Synonyms for the word “normal” are: usual, common, standard and typical. In medicine, “normal” is the standard of care and it means a person is sufficiently free of pathology and symptoms so as to function within the “normal” range and people do not usually seek care unless they are falling below this standard of “normal.” I am asking the question: is “normal” good enough?
Why is it that “normal” medical care is focused almost entirely on symptom treatment with little energy put into educating and training people in optimal health, not only for the well-being of individuals, but for the health of our society and for cost management of our delivery of medicine? Also, why is it that “normal” medical care in this society does not consider it to be a public-safety service, like the police and fire departments, but rather a for-profit business, while in practically every other advanced nation it is “normal” to consider health-care a human-right and public-service. Why is it “normal” to have a very “penny-wise, pound-foolish” health-care system that withholds medical care by way of cost to many, that skimps on preventive care and early detection and pays exorbitantly for disease cure, care, and management after people become much sicker than they would have with more preventive and early diagnostic care, as well as in preserving low-quality life after people have come to be unalterably terminal? Our health-care system seems to be sick, but it also seems we cannot address this problem rationally because we can’t break free of our society’s obsession with the for-profit business model and the outsized influence those who profit from this system have on the debate, even when it has proven to be an ineffective and even harmful model. Can we realize this is, in its own sense, a sickness, a product of what is considered “normal” in our society in the way of attitudes and values that do not serve us?
This brings us to the issue of mental health, where, I argue, the standard of “normal,” is inexcusably inadequate. Here we find a paucity of availability and affordability of services and a predominant emphasis on symptom management rather than achieving vibrant mental health, where we have not a mental health model but rather, a mental-illness model, for there simply is no model for mental health in Western medicine– only the varieties of mental illness. The standard, the “normal,” for what constitutes mental health is simply a relative absence of mental illness symptomology, and the levels of neurotic and character disorder symptomology that fall within the range of “normal” are very troubling and collectively may be leading to the collapse of an orderly, coherent society. The levels of what is acceptable, that is, “normal” narcissism, cynicism and sociopathy are setting a standard that is deeply deleterious to the establishment of a peaceful, just and compassionate society. Our political and commercial leadership – those who ought to be setting a standard for the society – instead often set a standard of cynical self-interest demonstrating principally talents for self-promotion and the manipulation of others. Meanwhile, the standard for common people has fallen to the level of reality (?) TV – where selfish, bickering, mean and conniving people with little emotional or impulse control are paraded as role-models. I suggest the result is levels of troubling character traits and of anger, anxiety, depression, family dysfunction and substance-abuse that are “common,” and “normal” to our society.
What ought our standard of normal be? Perhaps simple kindness and happy dispositions would be a place to start. Perhaps we could include generosity and compassion. Perhaps courage and optimism in the face of difficulty could be included, along with stable and lovingly kind families skillful in passing on stability and loving-kindness to their children. Perhaps we might include spiritual in the large sense, that is, able to revere and find sacred connection with life, with fellow human beings and the natural world. We might also include stable self-regard and self-respect that doesn’t need to be manipulative or competitive, along with freedom from addictive behaviors, and from undue anger, anxiety, and depression. Perhaps we could include freedom from prejudices against those who are not like oneself, and a sense of self-worth and well-being that is not dependent on external circumstances, and that concerns itself more with the worth and well-being of others than with one’s own as the paradoxical path to achieving one’s own humble sense of worth and well-being.
These are qualities of person that, I think, most can agree are desirable, but would not now fall within the range of “normal,” that is, “common,” in our society. The result is an increasingly unstable society made up of increasingly unstable individuals. No, normal is not good enough. It is, in fact, quite inadequate.
I long ago came to consider optimal mental health as inextricably linked to spiritual health, using the term “spiritual” in the broadest sense. I mean here, the ability to see and act in the world with a sense of the sacredness of all life; of one’s own life, of the lives of others, of the natural world and of the miracle of existence itself. I see the core religious teachings of many traditions as emphasizing compassion, forgiveness, tolerance, wonder, material simplicity, generosity, connection, respect, and love as actually pointing toward what is necessary for good mental health and happiness. Yet, while the core teachings have these points of emphasis, it is not “normally” how most religions or their followers have functioned in the world. I surmise this is because, considered “normal” in the cultures of these religions, are even stronger beliefs in competitiveness, greed, judgment, the threat and otherness of those who are different, and the need to control and dominate. These are beliefs that lead to anxiety, anger, problems of self-esteem and esteeming others, intolerance and conflict, and the elevation of character traits such as narcissism, materialism, belligerence, dishonesty, lack of empathy, and exploitiveness as “normal,” even admirable. These beliefs do not lead to mentally healthy individuals nor a mentally healthy society.
I have long admired Buddhism as a religion that seems to do better at walking its talk than the religions of the West, and I speculate that the difference is in its emphasis on the development of personal virtue rather than the imposition of morality as the key to healthy individuals and societies. This may seem like an issue of semantics, but it is not. The development of virtue is a personal responsibility and goal, and it requires constant self-examination and deliberate contemplation concerning one’s own motivation and equilibrium in the world. It works because it is self-reinforcing in that the development of virtue actually does lead to greater happiness and the alleviation of unnecessary suffering. It requires some degree of meditation, a quieting of the mind and the development of observant self-awareness that reveals how we are caught in psycho-social-culturally conditioned thought and emotion patterns that are unstable and untrue, and exposes how a life-strategy of selfishness and self-centeredness is ineffective in bringing happiness. Meditation also brings about liberation from these prisons of mental habit as we are able to experience directly the truth that we are inherently peaceful, good and wise, while also susceptible to corruption when we are taught to look outside ourselves to the socially “normal” standard of self-interest-first.
Morality, on the other hand, is a concept of externally imposed rules in a world viewed as one where people are inherently flawed and must be coercively controlled because self-interest-first is considered “normal.” Virtue holds that people are inherently good while morality holds that people are inherently bad. The difference is quite significant and is the basis of “faith” in Buddhism. When one’s faith is in one’s own inherent goodness, which can be experienced, rather than an unexperienceable judgmental and moralistic god, goodness as virtue is readily developed. After several thousand years of morality religion failing to produce with any consistency virtuous individuals or societies, perhaps a reexamination is called for. It seems to be an observational fact that societies dominated by religions of morality are less than mentally healthy.
A wonderful story concerning the Dalai Lama tells of his attending a psychological conference in his early days in the West where the topic of discussion was the problem of both deflated and inflated self-esteem in American culture. He was having a great deal of difficulty grasping the discussion and was uncertain if he was having a language translation problem in understanding. It turns out, that to a certain degree, he was; for the concept of self-esteem is not one that presents as a problem within Tibetan culture. The idea itself was foreign to him. When he did grasp what the topic was, he was greatly saddened to learn that in the West, with all its material wealth, there seems to be a spiritual poverty that creates this problem of imbalanced sense of self-in-the world. He said that Tibetans who were materially very simple never experienced this kind of spiritual/psychological poverty. For them, this objectification of life and people leading to struggles in self-esteem that is “normal” in America doesn’t exist.
It would seem that “normal” might be a concept that needs re-examination when it results in failure to live healthy, happy, kind, and virtuous lives. Perhaps we might consider finding ways of living and being, of creating a society, which is a bit saner than what is now “normal.” We don’t need to become Buddhist to see that perhaps Buddhism has some valuable insight that is wholly in keeping with Christian, Jewish, Islamic or Humanistic teachings and values that might be helpful if incorporated into a new “normal” that is truly healthy and sane.