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The concept of "normal" vs. symptoms?


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This is going to be kinda long, and I don't know if it will be triggery, so heads up and apologies in advance.

 

I'm struggling with the whole concept of what is normal and common, in terms of what I experience versus the majority of the world. Or versus MI or healthy. Not sure if that makes sense but maybe I can explain that better.

 

I started feeling the very first signs of depression when I was around 13 - I have a few very confused diary entries where I wondered if everyone else feels the same way and just doesn't talk about it, or if there was something actually wrong with me. I opted to believe the former for a long time, and didn't seek any treatment until I was 25 and was treated for PPD. But over the years, I have often wondered if most people experience the same things, or if I'm "unusual" in some way (with more perspective, I think I truly have been wondering if these experiences are things "everyone" deals with, even healthy people, or if it's more related to MI in some form or another).

 

Some examples, and my thoughts around them:

 

Depression - it took me AGES to come to grips with the fact that I was actually suffering from depression, in large part because my mom told me over and over that "all people feel like that sometimes, especially teenagers, and sometimes you just have a hard time." And as I got older, I had several big emotional hurdles, one after another, to deal with, so it made sense that I was "having a hard time" for things like that. It took many, many years for me to admit that it was more than "a hard time" and that I wasn't capable of making it better on my own. Until then, I really believed that life was like that for everyone, and I was just feeling sorry for myself.

 

Voices. I've never once said I hear voices in my head. But I hear voices all the time. I always assumed that was my inner monologue, and that everyone has that. I see them all as various facets of myself, not as distinct "personalities" or anything. I could call one "Negative Me" and another "Angry Me" and another "Mom Voice" and so on. I have always believed that most people have that, and that truly hearing "voices" is different - and therefore I have no frame of reference because I've never experienced it. I don't think I actually "hear voices" and have a hard time relating to what that might be like.

 

Another one is suicidal thoughts. This is a bigger deal for me, and the reason I'm concerned about any of this in the first place, honestly. For many, many years, I have had images that bombard me. Usually violent images or action sequences, typically involving me doing something horrible to myself or to someone else. One long-standing one has been me driving my car at high speed into a telephone pole or an oncoming truck. I know, in my logical mind, that I would never actually DO these things that I envision. But the images are so vivid, and they freak me out. Several years ago I mentioned them to my ex husband, and he looked at me in horror - and told me to get into counseling ASAP because I was having "suicidal thoughts." We actually got into a huge fight over it, because I didn't think I was suicidal and I felt that if I knew I wasn't going to act on these thoughts, it didn't count as "suicidal thoughts." I was too scared to ever mention it to my counselor, lest he think I was actually crazy (heh). But the fact is, I still have them, and they freak me out. I tell myself that everyone has them from time to time, and that they mean nothing - but Rational Me is starting to doubt that line of reasoning.

 

At the same time, there are some things that are clearly NOT the standard run of the mill for healthy folks - panic attacks are one obvious example for me that signal "something is wrong here." 

 

There are many more examples I could give, but ultimately I guess my concern, boiled down, is this:  How do you determine what is "normal" for most people - healthy or otherwise - and what is actually a sign or symptom of something more? How do you decide what to ask a doc about?

Edited by meow
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I think you should, if you can just tell the Doctor the whole of how you feel, let him/her decide what is a disorder or not (it's kind of what they are paid for). Remember pdocs have seen many cases of MI and there is nothing to be embarrassed about,one even told me about his own MI.

 

I also got told that it was normal for teenager to be a bit down or moody by a lot of people in my life/on TV, but i always felt there was something MORE.When i got suicidal thoughts, it was confirmed to me that this was depression.

 

I also have this internal monologue, it's made up of my thoughts and feeling and what people have said to me in the past, even things on TV.I also have no idea as to whether this is normal or not either. I once told my parents i heard voices and they completely freaked out, i didn't get a chance to explain what i actually meant. I sometimes think these are symptoms of childhood ptsd, but i'm not sure.

Edited by neptunesky
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Yes many people feel symptoms of mental illness at certain points of their lives but it's not the same. When doctors are diagnosing mental illness they look into these factors as well: 

  1. If a behavior is harmful to the person or those around them 
  2. If symptoms have direct negative consequences on the person's life
    (whether that be inability to hold relationships, a job, etc)
  3. The symptoms are consistently present for at least 6 months
    (sometimes it's longer depending on the disorder being diagnosed)
  4. The symptoms cannot be linked to a particular stressor (no known cause or event)

As for the voices, most people have a single inner monologue that is in their voice and perspective. I am making a very general statement here and it isn't uncommon for people to experience their monologue differently. Can you distinguish which voice is talking by different tones? Do the voices sound different? Do you ever hear multiple voices at once or voices conversing with themselves? Even if you answered yes it might not be standard "normal" but it still isn't a cause for alarm. As long as the voices aren't aggressive or coercive.

 

The suicidal thoughts are a form of intrusive thoughts and they are normal, to an extent. These thoughts commonly occur during mindless activities or alone time where your mind is wondering. If you are focused on a task when intrusive thoughts come in that's less along what is normal and more toward problematic. At one point my suicidal thoughts impaired my ability to focus in class. Again, it all depends on how frequently they occur and how disturbing they are to you.

 

At the end of the day, comparing yourself to others and what's "normal" isn't as important as whether you are feeling distressed. If you feel unwell then something is wrong and needs to be solved. Hope that helps :)

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Yes many people feel symptoms of mental illness at certain points of their lives but it's not the same. When doctors are diagnosing mental illness they look into these factors as well: 

  • If a behavior is harmful to the person or those around them 
  • If symptoms have direct negative consequences on the person's life

    (whether that be inability to hold relationships, a job, etc)

  • The symptoms are consistently present for at least 6 months

    (sometimes it's longer depending on the disorder being diagnosed)

  • The symptoms cannot be linked to a particular stressor (no known cause or event)
As for the voices, most people have a single inner monologue that is in their voice and perspective. I am making a very general statement here and it isn't uncommon for people to experience their monologue differently. Can you distinguish which voice is talking by different tones? Do the voices sound different? Do you ever hear multiple voices at once or voices conversing with themselves? Even if you answered yes it might not be standard "normal" but it still isn't a cause for alarm. As long as the voices aren't aggressive or coercive.

 

The suicidal thoughts are a form of intrusive thoughts and they are normal, to an extent. These thoughts commonly occur during mindless activities or alone time where your mind is wondering. If you are focused on a task when intrusive thoughts come in that's less along what is normal and more toward problematic. At one point my suicidal thoughts impaired my ability to focus in class. Again, it all depends on how frequently they occur and how disturbing they are to you.

 

At the end of the day, comparing yourself to others and what's "normal" isn't as important as whether you are feeling distressed. If you feel unwell then something is wrong and needs to be solved. Hope that helps :)

I agree with the general sentiment here - strongly. It's distress or impairment in functioning that really matter. The term "normal" is just not that helpful compared to looking at your quality of life.

But you got a couple of details wrong. 6 months might be a benchmark for, say, diagnosing generalized anxiety disorder. But for psychosis there's no minimum. For major depression it's two weeks. For dysthymia (now chronic depression) it's two years. And even if you don't make those cut offs, if it's creating problems it probably needs treatment.

And the stressor thing is basically not true - most MIs will be diagnosed regardless of if there's a stressor, including depression. cf "stress diathesis model." It's not unusual for MIs or their episodes to be triggered by stress.

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I spent a lot my teens and twenties agonizing about what was 'normal' and what kind of lives the 'normals' were having. My mental illness as a young person went untreated for a long time so I had very little reference to measure what I could have expected my life to be like otherwise. And I am glad I finally got help for what I knew wasn't 'right' and helped me back, even if the names for and treatment varied.

 

It is tricky because in a wider sense, mental health is not something we talk about in society. People will talk about having a cold or that time they got food poisoning, but no one really talks about having depression or the odd suicidal thought or the thoughts you describe, the intrusive disturbing ones. And when the population is studied, high numbers of people without a diagnosed MI admit having those experiences at times. Not regularly enough or intensely enough for it to be mental illness. But even if you take something like bereavement, which we all go through and is not mental illness, there is still a huge silence and secrecy around it. There is still a sense that there is a 'right' way to grieve. People still tip toe around it. And grieving people still feel guilt for not getting over the death quick enough. We;re living in a society has no real way to talk about what is going on peoples heads.

 

In that sense, what is normality and how would we know? Studies indicate that something one in four people in the UK have a mental health problem in any given year. That is a lot of normal looking people wandering around to compare yourself to. Who knows how much people struggle with this stuff? And many of my normal friends went about the 'normal' path in life - Uni>job>wedding>house>baby and are SO miserable and messed up at how dissatisfying they find that. There is nothing wrong with that path, but it's held up as what we ought to be aspire to.

 

Much of my suffering around my mental health dissipated when I realized that we're all just fucked up people, to varying degrees, hiding it with varying amounts of success and trying to get by. The majority of the people around me who spent their time telling me how life ought to be and whether or not I was ill or imagining it; most of those were denial about their own raging mental ill health.

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Did you tell the "examples, and my thoughts around them" from your diary also too pdoc?  You could let him/her read everything (of almost everything) from the diary, hiding things can give a wrong picture too the pdoc.

 

What I suppose is that you have had a very severe (psychotic) depression at young age.

 

It is mostly very difficult for people with a mental illness too determine what's normal and what's not. You can compare with others, or years before your depression. But personally I found the book CBT for dummies (about Cognitive Behaviors therapy) handful for this situation.  I learned much about what ....

 

:) Best wishes

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Yes many people feel symptoms of mental illness at certain points of their lives but it's not the same. When doctors are diagnosing mental illness they look into these factors as well: 

  • If a behavior is harmful to the person or those around them 
  • If symptoms have direct negative consequences on the person's life

    (whether that be inability to hold relationships, a job, etc)

  • The symptoms are consistently present for at least 6 months

    (sometimes it's longer depending on the disorder being diagnosed)

  • The symptoms cannot be linked to a particular stressor (no known cause or event)

But you got a couple of details wrong. 6 months might be a benchmark for, say, diagnosing generalized anxiety disorder. But for psychosis there's no minimum. For major depression it's two weeks. For dysthymia (now chronic depression) it's two years. And even if you don't make those cut offs, if it's creating problems it probably needs treatment.

And the stressor thing is basically not true - most MIs will be diagnosed regardless of if there's a stressor, including depression. cf "stress diathesis model." It's not unusual for MIs or their episodes to be triggered by stress.

 

 

I didn't convey my point as clearly as I intended. Those factors aren't boundaries for a mental illness diagnosis; they are reflective of what is a chemical imbalance caused by genetic predisposition as oppose to what is "normal" IE circumstantial chemical imbalance. They are often treated differently. 

 

 

I do realize that symptoms for people with genetic predisposition's can also be triggered later in life by stressors but these generally last much longer and are more treatment resistant than "normal" imbalances. 

 

I agree they diagnose, for example, depression in people who've suffered a loss and show the symptoms however this is considered "normal"

 

Thank you for clarifying. I've been quite sleep-deprived lately. 

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Did you tell the "examples, and my thoughts around them" from your diary also too pdoc?  You could let him/her read everything (of almost everything) from the diary, hiding things can give a wrong picture too the pdoc.

 

What I suppose is that you have had a very severe (psychotic) depression at young age.

 

It is mostly very difficult for people with a mental illness too determine what's normal and what's not. You can compare with others, or years before your depression. But personally I found the book CBT for dummies (about Cognitive Behaviors therapy) handful for this situation.  I learned much about what ....

 

:) Best wishes

 

You are not a doctor, have never met this person and are in not position to tell them if they have had a very severe psychotic depression from a young age. Please stop diagnosing, it is against forum rules.

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"I'm struggling with the whole concept of what is normal and common,"

 

Meow, I won't add to the good comments above about symptoms and mental health but, tackling a different angle, "normal" is a term and concept burdened with several different meanings and usages, and some distinct abuses on top of that.  

It's actually possible to say "It's not normal to be normal"  and not be far removed from accuracy.

 

Bottom line take it first as a mathematical, statistical effect.

With absolutely no essential connection such  that normal = good.

(there are times and circumstances where that is pretty much true, for instance with blood pressure readings, but that doesn't make it true in all instances.)

If "normal" always equated to "good" we'd be out trying to cure Olympic athletes.  

They are nowhere near "normal", taking humanity as a whole as the sample.

 

And the sample group used for establishing the "norm" for any "normal" matters immensely.

Obvious as soon as attention is brought to it, but often overlooked when the unspoken sample is just "local society."

A Kalahari Bushman could be quite normal, taken as an example from  a group of Kalahari Bushmen...

Elsewhere he would not be "normal" at all in a number of respects: the only thing changed was the surrounding society, or comparison.

 

It is not normal to be homosexual... statistically.  Pick one individual at random and it is odds-against them being homosexual.

But observations in humans and some other species report that to have a certain proportion of a general population be homosexual is very much normal.  To find none would be abnormal.  

 

Then the social judgements of "normal" behaviour overlap with this, and in different societies  the majority can define "normal" very strictly or include a much wider acceptance and tolerance of diversity under "normal".

"Wearing inappropriate clothing" is to break "normal" taboos in some settings.   Almost totally a local custom as "normal"

(you could go to prison for it, or even be executed for it, some times, some places.)

No wonder conformity (to a statistical or social norm)  is often seen as "good" and failure to meet expectations often seen as "abnormal".

 

We have at least mostly given up on trying to cure left-handed infants and make them "normal".

 

This is not complete, but may give a heads-up to help see what could be being connected to the term "normal" whenever employed.

Being connected, implied or assumed fairly OR unfairly.

 

Chris.

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Everything Emmettman said is dead on. And I'd turn it around too - it's possible for something to be "normal" in the sense of extremely common, but also have it be an illness requiring treatment.

We understand that much more readily with physical illnesses - everybody (practically) will get the flu at some point (maybe many times) in their lifetime. It's also unquestionably an illness which can be dangerous. So it's both "normal" and sickness. Major depressive disorder is also extremely common, but there's nothing "normal" or trivial about the illness.

You really have to use the same criteria you would for a physical problem - distress, impairment or in some cases risk - to decide whether something should be called an "illness". Or anyway, whether you need help and relief from it.

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Thank you all for the replies. I really appreciate the various perspectives.

 

I agree that "normal" is a very loaded and completely subjective concept/term. I also agree that just because something is "common" doesn't mean it's negligible. I think my question really stemmed from the fact that I don't know what to bring up as "issues" when I finally see a therapist/pdoc - it's been several years since I saw anyone or even really talked about this stuff, and my past experiences with treatment were, at best, not productive. I was never comfortable enough to talk about everything I wanted to get into, and felt judged for saying things - I ended up feeling like I wasn't allowed to be suffering, or that I was making mountains out of molehills. With enough time and distance from those treatment experiences, and a resurgence of some symptoms (and some that never went away but were able to be buried for a while), it is becoming clear to me that I need to seek help and I need to be more vigilant about finding a good "fit." I feel like I have never really delved deep enough into what is going on with me because I have been afraid that my "issues" will turn out to be what "everyone" or "most people" (by that I mean mentally healthy, stable people) deal with. I've been told that by people for a long time - that these feelings are "normal" and that I "just need to find a way to deal with them." And if that's really true, well, that sucks, because I am at a point where I refuse to believe that it is ok to feel like this, to have felt like this for so much of my life, and that this is as good as it gets.

 

The comparison to physical issues that kateislate brought up is interesting and, I think, very relevant. I'm one of those people who ignores physical symptoms until I can't deal with them anymore. I know it's "normal" to catch a cold, or have a headache. And I work on the assumption that everyone gets headaches from time to time, and therefore I don't freak out that it might really be a brain tumor or something. But I have been known to ignore symptoms that were potentially bigger deals because I thought it was "normal" to experience those things. I gained a bunch of weight and started growing tons of hair on my chin and elsewhere, and thought it was just part of getting older - turns out it was PCOS, but I ignored the symptoms for almost 10 years because I thought it was "normal." So when it comes to MI and things like that, I think of "normal" as things that most people naturally experience, things that don't indicate a real problem. And I don't have a good frame of reference for what is "normal" for me, because for the last 20 years of my life I have seen a gradual but fairly steady increase in the intensity and duration of things that I guess I should consider symptoms of "something wrong," whatever that "something" actually is.

 

So I know I need to get some help, but I'm not sure where to begin because I don't know where to start. I feel like if I went in with a list of all the possible symptoms I've seen, they'd laugh at me or immediately dismiss me as a hypochondriac. Without a trusting relationship already developed, I feel a little lost. I've totally rambled and I'm not sure I really made my point at all. But thank you, all of you, for weighing in and helping me muddle through this.

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Everything Emmettman said is dead on. And I'd turn it around too - it's possible for something to be "normal" in the sense of extremely common, but also have it be an illness requiring treatment.

 

 

Thank you, and absolutely:  BBC news article very recently about an area where the majority of the population suffer from the eye disease Trachoma.   Normal, but not good. And in no way should the rest of the population be made to conform!

 

And going beyond the purely physical -

"It is no measure of health to be well adjusted to a profoundly sick society."  J Krishnamurti.

- even if such a society may well not see it that way.

 

Chris

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