What’s Typical?

This article seeks to challenge the ways we think of psychiatry, disorders, and identity, raising provoking questions about diagnoses and the self.

Reading Time: 4 minutes

Is there a normal human mind? There’s a word for it: neurotypical, which originally described being non-autistic. But, that’s about all—psychology has a much more nebulous definition of wellbeing than other areas of medicine. While hematologists, for example, know the healthy ranges for blood proteins, psychologists rely on often vague standards for neurotypicality. While at the extremes of the mental health spectrum quality of life differences are undeniable, what is considered out of the ordinary around the middle range varies.

To recognize mental disorders, it is necessary to establish a baseline for the ways the brain ought to function. In the US, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association is the authority on psychiatric illnesses. Internationally, the compilation of disorders and diseases of all types is kept by the World Health Organization in the International Classification of Diseases (ICD). Both the DSM-5 and the ICD have been criticized for hardly taking into account the cultural factors involved in mental health diagnoses.

One of the controversies surrounding the DSM-5 is its alleged “medicalization” of mild issues. That is, psychiatrists worry the DSM-5 has labeled some normal troubles to the level of disorders. In particular, the previous DSM edition included a “Bereavement Exclusion,” which ruled out the responses to the death of a loved one as symptoms of Major Depressive Disorder. The removal of this exclusion in the DSM-5 sparked a debate about treating grief like an illness or as a fact of life. The issue at the core of the dispute is that there is no extensive standard for neurotypicality.

To explore this standard, people are working on defining the standard mind. Scientists like Dr. Sebastien Seung at Princeton University are working on technology capable of mapping the human brain in its entirety—every cell, synapse, and memory. The mapping process requires a beam of ions that vaporizes extremely thin layers of brain tissue, revealing layer-by-layer areas for electron microscopes to scan. This method is painstakingly slow and sensitive, and, once captured, the images still need to be connected to each other through tracing the cells in them. Seung has released an AI-powered game for the public to help with the tracing, but the project is still miles behind the speed and power needed to map even one human brain. Seung might be able to determine the exact structures that all humans “should” have, and if he succeeds in tracing out the exact pathways where thoughts are born and actions executed, it could revolutionize psychiatry. Categorizing and diagnosing mental disorders would then revolve around recognizing biomarkers—measurable physical substances indicating disease—of those disorders, as opposed to relying on psychological symptoms.

Even locating biomarkers for disorders might not resolve all diagnostic issues because not everyone has the same conception of a healthy mind. The cross-over points from neurotypical to disordered are not fixed. When someone is experiencing suicidal thoughts, it is clear that they are unwell, but when someone has been feeling depressed for some time, it might just be a predictable reaction to an event.

Culture changes perceptions even at the extremes—consider the case of schizophrenia, which can be debilitating. Schizophrenics can still lead meaningful lives, and there are methods to keep them in school and work, such as antipsychotics. Antipsychotic drugs block receptors in the brain to counteract dopamine excesses that lead to hallucinations. Managing psychosis, the loss of contact with reality, enhances the patient’s quality of life, and there is value in treating their mental distress. Yet, the perspective that disorders can be peeled back to reveal the “real,” productive self is not necessarily shared outside of the western psychiatric model. In some cultures, people who hear voices might become healers or shamans revered for their window to otherwise inaccessible things. Instead of medicating and urging a return to the norms of the majority, such cultures embrace neurodivergence. This response to exceptions to the norm, when compared with the American one, indicates that “disorder” and “the real you” are culturally specific definitions.

Questions of classifying disorders and whether or not one should seek to fix a pattern of behavior or mood raise further questions of how and whether to separate a person from their disorder, which opens a Pandora's box of definitions of identity and the effects of medication on it. Worries about changing some fundamental part of the self can result in resistance to medication, particularly for adolescents who are still solidifying their identities. To see the changes that treatment induces, changes in behavior and mood can be tracked easily enough, but to differentiate the medicated versus “true” self is a whole other matter: it requires defining the self.

Codifying personhood is another task dictated by cultural context, because people think of the self differently across cultures. In the US and other English-speaking developed countries, there exist personality tests to analyze what sort of person one is, with the full spectrum being reducible to combinations of the Big Five personality traits and the like. Some, such as Buddhists, reject the concept of self altogether. For others, identity is simply electricity and compounds moving around in the mind. If emotions are just chemical, perhaps the self produced with medication is like a laboratory-made diamond—identical to the real thing, with only human feelings insisting something is profoundly different about the naturally produced.

It’s hard not to feel as though all of psychiatry is based on arbitrary constructs, but perhaps to say so is to miss the point. Diagnoses, ways of thinking about mental health, and conceptions of identity and the self are all products of culture, and cannot be separated from those cultural influences. Everything about our approach to mental health is, to a degree, based in the subjective and constructed. But, above all, the symptoms of mental distress are being felt by people right now, regardless of how those symptoms are interpreted. Contemplation of cultural and psychiatric matters is possible and necessary for the future of the field in a culturally conscious world—but mental health interventions can and should still be made now, because regardless of their names, disorders have real impacts.