I tell medical students early in our interactions to avoid describing things as “normal” because it’s not the useful description they think it is.

I first learned this as a medical student myself. It was during our obstetrics and gynaecology posting and we were in a ward round. A fellow student was presenting a patient he had seen and used the phrase “normal delivery” to describe her recent childbirth. The consultant looked at him and said, very pointedly, “So if her delivery had been via Caesarean section it would have been abnormal?” And then he proceeded to teach us about simply describing delivery as vaginal, instrumental (like when forceps are required) or Caesarean.

I don’t recall the student’s response, if any, but the light that went off in my head in that moment has never since gone off.

It was my first exposure to the pitfalls within the landscape of “normal.”

I’ve always been interested in the meanings of words: not the meanings in the dictionary but the meanings we assign to them. A few years before that ward round, I had learned from CS Lewis how “nice” a similarly meaningless word for describing things. (I challenge you to identify what meaningful information anyone can gain about anything someone calls nice, other than that they like it.) And since then I’ve come to notice how, to the average person, the word “depressed” is understandable as mental illness (now anyway) but the word “psychotic” is a pejorative, connoting a bad person—even though both are, from a psychiatric point of view, simply two kinds of mental disorder.

The problems with “normal” as a description are quite different from that of “nice”, though. With “normal” it’s less that it can mean anything and more than it can properly mean opposing things. “Normal” can be what should ideally happen, like when we describe sickness as abnormalities in our body. But “normal” can also mean what most often happens, like when you observe it’s perfectly normal (albeit unpleasant) for human bodies to break down with time. (It’s also this meaning of normal that people really mean when they say things like “normal” is boring: that is, simply doing or being the expected, or average, or representative thing does not interest them.)

We can therefore say that normal can broadly mean either what we expect or what we observe.

But why does this matter?

Well, because while both interpretations are valid, they’re often in opposition. And that can lead to all kinds of conflict when people are using them in conversation and thinking they mean the same thing when they don’t.

For instance, I’ve often run into the difficulty of being taken to be excusing something when I’m trying to explain it, and that happens both professionally and personally.

Professionally because my job as a psychiatrist involves dealing with behaviour that’s, well, abnormal, and yet, the ways people act when experiencing mental illness act are perfectly normal for each kind of mental disorder. But where they have hurt people under the influence of their disorder, it can be quite hard (understandably) for those people to accept this abnormal behaviour as unfortunately normal while the illness took hold. It’s hard for them not to hear it as you saying the behaviour was excusable, and therefore invalidating their own pain.

Personally, too, I’ve often laboured to explain to people unhappy with various, less savoury aspects of my person, that said aspects were unfortunately normal. It’s an explanation people tend to take for an excuse. What they think I mean is that I’m saying that’s “just the way I am” and I have no intention of changing. What I actually mean when I say that is that while I’m fully aware of those aspects of myself, and have been working at them for years, the change has been incredibly gradual, and is more visible over years than over months. (I have a theory that this is particularly the case in the parts of our character that are the flip sides of our strengths.)

You might be shocked how long it’s taken for me to learn that this distinction, intuitive as it’s long seemed to me, is apparently nothing of the sort for many people.

So putting all this together, let’s return to my fellow medical student: what was the consultant trying to teach him? Well, that he observed that the student saw the woman’s delivery by Caesarean as less than ideal, and therefore abnormal—normal as expected. But the consultant had observed, obviously, that Caesareans are very frequent and, often, even desirable for and by many women. So he was trying to reframe the student’s idea of expected normal. Yes, childbirth via surgery might seem less than ideal, but that did not make it abnormal.

But that itself raises another question: why was this reframing important?

That goes back to what I said earlier about how we use words. To frame something as normal is often not simply a description: it’s often easily a moral judgement. We all intuitively understand that our considering normal, is to imply that what does not fit this is abnormal. And so this raises yet another meaning of normal: what is not simply expected, but ideal, in such a way as to render anything less, a bad thing.

And that, my friends, was what the consultant was really going after.

It’s also why I generally try to avoid the word “normal” and instead describe things more directly, either saying what they are as I see them, or explicitly saying if I consider it unexpected, unusual or bad.

Also, normal is boring.

Published by Doc Ayomide

I’m a medical doctor with specialty training in psychiatry, and I love thinking and writing about what it means to be human.

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