The mental health system increasingly takes not just symptom remission, but also personal recovery seriously (e.g., Slade 2009). Since mental disorder criteria frequently refer to distress and/or dysfunction, the value of wellbeing and function seems implicit in the diagnostic system, whereas few psychiatrists would argue that being normal is valuable in itself. Nevertheless, we argue that talk of wellbeing, function, and recovery sometimes hides an implicit bias towards normalcy for its own sake. This issue is recognised in disability studies (e.g., Bailey 2019), but has received little attention in psychiatry.
Attempts to normalise the behaviour and cognition of people with mental illness might be motivated by appeals to wellbeing and/or better function, but these often rest on inadequate grounds. Examples include encouraging self-harming patients to hurt themselves through more acceptable means, such as holding ice cubes or snapping their wrists with rubber bands instead of cutting themselves (Sutton 2007). Yet, it is unclear whether replacing one kind of self-harm with another can help the patient feel better. Another example is the push to have people with psychosis disorders take medication, not just when the patient finds it helpful, but also when the patient says they prefer a higher risk of relapse to the medication side effects (Todd 2021). If a patient complains that the medication causes both suffering and dysfunction, an implicit pro-normality bias can explain why some clinicians will still insist that the patient continues to take it; someone who suffers physical side-effects, finds it hard to think and sleeps away their days, might still seem more normal than one who relapses into florid psychosis.
We argue that if psychiatry is to take seriously personal recovery as a goal, the existence of a problematic bias for normalcy for its own sake must be recognized and fought.