What is not normal

Social norms: Not “normal” does not mean mentally ill

In social coexistence we want to rely on the fact that our counterparts behave “normally”. But who determines what is normal? In his book, the psychiatrist and sociologist Asmus Finzen works out how social norms determine our perception of normality and how they depend on the cultural framework. When the public equates “not normal” with “sick”, the dilemma that Finzen wants to draw attention to is revealed. It is just not true that a person who does not behave “normally” is automatically mentally disturbed, that is, “insane” in the popular sense. He worries his surroundings through inappropriate behavior. If this appears unpredictable or dangerous, the community tends to be excluded, be it through avoidance of contact, in the direction of prison or a psychiatric clinic.

In the first, general part, Finzen explains these complex relationships and definitions of “normality” from different perspectives. In the second, special part he comes to the use of the word in connection with mental illnesses. When distinguishing between health and illness, doctor and patient move in a wide field between pathological clarity, clinical "abnormalities" and normality, which in turn is determined by socio-cultural factors. The abbreviated formula “normal is healthy - healthy is normal” does not apply in any case. Or are all sick people “not normal”? In somatic medicine, disease can be more easily verified through laboratory results, imaging procedures and other things. The psychiatrist is largely dependent on statements from the patient and his relatives and his own observations. Based on the symptoms, the anamnesis and his findings, he then comes to a diagnosis, which is listed in the specified ICD-10 and DSM-5 catalogs. These classifications were created because of the better international comparability of diseases and their frequency, but are now often misunderstood as establishing diagnostic criteria, says Finzen. If you want to deal with psychiatric diagnostics in more detail, he refers you to the AMDP system, in which symptoms are described and weighted. It allows the examiner to differentiate between mild and severe, acute or chronic psychological abnormalities. If several symptoms together form a typical pattern, the psychiatrist can then come to a diagnosis.

Finzen also deals with the influence of the mass media, which attract readers and reinforce prejudice with sensational reports of the "crazy, publicly dangerous criminal". In fact, crimes committed by the mentally ill are extremely rare, as the author proves through figures. He puts statistics on the frequency of mental illnesses and their alleged increase to the test.

After reading this book, one will refrain from using the term “normality” in connection with mental illness. A patient is not “abnormal”, but simply sick. Beate Ringwelski

Asmus Finzen: Normality - The untamed category in psychiatry and society. Psychiatrie Verlag, Cologne 2018, 144 pages, paperback, 20.00 euros