you consider yourself to be normal? Note down some thoughts and, if possible, discuss your views with someone else.
It is not easy to define normality as it differs over time and between cultures. However, there is a sense of it meaning the ordinary or everyday aspects of life. This was certainly what course testers thought when asked what normality meant to them. One said:
Normality for me is ‘everyday’. This might cover a range of emotions and feelings, from boredom and dissatisfaction to happy and engaged. Normality includes the usual, whether that be activities such as shopping, working or driving, or the uncommon but planned-for, such as going on holiday.
Normality means day-to-day coping and rational thoughts; an ability to look at things objectively.
By way of contrast, creative artists and inspirational leaders live at least some of their lives in ways that are not ordinary and everyday. They may not be normal in that sense. But with talents that are way beyond those of the average person, they may come to be greatly revered. Other people, on the wrong side of the divide, may fare less well. The challenges of defining normality are highlighted well by Johnstone:
How quiet do you have to be before you can be called withdrawn? How angry is aggressive? How sudden is impulsive? How unusual is delusional? How excited is manic? How miserable is depressed? The answers are to be found not in some special measuring skill imparted during psychiatric training, but in the psychiatrist's and relatives' shared beliefs about how ‘normal’ people should behave.
(Johnstone, 1989, p. 243)
It is interesting to think about how normality and abnormality come to be defined in society. This point is taken up by Shaw and Woodward (in press), who suggest that people are less tolerant of unhappiness. This has led to more and more medicalisation of what at other times and in other countries might be regarded as normal human distress. Another take on the pathologising of day-to-day life experiences is the (rather tongue-in-cheek) concept of happiness as an abnormal state (Bentall, 1992). It is abnormal in the sense that it is not something experienced as ordinary and everyday. There are, of course, dangers in extending the boundaries of abnormality ever further, and the absurdity of classifying happiness as ‘a major affective disorder, pleasant type’, for instance, is plain to see. The nature of normality is contested, and so too is the nature of mental illness or distress. In the next section, we look at competing explanations of mental distress.