Psychotherapy
ABNORMALITY, NORMALITY AND HEALTH
LUCIEN A. BUCK
Dowling College
Ideally, each participant in
psychotherapy should be accepted as a
unique individual with no reference to
diagnosis. Most forms of psychotherapy
are limited by assumptions about
abnormality that focus on pathology
while ignoring the potential for growth
that exists in all. Effective
psychotherapy requires respect for
human complexity. Each person needs
to be perceived as embodying a unique
balance of strengths and weaknesses:
the potential of normal people cannot
be properly evaluated if their
limitations are ignored, nor can
individuals diagnosed as abnormal be
understood by relying upon a pathology
perspective. "Normalization" —
psychotherapeutic practices aimed
toward producing normal behavior—
can deprive people of existing
strengths.
Within the context of psychotherapeutic practice,
current diagnostic approaches need to be thoroughly
revised. The reconceptualization must go beyond
controversies regarding biological versus psycho-
logical origins, evaluations of reliability and va-
lidity, and other traditional questions. To begin
with, one-dimensional analysis must be avoided
in favor of the complexity necessary to reflect the
full humanity of every participant in the process
of psychotherapy—strengths and liabilities can
be detected in all people. It is true that many
diagnostic systems warn against equating the label
Correspondence regarding this article should be addressed
to Lucien A. Buck, Department of Psychology, Dowling Col-
lege, Oakdale, NY 11769.
Volume 27/Summer 1990/Number 2
with the total person, but it is difficult, if not
impossible, to avoid this extension by the therapist
and the client. Further, continuity between those
who exhibit the highest levels of satisfactions and
personal achievement and individuals who are
overwhelmed even by the ordinary tasks of life
needs to be the central focus of the therapist, i.e.,
commonality is more important than difference.
While the extreme maladaptation of some human
beings cannot be ignored, all people need to be
viewed as striving to accomplish the same human
goals. Ideally these assumptions could result in
the elimination of specific labels such as autism
or schizophrenia. Each person would be assessed
in terms of the degree of interpersonal, creative
and intellectual competence demonstrated with
the expectation that weakness in one area is not
inevitably connected with failure in all. Movement
toward this ideal requires fundamental changes in
the way many psychotherapists think about people.
One of the primary implications of this reassessment
is that the health of people previously conceived
of as normal needs to be challenged—no longer
utilized, even implicitly, as an inclusive model
of desirable behavior.
While delabeling is desirable, it is impossible
to challenge the existing diagnostic categories
without naming them. Therefore, a variety of terms
will be used in order to communicate within the
current framework. As a first approximation, it
is possible to conceptualize abnormality, normality
and health as segments along a continuum of in-
creasing capacity for managing the essential issues
of living: autonomy, identity, work, creativity,
propagation, aging and death. Most individuals,
however, will not exhibit uniformity in their com-
petence. It is likely that only a small proportion
of the population—the healthiest and the most
maladaptive—will demonstrate accomplishment
or failure over a broad range of abilities. At one
end point are those efforts which are generally
ineffective, labeled as strange and peculiar, and
tend to be self-destructive—the extremes of ab-
187
Lucien A. Buck
normality. Normality reflects a group of reasonably
efficient means of managing the crises of the life
cycle which tends to avoid disaster even while
retreating from consummate fulfillment. The cost
of this efficiency is a cycle of regularly recurring
physical and psychological ailments: headache,
backache, constipation, cancer, anxiety, frustra-
tion, alienation, dissatisfaction and loneliness
(Costello, 1982; Friedman & Booth-Kewley, 1987;
Jourard, 1971; Klerman & Weissman, 1984; Sie-
gel, 1986). In contrast, health refers to a variety
of adaptations, sometimes less efficient than those
of normality, reflecting highly effective means of
living. Efficiency, in reasonable degrees, enhances
competence, but, in the extreme, it dehumanizes
and limits freedom of choice. While moderation
represents an available path for the healthy, ac-
ceptance of creative and interpersonal risks fre-
quently lead to a heightening of anxiety and dis-
appointment which are balanced by periods of
deep satisfaction and intimacy. However, the cycle
of normal ailments is minimized. It is assumed,
however, that abnormality, normality and health
represent clusters of options, and not a simple
dimension—the willingness to risk success by the
healthy can lead, at times, to the experience of
greater pain than is typical of normality.
The style with which people within these general
groups manage life emphasizes the complexity of
this dimension. Health is best characterized as a
process of adaptation built upon considerable
autonomy—capacity for internal locus of choice.
Such individuals fit in with social expectations to
varying degrees or radically dissent. Whatever the
similarity to existing social values, the healthy
person's choices are a result of a process of critical
analysis—even agreement with particular norms
does not, in this case, reflect conformity. Consistent
with this point, personal and social must be united
in a fashion that facilitates "free assent" as part
of resolving the Eriksonian (1968) crisis of identity
formation, and the "healthy autonomy" of Mas-
low's (1971) concept of self-actualization. Values
are internalized as one's own based on their rel-
evance to the unique potential for growth within
the person and the necessity of adapting to social
conditions, but the term adaptation includes the
option of rebelling against existing traditions—
as May (1981) has proposed the possibility for
rebellion is "necessary and inevitable for human
freedom." Therefore, adaptation does not provide
an appropriate conception of the normal mode of
managing life. Normality requires adjustment—
188
conformity. It allows little room to challenge po-
litical or religious ideology; sameness is the model
for behaving. Choices are left to external
sources—authoritarian. Much of this form of ad-
justment is captured by May's (1953) character-
ization of "The Hollow People." Loyalty, duty
and obligation are the central foci, and these values
grow out of discipline rather than a process of
questioning and challenging. Obedience, for ex-
ample, has been described by Gibson and Haritos-
Fatouros (1986) as an essential part of the "ed-
ucation" of "ordinary" people to become torturers
during the Greek dictatorship. Similarly, Lifton
(1986), in his examination of the "demonic" ac-
tivities of the Nazi doctors, has focused on con-
formity to established biomedical and political
ideology by people best characterized by their
"ordinariness." The limited autonomy permitted
by normality promotes caution leading to an
avoidance of risk—failure is minimized compared
with the healthy, but so is fulfillment. This analysis,
as a first approximation oversimplifies the variety
of divergent styles which reflect obedience to au-
thority (Fromm, 1965; May, 1981). The inference
to be taken from this discussion, however, is that
normal human beings can derive considerable
psychological and biological benefit from psy-
chotherapeutic intervention. While the healthy have
considerable potential for self-initiated growth,
this is typically stifled in the normal individual.
Abnormal management of the life cycle is best
conceptualized as maladaptation. This, paradox-
ically, implies more in common with health than
with normality. Abnormal modes are not efforts
to conform but rather attempts to resist social
regulation—to maintain personal integrity. While
this parallels the potential for unconventional
choices in the healthy, most efforts to maintain
interpersonal relationships and to work efficiently
are less adequate than with normal people. Insight
into these impoverished efforts has been proposed
by a number of clinicians who have overcome
their professional biases sufficiently to develop a
facility with intimate contact with those people
labeled as schizophrenic: Buck & Kramer
(1974-1977), Fromm-Reichman (1959), Laing
(1969), Sullivan (1956), Szasz (1970) have dem-
onstrated the schizophrenic's continuing struggle
with the problems of living, and with the unique
opportunity available due to the lack of "conven-
tional adjustment." The term abnormality applies
to a variety of indirect means of criticizing and
challenging conformist pressures.

. . .the person who is normal in terms of being well adapted
is often less healthy than the neurotic person in terms of human
values. Often he is well adapted only at the expense of having
given up his self in order to become more or less the person
he believes he is expected to be. All genuine individuality
and spontaneity may have been lost. On the other hand, the
neurotic person can be characterized as somebody who was
not ready to surrender completely in the battle for his self
(Fromm, 1965, p. 160).
In this sense, it is a question of adaptation—as
in the healthy—but adaptation which fails. Since
there is less autonomy than with normality, choice
is overwhelmed, and resistance is taken over by
automatic, involuntary, irrational behavior which
is largely determined by factors outside the person's
conscious awareness. Even though such individuals
are more open to risk taking than normal people,
their efforts typically miscarry and only occa-
sionally succeed. There is no solid locus of choice
within, nor readiness for acquiescence to external
authority. Nevertheless, their confusion and despair
provide an opening for change—for growth. Psy-
chotherapy needs to make use of the opportunities
for healthy movement which can be detected in
each maladaptive style rather than encourage nor-
mal conformity.
Health, normality and abnormality represent
processes which unfold throughout the total life
cycle—change is universal. This assumption,
however, is not intended to suggest that all human
beings accept the inevitability of change. Normality
can be characterized as an attempt to create a
stalemate—to maintain sameness. Growth con-
fronts one with uncertainty and risk; regression
leads to helplessness and self-annihilation.
Nevertheless, one must transform identity in order
to maintain continuity between what one is at the
moment and what one needs to become in response
to the requirements of the next phase of the life
cycle. Therefore, one must change in order to
remain the "same." As Erikson (1974) has phrased
it, " . . . they who cannot choose to be different,
cannot decide freely to remain what they are."
Normal efforts to hold on to the present, alter the
individual, but this stifles growth rather than pro-
viding an adaptation to the new circumstances of
life. In a parallel fashion, the abnormal person
attempts to hold on and resist change. In this case
it is not an attempt to avoid the future, it is an
effort to prevent being overtaken by the past—
to stem the tide of regression. The efforts of the
normal stalemate allow for moderate satisfaction
and unhappiness, but the fight against deterioration
(abnormality) leaves one overwhelmed by the im-
Abnormality, Normality and Health
pending disaster. In contrast to a process aimed
toward withstanding regression or seeking an im-
passe, health is depicted by an openness and flex-
ibility that permits growth which fits in with the
coming stages of life even as the past is reconciled.
By adapting to the inevitability of change, the
capacity for growth and satisfaction is optimized
consistent with one's place within the life cycle.
Health opens one to the next moment—it is future
oriented; normality is tied to the present; abnor-
mality has difficulty moving beyond the past.
Psychotherapy with the maladapted needs to focus
on resolving the past, while the task with normal
people is to assist with an acceptance of the process
of aging.
It is not possible to provide a complete analysis
of the limits of normality or of the strengths of
abnormality in a single paper. In order to illustrate
the complexity of these issues, creativity will be
examined in greater depth than the previous points.
Growth in autonomy is intertwined with creative
expression in the healthy. The sense of well-being
and self-confidence resulting from independent
choice enhance a readiness for the risks of creative
expression. In addition, the self-actualizing process
promotes the curiosity and critical awareness which
leads toward a reassessment of existing artistic
and scientific solutions, for example, the problem
of three-dimensional representation on a two-di-
mensional canvas. Creative risk opens one to fre-
quent failure, and requires rebellion against con-
temporary standards. May (1975) points out the
courage necessary for the discovery of "new forms,
new symbols, new patterns"—authentic creativity
necessarily threatens the status quo. The process
of healthy growth also allows for access to un-
conscious materials that provide the source for
breaking out of stereotyped modes—the flexibility
to permit ego loss and creative fantasy. The self-
actualizing person has contact not only with the
assets provided by the primary process qualities
of the unconscious (Kris, 1952), but also with
those of Maslow's (1971) Being-Cognition which
are enhanced by contact with altered conscious-
ness—peak experiences. However, creativity also
requires the self-control necessary to implement
insight within the limits of the artistic or scientific
medium—technical skill. This merger of creative
uncovering and competence can be found most
frequently in the healthy.
In contrast, normal people resist tapping into
fantasy, walling themselves off from the resources
of the unconscious. The need to maintain the safety
189
Lucien A. Buck
of conformity to social expectations deprives them
of curiosity and a capacity for critical analysis.
The reluctance of normal college students to pro-
duce original poems and to submit them to public
scrutiny has been repeatedly observed by Buck
and Kramer (1974). In joint poetry worships, the
lead, characteristically, has been taken by hos-
pitalized, schizophrenic people both in the sub-
mission of poetry to the group and the discussion
of its personal relevance. This disparity has been
regularly acknowledged by the students, frequently
as a sense of being overwhelmed by the creative
superiority of the hospitalized people (Buck &
Kramer, 1983). Rationality, orderliness, efficiency
and alert, focused attention provide fine assets for
technical proficiency, but this competence is im-
itative rather than creative. Rebellion against con-
formist pressures by the abnormal individual, re-
sults in openness to unconscious sources and
sometimes leads to considerable creative insight.
However, the extreme vulnerability of people la-
beled schizophrenic and autistic, for example,
sometimes leaves them unable to marshall technical
proficiency. Regressed thought—delusions and
hallucinations—can be viewed as failed efforts
toward poetic expression. The closer to normality
the particular subcategory of abnormality, the less
likely the creative access. At the extremity of
maladaptation, there is a deficiency in self-
control—both a lack of the rigid defenses of the
normal and the conflict-free problem solving ca-
pacity of the healthy. Nevertheless, many schizo-
phrenic and autistic people do demonstrate the
technical proficiency that is indicative of consid-
erable artistic accomplishment. It is pathology
oriented diagnoses that obscure—distort—the
authentic artistic achievements. (Buck, 1983; Buck,
Goldstein & Kardeman, 1983; 1985; 1987; Buck,
Kardeman & Goldstein, 1984; 1985; Buck & Kra-
mer, 1973; Buck & Kramer, 1977; Kramer, 1969).
As Anthony (1987) has proposed in regard to the
quality of resiliency, creative capacity can be
viewed as an ingredient of ego strength. As such,
it provides an asset for psychotherapeutic inter-
vention. In spite of professional bias, there is
evidence to indicate that those labeled abnormal
exhibit greater openness to the original than in-
dividuals considered normal. This access, however,
needs to be coupled with skill in order to maximize
the therapeutic value of creativity. With normality,
the problem is to facilitate the courage to risk a
creative search.
190
In order to further undermine the pathology
perspective which can obstruct a psychotherapist's
ability to grasp the full humanity of people, se-
lected, representative examples of the creative
capacity of individuals who have been labeled as
outcasts will be presented. Evidence which refutes
traditional diagnostic wisdom regarding intellec-
tual, interpersonal and artistic limitations in
schizophrenia can be found in the work of Buck
and Kramer (Buck & Kramer, 1974; 1977; 1983;
Kramer 1983; Kramer & Buck, 1974). The poetry
of a middle-aged, frequently hospitalized man
represents one of the best illustrations of inter-
personal and creative growth.
In Praise of Poetry
How it changes the seasons and the stars,
How it names things
giving them meaning. . .
How it multiplies
wonder
and majesty
and metaphor.
How it elevates the soul
How it penetrates below the surface
where the power is. . .
How it gives instant joy to both
writer and reader.
How it sometimes is more real
than reality,
bigger than life.
How in poetry
everything is possible. . .
. . .when poetry speaks,
people listen
and things happen.
The creative mastery of language in a relatively
uneducated man who had no prior training as a
poet raises doubts about any research which limits
its focus to thought disorder in schizophrenia. His
concern about the world and the values necessary
for people to live together in humane ways is
found throughout his writing. His empathic re-
sponsiveness, not always reflected directly in per-
sonal contacts, is surpassed only by the imaginative
use of words. The importance of poetry to his
identity as an artist and self-worth as a person
was also evident during group discussions. The
respect he received within the Dowling Poetry
Workshop enabled his creativity and desire for
relatedness to flourish. An atmosphere that en-

courages such originality permits an opportunity
for a balanced understanding of this man (e.g.,
his linguistic and cognitive competence) as well
as providing a source for self-examination.
Similar to schizophrenia, autistic thinking has
been considered concrete and impoverished. Art-
work from the West Islip Long Island Talented
Handicapped Artist's Workshop demonstrates the
imaginative productiveness which regularly appears
in a flexible, respecting environment (Buck, 1983;
Buck, Goldstein & Kardeman, 1983; 1985; 1987;
Buck, Kardeman & Goldstein, 1984; 1985). The
series of paintings produced by a 24-year-old,
autistic young man participating in the THAW
Program shows the kind of creative unfolding
typically found in people categorized by this label.
The probing of various, self-initiated, artistic styles
led from a focus on other worlds and outer space
to a concern with materials from his observation
of the world around him. One of his earliest paint-
ings was called "Unknown Woman." This creation
has the quality of Roman portraiture, but it includes
a casual glance and three quarter turn of the head
that establishes a more contemporary tone. Early
work included "Venus" which explored a different
set of technical problems. Black and silver dominate
the painting—heavy, gloomy tones—yet the soft
shading integrated with the balance achieved among
the forms create a sense of warmth. Equilibrium
is built by opposing a large, black, asymmetrical
mass in the lower portion of the canvas with the
powerful strokes used to create the atmosphere
and the subtle curvature of the stars scattered above.
Soon, however, new challenges were explored as
exemplified by "Rams on a Mountain" and "Fire
Island." Both paintings reflect contemporary subject
matter, and the keen sense of balance evident in
his other work. These pictures are highlighted by
a diagonal perspective focused by a solid, dark
form in an upper corner and an animal figure in
the opposing lower corner. The animals are rem-
iniscent of the scratchy but fluid lines of Picasso's
ink drawings. The similarities to various artistic
traditions originated from his creative growth rather
than any familiarity, at this time, with other paint-
ers. As he focused more on his contemporary
experience, he painted, from memory, "Verrazano
Bridge." On his own, he continued to discover a
number of technical innovations: new-found ac-
complishments with perspective enabled him to
surmount the boundaries of the canvas. Following
this period, a series of portraits of individuals
Abnormality, Normality and Health
within the program and of black women were
created—an artistic concern that paralleled his
growing interest in people. As is typical of the
autistic in the THAW Program, creative unfolding
continued: for example, the simultaneous explo-
ration of the requirements of abstract ("Diamond")
and realistic painting ("Iris"). A firm sense of
identity as an artist has become evident in his
dedication to painting, and an increased sense of
personal worth (in this previously disheveled young
man) has been displayed in his neat appearance
and dress. An increased personal openness has
also revealed a full range of human feelings, and
a command of the English language which con-
tradicts past assessments of limited capacity for
abstraction. As with people categorized as schizo-
phrenic, many autistic are capable of creative
expression that contradicts traditional assumptions
of rigidity and concreteness. In addition, this artistic
unfolding is typically (in the THAW Program)
coupled with progress in intellectual and inter-
personal areas. Psychotherapists must overcome
self-fulfilling expectations of limited potential in
such individuals in order to permit the conditions
necessary for personal growth. Each client, even
if diagnosed as autistic, should be thought of as
having considerable maturational capacity however
slow its evolution.
Comparable, but even less anticipated, creative
development has been demonstrated in the retarded
at the Western Carolina Center in Morganton,
North Carolina (Stamatelos & Mott, 1982; 1983).
Black sea and black night.
Feel like a bad night.
Sad because peoples hearts are breaking.
I feel crowded, sad and homesick
Sometime like a black night.
This poem, written by a 28-year-old, mildly re-
tarded man, contradicts expectations of creative
expression in the mentally deficient, but also reflects
symbolic communication which refutes established
wisdom regarding the capacity for abstraction.
While the work is representative of mild retardation,
Stametelos and Mott (1983) have reported on im-
aginative progress with individuals designated as
severely retarded. Much of the concreteness and
rigidity typically observed is derived from insti-
tutionalization rather than mental deficiency. Some
of the feelings and concerns with typical issues
of living are evident in these poems, but a broader
sampling reveals the full range of human adap-
191
Lucien A. Buck
tations, e.g., an attempt to work-through the death
of a friend. Consistent with the creative expansion,
the growth of an identity based on a sense of
competence and worth is clearly illustrated. The
retarded struggle with and attempt to resolve the
same issues of living that are a nucleus for all
human beings. Psychotherapists need to be ready
to explore concerns with death, loneliness, creative
expression and other interests of the mentally
deficient—they have a capacity for self-exami-
nation and for personal growth. While it is nec-
essary to begin at the existing level of strength
and deficit, the ultimate therapeutic achievement
needs to be left open.
While progress has been made, the stigma of
hearing impairment—deafness—has still not been
entirely overcome by professional helpers. The
difficult process of learning to speak with a pro-
found hearing impairment leads to linguistic con-
creteness and rigidity that has been confused with
general cognitive incapacity. However, Buck and
Kramer's (Buck, 1976; Buck & Kramer, 1973;
Kramer & Buck, 1976) work has demonstrated a
capacity for abstraction and creative expression.
In addition, the range of poetry produced by the
hearing impaired reflects the same human dimen-
sions that all people confront: the struggle to achieve
autonomy, identity and relatedness. For example:
Peace in one Piece and Guess??
Guess who did the first sign of peace with our
fingers,
But peace is a piece because there will never be
peace
on earth.
Who did it first? Here you are one who says
PEACE to me,
and PEACE back means love.
While linguistic and technical difficulties are ev-
ident in the poem of this 16-year-old deaf girl,
the creative potential is clear. Sometimes, the
language deficiencies, freed from conventional
phrasing, offer unique poetic assets. The linguistic
consequences of profound deafness provide,
therefore, opportunities for creative expression
simultaneous with the obstacles to acceptable
grammatic and syntactic communication. Even
these brief samples provide evidence of access to
feeling, fantasy and concerns about critical human
issues, and recognition of her imaginative potential
led to the beginning consolidation of an identity
as a poet. Psychotherapeutic work with a hearing-
impaired individual should anticipate linguistic
192
inadequacies, but this is an obstacle for the therapist
to overcome. If the psychotherapist is able to
grasp the unique linguistic style of the particular
person—which can be enhanced by skill with
sign language—a full range of human capacities
and concerns will be found, including artistic
strengths.
The elderly are usually not overtly diagnosed
as abnormal, but the response of society emphasizes
a point of view implying that they have outlived
their productiveness—usefulness. Kramer's (1979)
poetry workshops, however, support a different
point of view. In many of the elderly, a self-
image of worthlessness has been fostered which
cripples their ability to manage the frequent con-
frontations with loneliness, illness and death. This
too often deprives the elderly of savoring the
strengths which can be derived from the final
stages of the life cycle. At this time, it is not easy
to remain engaged with the essential issues of
living. However, Kramer has demonstrated the
readiness with which each person can find his or
her voice. The struggle to regain active com-
munication of one's feelings is not easy.
I've tried to put words on paper,
but somehow my mind could not focus.
I feel it all inside of me,
but my pen does not seem to know it.
Oh foolish me to blame my pen,
when I know it's just plain
You know who.
Try again I must.
Yet, the creativity within and the desire to face
the remaining years in meaningful contact with
life ends by surprising both poet and listener.
A Summer Happening
Bare feet quickly hopping over hot tar roads.
Stones and shells graze my toes.
Their edges bring sharp pain.
I smell the sweet salt fragrance of the sea air.
I rush to the sea to find relief.
There is pleasure and pain
As I'm buried in the cool water.
As I sink gently to the bottom,
I grasp the ocean bed to hold myself in place.
Sand and gravel seep thro my grasping fingers
As I search and find a secure rock as an anchor.
The amniotic fluid of the earth rocks me, rocks me.
The bass voice of the sea is roaring, roaring.
Beating, beating torn toms against my eardrums.

The strong current loosens my grip.
I'm torn from Earth's womb again.
I'm borne again to the surface.
Empty lungs crying for air.
The grasp of language and the openness of the
poet's feelings are evident, but the expression of
rebirth celebrates a contact with life which had
been slipping away. Much of what purports to
define the process of aging needs to be refined to
include the capacity which appears in an enriching
environment rather than the deterioration which
comes from living within conditions that produce
deprivation. Psychotherapy with people adapting
to the final stages of life needs to go beyond
cultural prejudices in order to grasp the creativity
present. It is necessary to be able to get in touch
with the unique assets of this time of life. Erikson
et al (1986) describe the last stage of the life cycle
as one characterized by vital involvement—a
heightened awareness that emphasizes qualities
of activity, synthesis, and initiative. In the healthy
person, the promotion of integrity allows for the
possibility of wisdom—a "detached concern with
life itself" (1986). This focus can prepare the
therapist for the concern for life and creative en-
gagement demonstrated in the poetry presented
above.
Conclusions
This discussion does not provide a complete anal-
ysis of the multifaceted relationships among health,
normality and abnormality. Broad labels oversim-
plify a complexity of similarities and differences
which must be applied, in the final analysis, to
the unique individual. The critical point is to focus
on the assets and weaknesses to be found within
the cluster of characteristics representative of each
classification—of each person. One of the primary
implications is that the psychotherapist needs to
place greater emphasis on the limitations of nor-
mality and on the strengths to be found within
people labeled abnormal. For example, Taylor
and Brown (1988) have proposed that there is
considerable research that supports a conclusion
of "overly positive self-evaluations, exaggerated
perceptions of control, and unrealistic optimism"
in the thought of "normal" people. While they
believe that these "illusions" (Snyder & Higgins,
1988 regarding excuse-making as a means of
blocking some aspects necessary for "an accurate
view of reality") faciliate success with socially
Abnormality, Normality and Health
approved goals, they also point out that people
with low self-esteem and depression perceive the
world in a more realistic fashion—with less re-
course to illusion. In addition, Cohler (1987) has
reviewed a series of studies that indicate that there
is a subgroup of the children of schizophrenic
parents who appear to be "even more effective,
creative and competent than counterparts from
families in which there was no history of parental
psychiatric illness" (pp. 292-293). While this can
imply a genetic contribution, it is also possible
that some schizophrenic parents—in spite of, or
because of—their problems provide a health-pro-
moting environment for their children. Psycho-
therapists need to be ready to observe such talents
in spite of expectations of pervasive pathology.
Normality cannot be used, therefore, as an inclusive
baseline for assessing abnormality. Significant
difference from normality can demonstrate health
or incapacity. In addition, it is necessary to look
toward the commonality among people rather than
the one-sided emphasis on difference—a psy-
chology of significant similarities needs to be de-
veloped.
Adequate recognition of the complexity of hu-
man functioning by the psychotherapist includes:
helping normal people, if they so choose, to over-
come the restrictions of obligation and orthodoxy;
and assisting those labeled abnormal to convert
their nonconformist inclinations into a capacity
for healthy choice. The autonomy of the healthy
allows for the self-initiated growth in identity re-
quired by the process of aging: in contrast, normal
people need to overcome the pull of sameness;
and the abnormal individual has to struggle with
interference by trauma from the past. Creativity
provides an enormous reservoir of satisfaction in
the healthy: normality permits technical profi-
ciency, but fear of being different blocks the plea-
sure derived from originality; the access to creative
exploration (an asset for self-examination) in those
labeled abnormal is frequently limited by cognitive
or emotional deficits that obstruct the skills required
for implementation. Hov/ever, nothing stated in
this paper should be taken to imply that abnormality
is being equated with health, even though some
parallels have been discussed. The probing of
these similarities is intended to challenge current
professional bias, and to emphasize that the starting
point for assessing lack of therapeutic progress
should be to examine inadequacies in the way
that psychotherapists think about people rather
than automatically proposing deficits in the client.
193
Lucien A. Buck
Finally, the limitations of abnormality should not
be replaced by the inhibitions of normality.
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