Defining Normal

This is actually an essay I wrote for a contest to combine several usually distinct disciplines. Here, I combined the idea of a statistical norm with our sociological and psychological perception of what is normal behavior for a child, as exemplified by the saga of ADHD. 

It's very long, so please, don't feel the need to read the whole thing. I just felt silly, because only one or two people ever actually got to see this essay. 

         "There is a reason children love stories. Their imaginations are uninfluenced, free from the petty physics of this world. My love of stories began when, at 8-1/2 years old, browsing through Mrs. O’Keefe’s book nook, I happened to pick up Madeline L’Engle’s A Wrinkle in Time. As I read it, I became enraptured. To me, L’Engle’s world was consuming, a place I yearned for and never wanted to leave. Since that hunger was born in me, I have developed a voracious appetite for children’s literature. I cherish the ability children have to see more clearly than adults do, unburdened by world-weary baggage.

            Children understand that the lifeblood of the world is a good story. The smallest thing can inspire an excellent anecdote for a child, from seeing a surprise rainbow, to finding a toad in an unexpected place. Children recognize that without stories, life would lose some of its glorious luster, the ability we have to allay the pedantic meanderings of this world with the distracting magic of imagination. It seems that as we grow older, our spectrum narrows, as we necessarily focus our attentions on this or that responsibility. While not always needed, occasionally tempering this new adulthood with the clarity of youth can be one of the most insightful ventures we have the privilege to undertake.

            When you grow up in the thick of storytelling, you start to see narratives popping up wherever you go. Stories lead meandering paths through everything, from the defining moments of our lives, to the saga of research and development that goes into the creation of a diagnosis, a drug, or the making of the atomic bomb. Stories have the natural tendency to bring together discordant characters, to merge plotlines in places where we wouldn’t have been able to make connections before, and to create a little color in the amazing amalgamation that is the human experience. One of the most amazing gifts of the viewpoint of a child is this ability to examine the stories within our lives. It’s refreshing – and revealing. Seeing stories in the often “mundane” patterns that exist in scientific areas like neuroscience and psychology can help reveal quintessential questions, and hopefully develop, like a gently arcing plot, some answers.    

            I study childhood disorders in psychology because I empathize with a child’s perspective. In my own search for truth and knowledge, I am constantly donning the glasses of a child. With a little brother diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), I am well aware of the piercing pain that comes from seeing a disabled child who, through no fault of his own, cannot comprehend where to find his own stories. He turns, anxiously, each new day bringing questions of why he struggles to belong, where his place is in this world. I would love to be able to give him the pride of knowing he is a master storyteller, even if his is not the “normal” tale.

I firmly believe that our experiences in childhood form the backbone of the “story” of how we handle the rest of our lives. It is this belief that brings me time and again to the question: “What is normal?” How we craft the definition to this word determines the course of the lives of millions of children and adults every day. Popular estimates show that between 12-22% of children under the age of 18 suffer from a “mental disorder[1][1].” Where is the story behind that statistic? How did we get to be such a diagnostically-fevered society? A now infamous article by child psychologists John Richers and Dante Cicchetti uses the case studies of both Tom Sawyer and Huckleberry Finn to point out some of the absurdity behind our hunger for diagnosis. Both boys, according to the Diagnostic and Statistical Manual (psychology’s Bible of diagnostic criteria) would qualify for a diagnosis of Conduct Disorder, which is characterized by the engagement in certain anti-social behaviors for at least six months[2][2]. One of the main focuses of the article is on the simple point that children have to be examined within context. How did these children perceive themselves? Certainly not as enfeebled and mentally crippled victims! This is one of the main conundrums of diagnosing children. What upsets and disrupts the life of a child is usually significantly different from those things that we would label as “upsetting and disrupting” in the life of an adult. In other words, how we define normal for children is going to be inherently different from how we define normal for adults.

Nowhere is this concept of normality and how we define it more salient than in the debate surrounding the childhood disorder ADHD. ADHD is marked by “developmentally inappropriate” hyperactivity, impulsivity, and inattention. It has come under extreme fire in both the media and in the research community for being a collection of symptoms that most people inherently associate with children, especially boys. Many argue that ADHD is just another example of this “hunger for diagnosis,” that children don’t actually have anything “wrong” with them, but psychologists and parents would like to make something wrong with them. In reality, parents and children alike struggle every day with this very real disorder, trying to make schedules, reward posters, and behavioral management programs to help their child succeed. The stress, frustration, and exhaustion that come along with the reality of a disorder like ADHD aren’t things you can portray with a diagnosis. Because of this, many see a diagnosis of something like ADHD, and are repulsed by what they view as unnecessary and ridiculous. But even more important is the fact that ADHD is defined by what psychologists call “appropriate development.” The term “appropriate” is given to that range of behaviors that is considered “normal.” Perhaps the real question behind the reality of ADHD is, “What is normal?” Defining normal necessitates a holistic outlook, much like a child’s tendency to see endless stories in everyday life. While stories may seem childish, the value of looking at a “whole-picture” scenario is immeasurable, especially when we are attempting to redefine a child’s life with a diagnosis.

The idea of having a child-like, holistic outlook on how we define “normal” is a new and intriguing idea for psychologists and neuroscientists alike. Science, as a “field,” tends to be rather serious. It has its own language, its own edicts of how to “get in” and what sorts of things you have to do in order to “belong.” It wouldn’t rank particularly high on my list of specialties in which taking the viewpoint of a child is encouraged. And yet, neuroscientists and psychologists are faced daily with the heart-wrenching issue of whether to give a child a serious diagnosis or not. This is where the question, “What is normal?” has come to dwell. I believe that finding the answer lies in discovering the true value of stories as paths to wisdom.

Historically, normalcy has been statistically defined by the bell curve. Simple and easy to understand, the bell curve represents the distribution of everything from childhood disorders to eating habits. Most people fall in the middle. This peak is “normal.” Here, “normal” is defined by the median of the population – an anomaly of data suggesting that “whatever most people are, that is what’s normal.” Unfortunately, in a large enough population, that leaves a lot of people dragging along the edges. Is every child who engages in certain anti-social behaviors for six months really suffering from Conduct Disorder? Even if they fall along the edges of the “normalcy curve” diagnosing them may not be the best option. Diagnoses carry a lot of weight. They are small burdens for many people, packages to be carried from high school, to college, into relationships, and out of jobs. They can change the course of the entire story.

When my little brother was diagnosed with ADHD, a lot of plans and hopes had to be put aside or remade in the light of what we were now facing. Josh struggles with everything from making friends to finishing homework. We’ve had to find a new school, a new schedule, and a new way of dealing with everything from spilled soup to driving to the store in order to accommodate him. None of the changes we have made as a family have been easy, nor were any of them in mind when my mom received the fantastic news that she was pregnant again. Everything we’ve done for Josh has caused major adjustments to the plotline. Every new medication brings about a slightly different protagonist, every new therapy a small hope for success. This is the real story of a diagnosis, and it emphasizes the need for a good definition behind “normal.”

  Most psychologists and neurologists offer the definition of normalcy with a caveat – Are the symptoms causing the individual significant distress and disability? If a child (or adult) is not suffering from the “presentation” of his or her “symptoms,” do clinicians have any right to bend him or her to our liking and redirect him or her onto the “path of the average?” The issue that lies behind the assumption of the standard curve is that we may all determine our curves in different ways. What if we have a unique population with a skewed idea of “most people?” What if the “glasses” we don to look at our world are different from one another? In the 1930’s and 40’s, we had barely begun to acknowledge that children could have mental disorders. Today, as many as 1 in 4 children meets diagnostic criteria for one. If this is a result of parent advocacy, a changed perspective on childhood, or research only being done in specific populations, we need to step back and evaluate our case for pathology. Neuroscience and psychology are enchanting, fascinating disciplines. They provide the model for answering questions of normalacy, pathology, bias, interest, childhood and history. In the study of neuroscience and psychology, you find a study of humanity itself, an examination of the development of the mind.

Whether in these fields or in the creation of a beloved work of children’s fiction, we are all subject to the veil of the question, “What is normal?” It is not enough that we claim to have the best interests of children at heart. Research, by its nature, peers into the lives of the individuals it studies and demands an explanation for errant or untoward behavior. It is, in short, looking for a diagnosis. Children deserve the opportunity to exist outside of adulthood before we thrust our machinations of normalacy and functionality upon them. When people ask me how I define normal, I insist upon the examination of a person as an individual entity, trying to piece out the ways in which he or she defines him or herself, and most importantly, whether he or she is distraught about the manner in which his or her symptoms are cropping up. In short, I want to view any child I work with as a protagonist in an intricate and complicated story. What is the difference, after all, between psychopathic delusions of grandeur and a child’s innocent desire to imagine a kingdom for herself? This is where stories and science merge. Without context, you cannot imagine the scope of a disorder. Without reading the story, you cannot truly know the characters.

Children are one of our greatest gifts. Our recognition that children have that essential and wonderful quality of “childhood” makes their existence in our lives all the more vivid and revealing. Neuroscience and psychology bridge many divides that have long puzzled us with regard to childhood and the mind. Our greatest challenge is finding a way to fit psychopathology within the framework of helping children grow and feel unconditionally loved, even if theirs are unconventional tales."