The World Health Organization (WHO) considers normality to be a state of complete physical, mental, and social well-being. Mental well-being presumes the absence of mental disorder.
A mental disorder is a behavioral or psychological syndrome or pattern associated with distress (e.g., a painful symptom), or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. In addition, the syndrome or pattern must not be merely an expected and culturally sanctioned response to a particular event, such as the death of a loved one.
Historically, the two broad categories of mental disorder are psychosis and neurosis. Psychosis is defined as grossly impaired reality testing. With gross impairment in reality testing, persons incorrectly evaluate the accuracy of their perceptions and thoughts and make incorrect inferences about external reality, even in the face of contrary evidence. The term psychotic does not apply to minor distortions of reality that involve matters of relative judgment. For example, depressed persons who underestimate their achievements are not described as psychotic, whereas those who believe that they have caused natural disasters are so described.
Neurosis is defined as a chronic or recurrent disorder that is characterized mainly by anxiety, which appears alone or as a symptom such as an obsession, compulsion, phobia, or a sexual dysfunction. Psychosis is synonymous with severe impairment of social and personal functioning characterized by social withdrawal and inability to perform the usual household and occupational roles. Neurosis implies that reality testing and personality organization is intact but the person is distressed by a variety of disturbing symptoms.
Normality has been defined as patterns of behavior or personality traits that are typical or that conform to some standard of proper and acceptable ways of behaving and being. The use of terms such as typical or acceptable, however, has been criticized because they are ambiguous, involve value judgments, and vary from one culture to another. To overcome this objection, psychiatrist and historian George Mora, M.D. devised a system to describe behavioral manifestations that are normal in one context but not in another, depending on how the person is viewed by the society. This paradigm, however, may give too much weight to peer group observations and judgments.
In Mental Health: A Report of the Surgeon General, mental health is defined as a successful performance of mental functions, in terms of thought, mood, and behavior that results in productive activities, fulfilling relationships with others, and the ability to adapt to change and to cope with adversity.
A controversial view is held by the psychiatrist Thomas Szasz, who believes that the concept of mental illness should be abandoned entirely. In his book, The Myth of Mental Illness, Szasz states that normality can be measured only in terms of what persons do or do not do and that defining normality is beyond the realm of psychiatry. He claims that a belief in mental illness is akin to believing in witchcraft or demonology.
Psychiatry has been criticized over the years by certain groups for its portrayal of normality. The psychology of women, for example, has been criticized as sexist because it was formulated initially by men; similar criticism comes from other groups who believe the portrayal of their psychological issues is biased by placing undue emphasis on psychopathology rather than healthy attributes.
Functional Perspectives of Normality
The many theoretical and clinical concepts of normality seem to fall into four functional perspectives. Although each perspective is unique and has its own definition and description, the perspectives complement each other, and together they represent the totality of the behavioral science and social science approaches to the subject. The four perspectives of normality as described by Daniel Offer and Melvin Sabshin are (1) normality as health, (2) normality as utopia, (3) normality as average, and (4) normality as a process.
Normality as Health
The first perspective is basically the traditional medical psychiatric approach to health and illness. Most physicians equate normality with health and view health as an almost universal phenomenon. As a result, the behavior is assumed to be within normal limits when no manifest psychopathology is present. If all behavior were to be put on a scale, normality would encompass the major portion of the continuum, and abnormality would be the small remainder.
This definition of normality correlates with the traditional model of the doctor who attempts to free his or her patient from grossly observable signs and symptoms. To this physician, the lack of signs or symptoms indicates health. Health in this context refers to a reasonable, rather than an optimal, state of functioning. In its simplest form, this perspective described by John Romano views a healthy person as one who is reasonably free of undue pain, discomfort, and disability.
Normality as Utopia
The second perspective conceives of normality as that harmonious and optimal blending of the diverse elements of the mental apparatus that culminates in optimal functioning. Such a definition emerges when psychiatrists or psychoanalysts talk about the ideal person when they grapple with a complex problem, or when they discuss their criteria for a successful treatment. This approach can be traced back to Sigmund Freud, who when discussing normality stated, A normal ego is like normality in general, an ideal fiction.
Although this approach is characteristic of many psychoanalysts, it is by no means unique to them. It can also be found among other psychotherapists in the field of psychiatry and among psychologists of quite different persuasions.
Normality as Average
The third perspective, commonly used in normative studies of behavior, is based on a mathematical principle of the bell-shaped curve. This approach considers the middle range normal and both extremes deviant. The normative approach based on this statistical principle describes each individual in terms of general assessment and total score. Variability is described only within the context of groups, not within the context of the individual.
Although this approach is more commonly used in psychology than in psychiatry, psychiatrists have been relying on normative pencil-and-paper tests to a much larger extent than in the past. Not only do psychiatrists use instruments such as the Minnesota Multiple Personality Inventory (MMPI), they also construct their own tests and questionnaires.
Normality as Process
The fourth perspective stresses that normal behavior is the end result of interacting systems. Based on this definition, temporal changes are essential to a complete definition of normality. In other words, the normality-as-process perspective stresses changes or processes rather than a cross-sectional definition of normality.
Investigators who subscribe to this approach can be found in all the behavioral and social sciences. A typical example of the concepts in this perspective is Erik Erikson’s conceptualization of the epigenesis of personality development and the seven developmental stages essential to the attainment of mature adult functioning.
Psychoanalytic Theories of Normality
Some psychoanalysts base their concepts of normality on the absence of symptoms; but whereas the disappearance of symptoms is necessary for cure or improvement, the absence of symptoms alone does not suffice for a comprehensive definition of normality. Accordingly, most psychoanalysts view a capacity for work and enjoyment as indicating normality or, as Freud put it, the ability to love and to work.
The psychoanalyst Heinz Hartmann, M.D. conceptualized normality by describing the autonomous functions of the ego. These are psychological capacities present at birth that are conflict free, that is, uninfluenced by the internal psychic world. They include perception, intuition, comprehension, thinking, language, and certain aspects of motor development, learning, and intelligence. The concept of autonomous and conflict-free functions of the ego helps explain the mechanisms whereby some persons lead relatively normal lives in the presence of extraordinary external experiential trauma the so-called invulnerable child, that is, a child who is invulnerable to the slings and arrows of outrageous fortune by virtue of autonomous ego strengths.