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40-1 How should we draw the line between normality and disorder?

Most of us would agree that a family member who is depressed and isolated for three months has a psychological disorder. But what should we say about a grieving father who can’t resume his usual social activities three months after his child has died? Where do we draw the line between clinical depression and understandable grief? Between bizarre irrationality and zany creativity? Between abnormality and normality? In their search for answers, theorists and clinicians ask:

A psychological disorder is a syndrome (a symptom collection) marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior” (American Psychiatric Association, 2013). Such thoughts, emotions, or behaviors are dysfunctional or maladaptive—they interfere with normal day-to-day life. Believing your home must be thoroughly cleaned every weekend is not a disorder. But if cleaning rituals interfere with work and leisure, as Marc’s rituals (noted earlier) did, they may be signs of a disorder. And occasional sad moods that persist and become disabling may likewise signal a psychological disorder.

Distress often accompanies dysfunctional behaviors. Marc, Greta, and Stuart were all distressed by their behaviors or emotions.

Over time, definitions of what makes for a “significant disturbance” have varied. In 1973, the American Psychiatric Association dropped homosexuality as a disorder after mental health workers came to consider same-sex attraction as not inherently dysfunctional or distressing. In the 1970s, high-energy children were typically viewed as normal youngsters running a bit wild. Today, more of them are seen as dysfunctional and diagnosed with attention-deficit/hyperactivity disorder (ADHD).

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