Interview with psychiatrist Adam Wichniak, deputy head of the Third Psychiatric Clinic at the Institute of Psychiatry and Neurology in Warsaw.
They say that each of us is to some extent abnormal. It's true?
Adam Vihnyak: Psychiatrists do not use such concepts as normal or abnormal. We avoid such definitions even in private conversations. We can say that someone is suffering from a mental illness or, conversely, mentally healthy. We are entitled to give only such an assessment.
How is it determined what is included in the concept of the norm and what is not? Has this concept changed in a hundred years?
- It is surprisingly very simple. If I am asked what a mental illness is, I will give the following definition: mental illness or disorder are diseases that I can identify based on the level of knowledge existing in modern psychiatry. And this level of knowledge is summarized in the classification of mental diseases and disorders. If someone meets these conditions, we can identify a disease or disorder.
What, then, is called mental health?
- This is a more difficult task. I could say that M's mental health is the absence of mental illness and disorders in a person. And this is most often written in their certificates by psychiatrists, if someone wants, for example, to obtain permission to own a weapon. However, the very absence of such diseases and disorders, in my opinion, is not enough to say that a particular person is fully mentally healthy. After all, full-fledged mental health is not only the absence of diseases, but also successful functioning in life, stable social and professional ties, and self-realization.
Who sets the standards?
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- There are two main classifications in the world. One is ICD-10, the International Classification of Diseases, section VI of which lists all mental disorders. The second is the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, the fifth version of a document produced and printed by the American Psychiatric Association.
Is psychiatry generally a scientific discipline?
- Of course, because we use in our work knowledge that, in particular, is collected in the above classifications. And on this basis, we identify (or not) mental illnesses and disorders.
Is it important in making a diagnosis how much a particular symptom interferes with a person in life?
- Very important. In the American leadership, this is one of the most important criteria for recognizing a disease. Symptoms come first. This is usually a whole group that develops into a corresponding complex. Further, these symptoms must be observed for a long time. For depression - at least two weeks. Then comes a very important thing: the patient's condition should not be caused by diseases of the brain of a neurological nature, that is, brain damage, or any somatic illness, as well as the effect of psychoactive substances. The next important criterion, which Americans especially emphasize, is the noticeable effect of symptoms on a person's well-being and vital activity. And only if all these conditions are met, the psychiatrist can diagnose the disease or disorder.
That is, if some one-time deviation from the norm happens to us, it should not be considered a sign of a mental disorder?
- Yes, if something happened once, did not last long and was completely gone, usually there is no reason for concern. Although as a doctor, I always advise you to be careful in such situations. When psychiatrists do not know how to classify symptoms with 100% certainty, they usually wait for their next manifestation. It is never known when they will appear and whether they will appear.
Do people often have such deviations from the norm?
- According to various sources, about 7% of people in the world have hallucinations from time to time, that is, they see or hear something that others do not see or hear. Something that others think is not. If this is a so-called isolated symptom, that is, the patient does not complain of other abnormalities, this is not a disorder or a disease. There are many behaviors that have nothing to do with brain disease, but do not fit into the norm. It is enough to turn on the TV: there you can see how perfectly healthy people can behave in such a way that their actions cause protest, disgust, amazement in us. However, from a psychiatric point of view, these people do not suffer from mental illness.
Are there any types of behavior that used to be the norm and now are not, or vice versa?
- Sure. This was the case, for example, with homosexuality. In the first edition of the DSM classification, it figured as a mental disorder. In 1974, homosexuality was dropped from this guideline. In the latest fifth edition, the disorder is, for example, premenstrual tension syndrome. There is debate as to whether a disease requiring pharmacological treatment is a condition called the prodromal period of schizophrenia.
What it is?
- The patient, most often a teenager, develops the first symptoms associated with schizophrenia, but they cannot yet be called schizophrenia. A certain number of future patients show symptoms that herald the disease: certain traits, behavioral features that can be called abnormal. However, the same symptoms can occur in people who never develop schizophrenia. Psychiatrists are obliged to notice these symptoms, but, on the other hand, a teenager has every right to be hypersensitive due to the fact that he is going through the growing up process. And for everyone, it can happen in its own way. Many experts believe that it may be premature to diagnose a mental disorder in an adolescent with only mild symptoms.
Isn't there such a phenomenon that now many, especially children, are more often included in the category of people with disabilities? They used to say that the child is active, but now that he has ADHD. Maybe we have too little time to endure all deviations from the "norm", and we prefer not to educate, but to get pills?
- You cannot draw a conclusion based on one symptom. For example, a person is considered sick because he cannot sit still. But this is only, perhaps, interfering with others and the person himself, but a separate symptom of the spectrum of this disease. To sum it up as illness, for example, when it seems to parents that this way their child will overcome school more easily is wrong. We open the door to calling virtually every person mentally ill.
They say that recently parents have turned to doctors who claim that their child has a delayed onset of sleep phase syndrome, and ask to release their offspring, who fall asleep late and cannot get up in the morning, from morning lessons. Of course, this can be a medical problem, but it can also stem from the lifestyle and rhythm of a particular family. On the other hand, other parents may decide that their children are not given such discounts, and that this is a search for disease where it does not exist in order to gain an advantage over the rest. There are many such new disorders, which are called disorders of one spectrum or another, and it is not known how to treat them. “Spectrum” is no longer the norm, but at the same time it is not enough to talk about a mental disorder. In this regard, you can, in fact, say that most of us,deviate from the norm.
In one cultural circle, some phenomenon may be considered the norm, but in another it is no longer. Do psychiatrists take this into account?
- Of course. The cultural differences are strong here too. The World Health Organization draws special attention of specialists to this aspect. This applies, for example, to the Indians. If a person belonging to this ethnic group tells a doctor that he is talking to spirits, this should be interpreted differently from a similar statement by a European. In this case, it is not a psychopathic disorder. Or in Africa. African cultures have their own common beliefs that cannot be judged by the standards of our culture. And vice versa.
In South Asia, they diagnose koro syndrome, an anxiety disorder in men: a person is afraid that his penis will be pulled into the stomach. In Europe, most psychiatrists have not encountered this disorder. So the recommendations in the guidelines are written with a region of the world in mind.
Are we generally normal or not?
- It's not for me to evaluate it. I would say that most people have some peculiarities of behavior, emotions, perception, which deviate from the norm.
Are there supernormal people?
- I would be afraid of such. If someone believes that he is supernormal, this fact alone raises concerns. People who hold this point of view tend to deny normalcy to others.
Do you have manias?
- Many people have thoughts to which they obsessively return at some time. For example, someone might be constantly counting in their mind. They count steps, stairs, plates that they put away in the closet. Is this normal? As long as this does not make us, for example, be sure to count ten plates and only then put them on the shelf, there is nothing wrong with the love of counting. Scientists say that our brains sometimes come up with tasks like counting to stay active when the body is busy with boring repetitive activities. In turn, the British psychiatrist Paul McLaren (Paul McLaren) prefers a different explanation. He believes that obsessive thoughts are a kind of psychological ritual. During the development of our species, they were evolutionarily beneficial, as they prepared us to face future risk. Therefore, so many of our thoughts and rituals,for example, those concerning cleanliness are associated with a potential threat (disease). Many psychiatrists believe that the Briton has gone too far in his concept. However, there are times when we may notice something like obsessive thinking in ourselves. At the age of two to four years, children usually develop different kinds of ritual behavior associated with going to bed or eating (the same sequence of events, the same dishes, etc.). Children need rituals because they help them understand the world they have little control over. At this age, we need order, we do not like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life. Many psychiatrists believe that the Briton has gone too far in his concept. However, there are times when we may notice something like obsessive thinking in ourselves. At the age of two to four years, children usually develop different kinds of ritual behavior associated with going to bed or eating (the same sequence of events, the same dishes, etc.). Children need rituals because they help them understand the world they have little control over. At this age, we need order, we do not like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life. Many psychiatrists believe that the Briton has gone too far in his concept. However, there are times when we may notice something like obsessive thinking in ourselves. At the age of two to four years, children usually develop different kinds of ritual behavior associated with going to bed or eating (the same sequence of events, the same dishes, etc.). Children need rituals because they help them understand the world they have little control over. At this age, we need order, we do not like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life. At the age of two to four years, children usually develop different kinds of ritual behavior associated with going to bed or eating (the same sequence of events, the same dishes, etc.). Children need rituals because they help them understand the world they have little control over. At this age, we need order, we do not like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life. At the age of two to four years, children usually develop different kinds of ritual behavior associated with going to bed or eating (the same sequence of events, the same dishes, etc.). Children need rituals because they help them understand the world they have little control over. At this age, we need order, we do not like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life.we don't like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life.we don't like change. Some, McLaren says, it never leaves. Obsessive thoughts turn into a problem when they cause anxiety, aggression, or interfere with our life.
Are you talking to yourself?
- This is completely normal. In addition, it is useful, as it allows you not only to better remember information, but also to organize your thoughts. Self-talk can help us focus or prepare for action. Internal conversations are conducted by most people, some constantly. At what point should this be alarming? First of all, you need to pay attention to how often we conduct such conversations. It is bad if we lose control over them, and if it seems to us that these are other people's thoughts, broadcast from the outside.
Do you hear voices?
- Socrates heard "voices" that warned him when he could make some mistake. They accompanied Sigmund Freud when he traveled alone. In 2011, Charles Fernyhough and Simon McCarthy-Jones from the University of Durham in the UK presented a paper showing that approximately 60% of people experience inner speech through dialogue. Where is the line between self-talk and "voices"? Your inner voice speaks as you do, so you feel like you are in control, says Charles Fernyhough in an interview with New Scientist. One of the most extensive studies conducted by this scientist to date showed that from 5 to 15% of people hear voices from time to time. About 1% of people without a psychiatric diagnosis hear voices regularly. The same percentage of people are diagnosed with schizophrenia. Scientists have found no differences between people who do not have mental illness, but they hear voices, and those who never hear voices.
Do you have crazy ideas?
- These are false conclusions that differ from the generally accepted ones. Delusional conditions that occur in people with mental illness are, for example, the belief that their family has been kidnapped and replaced by intruders. Scottish scientists conducted an experiment to find out how many people have mild delusional ideas. In total, more than a thousand people were interviewed, who were asked questions about their beliefs, paranormal and religious phenomena, their political and social attitudes. It turned out that symptoms resembling delusional ideas were observed in 39% of the participants. Most often they dealt with the paranormal and religious beliefs. Where is the line between delirium and what only resembles it? People suffering from delusional ideas are sure of their truth. So the only way to be surethat your beliefs are "normal" - consult a psychiatrist. And believe what he says.
Margit Kossobudzka
