What is Normal? Subjectivity in Psychiatry Self-Destructs

This gay psychiatrist
would not want to live
in the world he promotes

‘What is normal today may not be normal in a year’s time’: Dr. Dinesh Bhugra on the idea of ‘normal’ in psychiatry (19 Sept 2024, Live Science). Describing Dr Dinesh Bhugra as a “leading psychiatrist” and head of the World Psychiatric Association, reporter Nicoletta Lanese allowed him to promote subjectivity about what is considered “normal behavior” in a culture. This “the first openly gay president of the WPA” described the message of a talk he planned to give at a conference with the quasi-religious title, “How the Light Gets In.”

It’s about “What’s normal?” And again, from a cultural perspective, what’s normal in one culture is not normal in another. Particularly from a psychiatric point of view, we need to be sensitive to those variations and variables. And it’s also worth considering that what is normal today may not be normal in a year’s time; what was normal 50 years ago may not be acceptable, may be seen as deviant now.

From a historical perspective, he’s right. Before 1973, homosexuality was listed as deviant behavior in psychiatric manuals. That was until homosexual advocates rioted and demanded acceptance. Here we are in 2024, with an openly gay leader of a world group of psychiatrists working to combat “prejudice and discriminatory policies” that he feels “impact the mental health and suicide rates of LGBTQ+ people.” And so now, multiple kinds of behaviors once called deviant are being considered “normal.”

But are they really normal intrinsically? It’s true that different cultures have different behavioral norms, but can they be stretched without limit? We all have human bodies and human brains that constrain what is possible. And we have body parts that were designed for “normal” reproduction, which requires the union of a male and female, true for the entire world of sexual organisms. That much is intuitively obvious.

What does not seem obvious to Dr Bhugra, reporter Lanese and those who agree with their view, is that subjectivity is not sustainable. Subjectivity implodes. It is self-refuting. To say that “nothing is absolute” is an absolute statement—it refutes itself. Hidden within Bhugra’s statements are absolutist moral principles, some agreeable, and some worrisome:

• And I think that needs to shift. … It’s incredibly important to see the individual as an individual rather than as a set of symptoms.
• Particularly from a psychiatric point of view, we need to be sensitive to those variations and variables.
• We all need to look after our mental health and well-being so that we can look after our physical health, and vice versa.
• And we need to be aware both from a policy perspective, but also from [the perspective of improving] prevention of mental illnesses and distress and promoting well-being and mental health.

For each of these points, ask “Why?” or “Says who?” Bhugra, afflicted with the common academic mental illness called the Yoda Complex, thinks these “needs” are normal today. But if they “may not be normal in a year” there is nothing to stop a future WPA president from declaring these opinions as abnormal, or worse, deviant. If that were to happen, Dr Bhugra could be subjected to shock treatment, drugs or even imprisonment some future day when the tides of normality have shifted in the temporary prevailing winds of a subjective world.

On psychiatry, see also:

• Psychiatry ascribes empty names to clusters of symptoms (23 Feb 2016)
• Psychiatry is not (yet) a science (10 May 2013)
• Shrink validity is shrinking (18 May 2012)

or search the category “Humanity / Mind and Brain” from the front page.

Lanese did not catch him on this point, because few are the people who think these matters through. It’s “normal” today to be accepting, inclusive, and sensitive to those who 50 years ago were considered deviant. But in a subjective world, if one culture’s deviancy is another culture’s normality, and vice versa, then anything goes—including intolerance of the tolerant.

She could have asked him if he condones child pornography, child molestation, sex trafficking, sex slavery (or any other kind of slavery), torture during sex, incest, polygamy, group sex orgies and worse things too graphic to mention. If he said that he “personally” did not like such things, she could have called him intolerant. If he condemned any of them, she could have said, “But you said what is normal today may not be normal in a year.” What could he say, except “I guess you trapped me in a checkmate.”

Bhugra would not want to live in a world with no absolute standards. If he were pushed with hard questions, he might express some very condemnatory words against people he does not feel sufficiently tolerant of LGBTQ+ people and others he now considers normal. But he would have no grounds for complaint. This is how “tolerance” ends: it collapses into intolerance of the intolerant, a contradiction of its own basic premise. The same goes for diversity, equity, and inclusion. [Think those through as an exercise.]

Christians have an absolute standard—the character of God—to guide their opinions about normal vs deviant behavior. Part of that includes love and respect for everyone created in his image. No Christian would, therefore, condone individuals acting as vigilantes, attacking those engaged in ungodly behaviors, unless someone else’s life or safety was at stake. God has the right to judge sin, as he did dramatically in Sodom and Gomorrah, and at the Flood. He has delegated some judgment to man. He instituted human governments to enforce the moral principles we all know in our consciences as part of the Imago Dei (image of God) that sets us apart from animals.

Government officials may argue vociferously about what is right or wrong, or normal vs abnormal, but when laws are made, it takes moral judgments out of the hands of vigilantes and places them under the rule of law. Without the rule of law, a human society will degenerate into a “war of all against all” that worried Thomas Hobbes. While there is some range of variability in what is considered normal or acceptable compared to 50 years ago, that variability is not unlimited. Dr Bhugra should thank his Maker for objective moral standards. Otherwise, he might be hiding out in the bushes in fear, trying to escape gangs of perverts trying to torture him and abuse his body for fun.

Exercise: Discuss in a group the limits of cultural variability. What things are subjective (music, dance styles, dress… what else?) and what are matters of objectively moral right and wrong for every culture and time? (murder, rape, theft… what else?). What are extreme examples of “normal” behavior in past cultures? For instance, Rome thought it normal to crucify Christians or turn lions on them—even women and children—in arenas as crowds had lunch and cheered. Many cultures have persecuted Jews and Christians, and sometimes those roles were reversed. Some recent cultures have committed genocide. Would a juror have solid grounds for condoning or condemning such things? On what basis? Another discussion topic: Is it acceptable for powers in government, entertainment or the media to foist notions of normal behavior against the wishes of the majority of citizens?