Is This Normal?

              Therapists are quick to say, what is normal anyway? We are reassuring our patients that there is significant variability in humans and encouraging people to not judge their symptoms or circumstances by comparing their problems to others. This level of judgment is counterproductive. Rather, we implore our clients to be curious about their issues. We want them to join us in investigating further, not feeling shame for having their problem.

              That being said, therapists act as the arbiter of what is normal, whether we want to admit it or not. One of the most therapeutic interventions we use is to normalize and validate our patient’s experience. “It’s normal to be so angry at your child that you want to hit them. That doesn’t make you a bad person.” “Given your history of being sexually assaulted, being anxious about sex with a safe partner is normal”. “If I was told my whole life that I was worthless, I would probably start to believe it too”.

              According to the group therapy guru Dr. Irvin Yalom, Universality is one of the core components to healing in a group therapy setting. People sharing similar stories and knowing that they are not alone is, in and of itself, therapeutic and relieving. Even more aberrant behavior is not as rare or unheard of in humanhood than we might think. Examples of this might be trichotillomania (pulling out your hair compulsively), fetishes, pica (craving and consumption of non-food items), cross-dressing, and excoriation (picking/scratching at your skin to the point of rawness). Other less discussed anomalies exist such as dissociation (disconnecting mentally) and asexuality which can lead a person to feel that they are the only one. Knowing you’re not alone is comforting.

              Conversely, it is your therapist’s job to acknowledge and discuss what is not normal. Indeed, some psychological disorders or symptoms are objectively not “normal”. Psychosis, dementia, tic disorders, and catatonia are examples of organic disease states. These disorders require specific treatment and collaboration with medical professionals. It is less challenging for clinicians to say, “no, it’s not normal to hear voices”, “you are not having a heart attack, you are having a panic attack”, or “washing your hands 12 times is excessive”.

              But this isn’t really what we are talking about when we say normal. Many characteristics differentiate humans and lie on a spectrum. It can be normal to have anxiety in a job interview to the point that your voice cracks and your mind goes blank. We consider it disordered (thus not normal) to have a panic attack. Most feel sad when a loved one dies, but it is unreasonable if the person can’t get out of bed for three weeks. It can even be normal to think of your own death when overwhelmed with difficult emotion, but it is extreme if the person is planning and rehearsing their suicide.

              Therapists are continually analyzing your symptoms. We reassure and validate when you have an expected response or normal symptom. We also point out the red flags in your behavior, symptom severity, or response. This is the process of conceptualizing diagnosis when working with patients. Therapists look at the cluster of symptoms, the severity and longevity of the problem, and decide if it is disordered or within the normal scope of the human experience.

              So why do therapists rely on the familiar non-answer of, “What is normal anyway?” Personally, I don't find it very helpful when patients become preoccupied with whether they are normal. My concern is whether they are suffering and whether I can help. A diagnosis may guide treatment, but it is not the most important thing happening in the room. The goal of therapy is not to prove that you are normal. The goal is to help you suffer less and live better.

              So, forgive us for being squirmy around this question. We do so with your best interests in mind!