Is This Normal?

Throughout my many years working as a psychologist, countless times I have often been asked the question by friends, colleagues, and clients :”Is this normal?” They may be referring to a variety of different things from a certain feeling they are experiencing, a reaction they may have had to a particular scenario, or a situation they may have witnessed or watched outside their own circles. Now though this may appear to be a fairly innocuous question with a pretty simple yes or no answer, the truth is it is far from simple.

What are people really wanting to know when they ask this question? They are checking to see: “Am I O.K ? Do I fit in? Is there something wrong with me? Is it ok to have these feelings, or thoughts? Am I alone with these thoughts or feelings or do others have them too?” It is human nature to want to fit in, to want to belong, to be part of a group or community. What is wrong with that? It’s normal, right?

Unfortunately, in a world filled with instant access to information at our fingertips Dr. Google may lead us down a path that is not only not helpful, but indeed could be destructive. Compound that with the barrage of messages that touts us with that we are not thin enough, young enough, pretty enough, smart enough.

The advent of social media may leave teens in a vulnerable place where they can be criticized or bombarded with negativity. We are told that depression and anxiety have increased exponentially, yet Canadian studies indicate that cases of anxiety have remained steady for the past 20 years .

According to Statistics Canada in 2012 about 3.5 million Canadians, or 12.6%, will meet the criteria for a mood disorder during their lifetime. A total of 2.4 million Canadians reported symptoms consistent with anxiety disorder. 20% of youth, 1 in 5 suffer from a mental disorder.

While these issues are very real and do impact people’s lives in so many ways, we need to be careful and thoughtful in labelling what otherwise may be feelings of sadness as depression or feelings of worry as anxiety.

Sadness and worry are very normal feelings during this time of a pandemic. Just the other day a friend of mine expressed feelings of sadness, worry and confusion with this prolonged self isolation. She asked the question, “Is this just me or are other people feeling this way?” I assured her she was not alone in her feelings and gave her some practical suggestions to help mitigate the situation so she did not become overwhelmed or feel incapacitated by those feelings.

In my career I have always professed to all of my clients that your feelings are not categorized as right or wrong, good or bad, but rather a gift of humanity. What is important is what we do with those feelings, how we manage them. It’s o.k. to be angry , but it’s not o.k. to hurt someone because of that anger. It is equally important to understand when these feelings are truly normal and natural given the specific circumstances . They ebb and flow and will come and go as we work through them. They are worry and sadness and do not need to be labelled as anxiety and depression.

Too often as parents and adults we may want to jump in and fix feelings so that the person feeling them doesn’t hurt as opposed to acknowledging the feelings and then having the person to work through these feelings the best way they know how or with our assistance. Identifying these feelings with the proper label and trying some practical relaxation methods such as: deep breathing, talking to a trusted friend, and positive self talk, can allow us to actually feel sad , scared, or worried. It helps to know we are o.k. and can gain a sense of our own power and self control.

For others however, the feelings may become too much with which to cope and even with the use of strategies can become overwhelming. If this occurs and persists across time to the point where the feelings interfere with day to day functioning this is a red flag. The frequency, intensity and duration matter and are indicators that it could come be the time to seek professional help. Just remember, reaching out is a strength, not a weakness.

For us as professional caregivers, we have a role to play in ensuring we truly understand the difference between “worried well” and someone who truly is suffering from a mental disorder. We need to constantly remind ourselves that the client is always at the front and centre of our practice. Our first priority is and always should be to develop a safe and trusting relationship with our clients so we better understand their story. Only when we see the person as who they are and not just as a diagnosis can we be truly effective.

So how does a health professional make a diagnosis of depression or an anxiety disorder and what tools and processes guide the diagnosis?

When making a diagnosis, psychologists and psychiatrists often look to determine whether what is happening to their client falls within the norm of behaviour for that client’s particular age, circumstances, and other contributing factors such as family history etc.

To form a specific diagnosis such as clinical depression or a type of anxiety disorder , a tool called the Diagnostic Statistical Manual {DSM-5} is used to see if clients meet the required number of specific criteria. Clinical interviews add to the information used to assess. In dealing with something as complex as the human mind, we need to be very judicious in the use of this tool. It is not just a matter of asking the right questions and ticking the boxes. So many other factors come into play when you are dealing with the human psyche.

We as mental health professionals must hold ourselves to higher standards of practice. As Dr. Allen Frances (former chair of DSM-1V Task Force) writes in his bestselling book, Saving Normal, “People forget the wisdom of Hippocrates:” “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” Of course, best practice would include looking at both. Just like any tool, The DSM has its’ place and function, but we must be careful not to rely on it in and of itself. Let us see beyond the symptoms and ask the right questions. In our vocabulary, let us bring back those everyday words like, sad, worried, afraid, distracted; that signify normal responses to a particular event or circumstances. Instead of catastrophizing day to day sadness and worries, let us give our kids and families strategies to build resiliency. Let us have a clearer understanding of what is normal so we can respond correctly and get help for those who need it when they need it.

Is this normal is a very complex question. One that certainly cannot be answered in a few short paragraphs. Those answering this should keep in mind mental health literacy , understanding data , what evidence based research is really saying and acknowledging that humans are complex beings who we are still learning from on a daily basis.

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