The Absence of Normality

The Absence of Normality

In behavioral science, normality appears defined as the absence of the characteristic being studied. Behavioral research experiments typically recruit at least two groups of people; one group that has been screened to ensure they show behavioral traits of the abnormality being studied, and another group that does not display these traits – the control group. Any number of tests can then be given to all groups and any differences that appear based upon group identity can be verified statistically and the difference published as a finding.

However, it is worth noting that there are no studies determining normality in mental health, after all, in a field that struggles with resource and funding, what would any research team have to gain by pursuing a credible diagnosis for normality? This means that normality is not scientifically verified and is made all the more impossible to pursue by the ever changing nature of a person’s mental health.

Yet, for such a cherished moniker of considering oneself normal, is it good enough to define it simply by the traits/dysfunctions/disorders that you do not have? It appears to be a travesty of thought to make an observation of somebody displaying difference to you and declaring that you are normal because you are not that. How satisfied would we be in situations where we needed to learn about another person, in knowing simply what they are not?

How do you determine a person’s substance by the absence of traits?

Lennard J. Davis notes in ‘The Disability Studies Reader’ (4th Ed.) that the terms norm and average only entered European languages in the 19th Century. Their arrival coincided with ideas that were being used in the field of statistics. What had been applied in the mathematical determination of astronomical events bled over into the study of human characteristics, such as height and weight. However in this natural accretion, unguided and subject to nineteenth century prejudices, the search for normal behaviors quickly became marred by the assumptions of the privileged.

Statistics is a powerful tool and can be used with great effect to convince scientists of the objectivity of research, but they are only as powerful as their interpretation. Statistics can demonstrate difference like nothing else, but the basis of comparison is loaded with assumptions of deviance versus absence of deviance. When it comes to understanding something as precious as humanity, is that good enough for us? Every single study should have a rigorous definition of what has been considered normal in light of the research question. Normal is needed for statistics to work.

Normality seems to be everything about humanity that we do not consider different or deviant, yet when pressed would struggle to define. This leads one to ask, “Is normality more of a feeling than a state of being?” Normality appears to have a lot in common with the mathematical concept of zero. Both concepts trick us into thinking they are well defined when it is in fact the opposite. The infinity of the absence tricks us into thinking there is substance.

In a world of scientifically and medically confirmed diagnoses, the definition of a normal person is one who would without fail qualify for the control group in any research (unless their socioeconomic markers do not match). Normality is a permanent membership in the control group for every possible behavioral experiment, yet this is clearly impossible, and even inhuman.

In a world where those who have been deemed different are having to fight for more inclusion and equal rights, conversations around normality matter.

If only there was a condition called Manifestly Normal Disorder, a list of symptoms to define normal would have to be rigorously defined in order to screen for the experimental group.

It is worth reminding ourselves that the middle of the bell curve is not where to find normal. Normal is the bell curve.

Mental Health Equality and Research Bias

In a way, control groups are more important to all research trials than the experimental group. When planning a study, researchers hope to show that they have found unequivocal difference between the group they are interested in and the group that has been considered healthy, normal, typical, etc. If the experimental conditions, delivered to both groups under the same circumstances then show a statistically different result or response, important information about a key difference between the groups can be reported. These responses could be different health outcomes from taking a drug, behavioral differences, or differences in physiology or biochemistry.

The problem is that control groups are not the stalwart comparisons we have assumed them to be.

There is no guidance on what healthy, normal, or typical actually mean. Researchers create their control group along with their study, and one of the most important things they look for are people who do not show the biology, behavior, or diagnosis they will use to create their experimental group. The control group is therefore simply the absence of traits that has been reserved for the experimental group. There can be additional measures to increase the power of the comparison, such as matching the experimental group for age, sex, race, etc., but these only strengthen the comparison, they do not justify why the control group should be considered healthy, normal, or typical.

This means that when the research is designed, a member of the control group is at first a stereotype or a symbol that the researchers then try to match with real people, unlike the experimental group, who are likely to be chosen from medical history or diagnosis. There is no diagnosis for normal and the use of a medical history would be to determine that it simply does not contain the events of interest in the experimental group. The control group is thus largely created from an absence of experimental traits and the ideas of what the researchers have decided to call normal as the antithesis of what they are investigating.

Researchers are upfront and do report at length about how their groups were created, however the way the control group is positioned throughout the study, as the anti-experimental group, is never really challenged, perhaps because this is how modern research has always been done. The readers’ focus is often on the point of interest, the interesting things about a certain group of humans that they have often spent their careers studying, and if they can be convinced that the control group is different enough from the experimental traits but matched for everything else, then any significance in the result must mean something.

But our bodies are constantly in flux with changing biochemistry that is influenced by our habits, diets, environments, and simple aging, so that what is true one moment might not be true the next. Tumors can be missed for years until they become problematic; stress, abuse, and trauma can be hidden from the public view; alcoholism, smoking, and drug use can be missed, as can rare genetic disorders; people may have simply stopped exercising; a change in drinks consumption might now mean the person is imbibing more microplastics. There is no reason these people cannot participate in a control group, but this should be done by excluding the language of healthy, normal, or typical. In our zeal to discover new truths, we must not forget that in the scheme of things, we know almost nothing. By declaring a control group as normal, we become guilty of claiming too much.

This approach to research obviously came from a history of studying disease and illness. When researchers are studying sick patients, it makes sense to call those without sickness healthy, normal, or typical – but within the strict confines of scientific research, where the quest for meaning has to be tightly regulated, calling anyone healthy, normal, or typical to any realistic standard is impossible. When the focus is disease, research bypasses the person to open discussion on the level of systems, organs, and cells, and it is seen as something foreign within a person. When the focus is mental disorder, the person cannot be bypassed and a new paradigm for analysis is warranted.

This might come across as pedanticism, but this is the root cause of considerable ill feeling with those living with autism, ADHD, and other classically defined mental disorders that are now defined as neurodivergent. In order to learn more about these disorders, there is no harm in having the experimental group with the traits (or diagnosis), or a control group that does not demonstrate these traits, but to use healthy, normal, or typical to define the control group immediately implies the experimental group is unhealthy, abnormal, or atypical. To carry this further, the experimental group for studies in mental disorder are also often referred to as disordered or dysfunctional, which would then mean the control group is ordered and functional – which would even be strange descriptors for this group.

There is no question that many people living with the traits of what have been termed disorders are either striving or seeking to strive on their own terms. With mindfulness, compassionate support networks, and either behavioral or pharmacological therapy, as needed, they are contributing to society, figuring out their place in the world, and constantly finding ways to overcome adversity – this is all demonstrably, and painfully human. Surely the value of their struggle merits not being compared to a group defined more by absence than by substance, a group that is determined to be the healthy alternative to themselves?

With the huge success of the neurodiversity movement and the introduction of more positive terminology such as neurodiverse and neurotype, research is now perfectly positioned to change. While debates still rage about what these traditionally defined disorders mean, whether their respective diagnoses are credible, and how the line between disorder and order might have been tragically oversimplified, the nuts and bolts for designing studies can be addressed, making us ready for when it is time to figure out what it really means to be human.

Finding My Voice With ADHD

Similar to the experience of many others, a late diagnosis of ADHD has me trawling back through memory after memory, now equipped to see things differently. The common themes of realizing somebody had become annoyed by me or I appeared to have shared some information or opinion that had not been well received all started to make sense. Academically, I had always been taught to be open and honest because it is only these things that can form a solid foundation for further inquiry and understanding. I have always had to be analytical in social situations, not just to understand other individuals, but also how they behave in groups, and I then relied on this analysis to determine how I might function within these dynamics. Consequently, I always had social analysis to hand and would share if prompted, backed up by those academic values of being open and honest. Needless to say, I both endeared and offended, and I have never known which would result. The diagnosis itself cannot provide a roadmap through this terrain, but it is more satisfying than simply feeling eternally weird.

I’m still struck by what I think is an ironic name for a disorder, because as a child I never felt a deficit in attention; I was laser focused on some things, just not the things that other people had decided needed my attention, and I think I would have subconsciously accepted the idea, without caveats, that it is normal to not pay attention to things one finds uninteresting. During my undiagnosed years at the end of high school, it was exhaustion and sensory issues that plagued my mental health, a time when I began consuming large volumes of strong coffee. Frequently, I found myself in the company of confused and annoyed teachers, most likely as a result of poor academic performance, which in turn confused and annoyed me. One thing I never seemed to be able to get across was that I was trying, and every now again, when the stars aligned, I could get good grades. I had begun to realize that if I could control my environment, get the solitude that I needed, and spend enough time with the material to be able to see and understand it in a way that worked for me, then a measure of success was possible. My personal mantra going into my adult years just became find your own way to do it. 

Now, after twenty years of this approach, I now have an arsenal of coping mechanisms and I am maintaining the steady course of a medication that works. Adderall is not a forgiving drug if missed, but the changes in my professional life have been extraordinary. In my capacity as a science and medical writer, I can see and hold onto the overall message and aesthetic of a document while I delve into a granular analysis of each section. The error rate of transferring numbers from data tables into narrative descriptions decreased, and the repetition of information now aggravates me to levels previously unknown. Managing my ADHD has allowed me to become better at one of things I love most in the world – writing. 

These changes, coupled with my pensive nature, has turned my attention to how I have communicated and expressed myself most of my life in speech and writing. I can rule out an analysis of fashion sense or cosmetic artistry because there I have always been quite boring, except perhaps for a tendency to prefer black clothes. I always considered writing to be the most satisfying means of expression. The practice of sitting alone with my thoughts and determining the best way to express them was therapeutic and enjoyable. I suppose it stands to reason that a precocious mind, prone to sudden flights of fancy, would benefit from a practice that distills ideas and experiences into written and unchanging structures.

My high school focus became science, but I was always privately irked that I had not had much academic success with English and language studies. At university, after initially enlisting for a business education, I could no longer ignore my need to gain a level of mastery over writing and read the kind of books I considered the most important. This began a love affair with the lives and thoughts of authors and thinkers. I am now familiar with the written voice of a few key writers, notably Susan Sontag and Christopher Hitchens, and sometimes I like to read anything by them just to glide over their sentences and thoughts, even if I have no idea what they are writing about. Their sentences, their choices, and their attitude remain a source of speculative bemusement.

Until recently, I never really thought about my voice and how I have learnt to speak, but my ADHD has been at work here, too. I have often felt that my voice comes with a forever depleted battery and after some conversations, I simply feel unable to talk anymore until I recharge. Attempting to join work conversations on those difficult mornings and insert myself into the dialogue has sometimes felt like I’m at the back of an aircraft hangar and I have to fight against a bungee rope all the way to the entrance at the front to join the storm outside. This would explain why I feel the need to pad out my work calendar around meetings for time to psych up and then retreat into solitude. When exhausted, I also sense an explosion of emotion threaten to overcome and tear my voice apart if I am being pushed to use it and further a conversation I have long lost interest in having. In addition, I have also experienced almost vocal paralytic silences when a response is being requested from me and I am convinced there is too much to process in order to formulate an answer.

I can also see that my preference for writing clearly substituted for speech during emotionally challenging moments in my life. Passing girls notes in school; feeling the need to share something important with an authority figure and doing it by handing them a page of scrawl; and in the days of letter writing, carefully crafting long streams of consciousness to friends or romantic interests. Even now, I prefer to text over talk for sharing ideas, and if I do need to meet with people, I prefer one on ones where we can connect and I am not distracted by the untamed presence of competing parties.

With these challenges, I seem to have semi-consciously determined that when I do speak, I have to make the most of it for the sake of time and for satisfying those needing to hear (from) me. This has resulted in my tendency to go for dramatic statements with as much meaning as I can pack into them, which often has the effect of preemptively silencing any further interest in my contribution for fear of having to interpret another verbal sledgehammer. The dramatic statements come direct from my essay-writing acumen, where I have constantly fought for the best articulation with the best word choice for maximum impact. These high-impact contributions, ironically coupled with the majority silence, has often resulted in me being seen as a character, which again, can endear or offend in a way that I cannot predict. And further, in addition to the dramatized content, I have modified my voice to sound maximally silky, with care to take pauses after the set up and before I deliver my key message. So, all of the troubles I have had with speaking, throughout my life, have culminated in a unique and carefully crafted voice as a way to thrive and survive in those public spaces I must attend. 

These traits I have discovered in myself are also traits that have been said of many authors for years. It is not uncommon for an author to become a recluse, experience long depressive episodes in solitude, or simply opt for silence while their work is still percolating in the mind, on their desk, or as the public digests it following publication. This control over the delivery of information is what gives some writers that air of mystery, especially when the prolonged silence gives way to explosive revelations that either further intellectual discussions or simply result in unbridled joy and merriment. Some of our best writers and thinkers had ADHD? Of course they did!

These realizations about the modification of voice, sent me to the scientific literature to see if ADHD has been linked to peculiarities of speech. While I am not a fan of terms like deficit, dysfunction, and healthy control population, I do like to use my background in brain science to see if some of the things I have identified from my life have been discovered in comparative studies. Recently, there was a study (2025) that found those with ADHD do have unique voice patterns, and has been tentatively linked to executive dysfunction  resulting in a unique modulation of the vastly complex voice system. So, some of us do struggle with our voices and no doubt, through grit and determination, find ways to make it work for us.

Perhaps ironically, the writer in me is excited by those with ADHD having their own unique relationship to their voice. When a person struggles with something about themselves, they are likely to spend a lot of time thinking about it. Here, you have a lot of people thinking about voice, how to communicate, and how to speak. People with ADHD have put a lot of time and thought into self-expression and so are likely to have done something unique with a core part of who they are. Firstly, this makes people with ADHD incredibly sexy, but these unique expressions invariably contribute to culture in novel and exciting ways.

In fact, more and more, I have become frustrated by the idea that those of us heavily documented in the DSM with deficits and disorders contribute richly, indeed disproportionately, to culture, art, and scholarship. So, what does it say about us as a species that the novel ideas and novel expression that we cherish for intellectual advancement and the nurturing of our souls comes from the disordered?

If I had the energy, I might say something.

The Milestone in Mental Health

My stake in the mental healthcare discussion is similar to everyone else’s. After half a lifetime of experiences that never quite made sense, things started to click and I was late-diagnosed with ADHD, although I think I’m more AuDHD. Mental healthcare is now a staple of popular media, millions of Internet users discuss it every day, and there has been a rise in activism to push for changes in the shared aspects of our world to accommodate for everyone. This might be a fire that needs to rage if we are to achieve the stubbornest of all civic goals, systemic change, but are we missing something more fundamental?

In this age of constant fighting, where everyone at a moment’s notice has to be prepared to cling-on to their rights, one can’t help thinking we’ve reached a moment in time for a much needed paradigm shift in terms of how we see each other. The wealth gap is eye-wateringly askew, willful planetary destruction coupled with climate change threatens our survival, and governments have inverted, to now be run by naïve ideologues obsessed with stripping all meaningful public services. It’s not surprising this is also the age that the contrived service of “AI” has been foistered on everyone as its core principle is to remove the person from exercising skillsets, although talking points mask this by marketing it as the removal of chores/inconveniences/thought; purveyors of lobotomies once promised the same thing. Chores and inconveniences are still needed to build us as humans – to remove them will make us less human and incapable of the oversight we are supposed to provide over the AI slop produced in our place.

From the outside, it looks like we are living in a fundamentally antihuman era.

With this background, it is not surprising that mental health is on everyone’s lips. One of our strongest pillars for maintaining control of our mental health is to believe that we have a future and it will be better than what we endure in the present. Maintaining this belief starts to become untenable if our standard of living drops and the world seems to be slipping into chaos.

In addition to these environmental factors, everyone remains at the mercy of their biology, something compounded in the US by struggles with health insurance companies. Our brain health can still be undermined by strokes, aneurysms and embolisms, cancer, Parkinson’s Disease, Huntington’s Disease, Alzheimer’s Disease, and Amyotrophic Lateral Sclerosis, etc. These maladies can impact memory, mood, and personality, if not directly then consequently. A decline in brain health impacts how a person can interact with the world around them and how they have traditionally thought about everything they do and everything they are.

Mental health is a concept premised on the idea that should something be wrong with our minds, we should seek to correct them back to a healthy state of normal. A problem with this idea is that the passage of time, combined with the impact of aging, means returning to a prior state is impossible and the concept of normal quickly becomes a mirage. Normal is a state of mind, once held, that provides a sense of peace and security. When it comes to how we see our health, normal is the security blanket we all crave, and we are sometimes prepared to pay for with defiance. Normal also stops us from recognizing and appreciating difference.

When it comes to brain health, unfortunately there isn’t a lot of utility in talking about what should be. What should be is the question behind systems of morality, law, and justice, so as a line of questioning it is natural for people to think this way. If a brain develops a tumor, the resultant tumor was due to the complexities of human biology, and the oncologist is tasked with removing the tumor and preventing recurrence. They can rightly assume this is a state of brain health that should result in the best outcome for the patient, but should bes are human judgments and attempts at wish fulfillment over complexities that can only be minimally influenced.

Neuroscience has also shown us that common mental health disorders are indicative of unique pathologies, literally meaning that the brains of autists and those with classical personality disorders pursued their own unique development that differs from those without these conditions. Changes are often found in gray and white matter volumes, white matter conductivity (resting and during activity), and gyrification (the amount of folding in the neocortex). But again, these complex and enduring pathologies are not changing course from some ideal, they just are. Human.

To be human and living in the world means we are all united by the same risks to our mental health, even if our desire to see ourselves as normal and healthy prevent us from empathizing with those vocal about their struggle. Disorder and disease are not outside forces looking to infiltrate our bodies, they reflect how our bodies have developed within the complex rubric of gene-environment interaction and how our bodies are responding to life around them; they are all part of what it is to be human, even though our knowledge and technologies have allowed us some influence in these areas to better understand how we can live.

This means that the quest for a compassionate society might not be best served by a multitude of advocacy groups, all competing with their own interests, and quick to be ignored by those who cannot currently identify or use it to turn a profit. An understanding and acceptance of our human nature, as it rightfully applies to all, might be the milestone we need to move forward.

Where is mental health going?

There was a time I was happy that mental health was being discussed, simply because it normalizes that many people, at least temporarily, endure challenging times with depression and anxiety. The need for others to take mental health seriously is important because it supports and encourages people to address their issues, but it also fosters a sense of community that merits the value of not ignoring or denying underlying concerns.

I still think this is important, even though I feel that mental health messaging has become trite and platitudinous, no doubt because it is now a market that needs strict control of messaging for profiting and brand development.

I feel that two problems have emerged from this.

Firstly, even though the realization that comes with understanding one’s own mental health is empowering, there is a key personal choice that follows – how will you live the rest of your life with this information? I would argue everyone has a responsibility to themselves and others to structure their lives in a way that allows them to live optimally with their mental health concerns. Simply speaking, a diagnosis is not a long-term excuse for maladaptive behavior.

Secondly, the sheer number of people to come forward with concerns about their mental health is mindboggling. This raises the very real concern of taking a look at society and expectations and making long-term, systemic changes that minimize declines in mental health. My fear is that mental health is becoming a reliable market, and as such, in order to profit, the mentally disordered become necessary. This is not unlike establishing a private prison system, which needs prisoners to justify its existence.

One cannot help feeling that we find ourselves at the concluding end of a system where we will have to go back to some sort of beginning again to rediscover who we are and what we need.

The vigilance we need to keep track of what is being normalized is exhausting.