Striving to define normal

Dr. Jordan Smoller
Dr. Jordan Smoller –Cheryl Richards

WHO

Dr. Jordan Smoller

WHAT

Smoller, an associate professor of psychiatry at Harvard Medical School and Massachusetts General Hospital, has just written a book called “The Other Side of Normal.’’

Q. You write in your book that psychiatrists are just starting to try to understand what it means to have “normal’’ mental health. Why is it important to understand normalcy?

A. The biology of normal teaches us about both our everyday life and also mental illness. Many psychiatric disorders are variations of some of the same brain systems that we use to navigate the challenges of everyday life. There’s really a vast spectrum of normal in terms of how we adapt to life. By understanding that, by having a basic map of how the brain and the mind work, we can start to make sense of things, demystify and hopefully treat disorders that cause people a lot of suffering.

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Q. How can we distinguish between normalcy and illness?

A. Normal and abnormal are like night and day. We recognize that they’re two different states, but the exact line between them is sort of impossible to draw. We’re comfortable with the fuzziness of twilight and that’s probably where we’re going to end up [with mental illness]. That doesn’t mean psychiatric disorders are inventions or myths. We know that there are extremes of some of these traits or behaviors that cause people real pain and suffering.

Q. Are there examples of where having a definition of “normal’’ will make a difference in understanding disease?

A. We have circuits in our brain for detecting danger and harm. That’s entirely normal. Sometimes [these systems] are active in the face of situations that are not really dangerous and they can take on a life of their own, they can go awry or go into overdrive. That is essentially what’s happening in many anxiety disorders.

Q. So understanding “normal’’ anxiety can help us understand where anxiety becomes pathological?

A. It was an understanding of how the brain lays down emotional memories that led to a new avenue for treatment. [D-Cycloserine], a drug originally developed to treat tuberculosis enhances the function of emotional memory circuits. There have now been several studies suggesting that taking this pill an hour before cognitive behavioral therapy can boost effectiveness of therapies for panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder.

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Q. What role does life experience play in mental health?

A. At a neural level and even at a molecular level, experience — especially early experience — seems to affect the programming of our stress hormone systems, and how our genes tend to turn on and off.

Q. If early childhood is so crucial to future mental health, doesn’t that put even more pressure on parents to get it right?

A. The brain is lying in wait for information that will help it organize basic functions like language and vision and emotional and social kinds of systems. But it’s waiting for the ingredients that have been present throughout evolution — the presence of a caregiver, some degree of nurturing, some degree of exposure to language, exposure to social information. In the presence of that, kids do well. It’s not about perfection.

Q. But adversity in childhood can have terrible effects on later life?

A. Real adversity and toxic stress, maltreatment and deprivation — those kinds of things especially early in life can have long-lasting effects. We know there is plasticity throughout life — the brain responds to the environment. That gives us a lot of hope that even if there has been adversity or difficulty early in life, there are things we can to help restore the course towards health.

Correction: An earlier version of this article had an incorrect photo of Dr. Jordan Smoller.

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