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Normality: Theoretical and Clinical Concepts of Mental Health
Book Reviews
583
their clarity and application to the principle discussed. Some examples are oversimplified, and this may pose problems for the inexperienced worker in the field. The numerous diagrams are meant to clarify concepts, but often are unnecessary. The major concern for this reviewer is that the reader is offered a sense of simplicity of what are really complex problems. Chapters II and 12 deal with principles of therapy. Pinkerton advocates treatment of the person rather than the problem, both family and community based. He emphasizes the therapeutic value of listening, an approach to treatment that is often forgotten. The last chapter summarizes the biopsychosocial spectrum of forces affecting the child, and presents a philosophy of clinical management emphasizing that regardless of the nature and severity of the problem, the child is indivisible and must be seen as a whole within the context of his family and community.
Normality: Theoretical and Clinical Concepts of Mental Health. By Daniel Offer and Melvin Sabshin, with the assistance of Judith Offer. New York: Basic Books, 1974,270 pp., $8.95.
Reviewed by Edward Sperling, M.D. "When I use a word," Humpty Dumpty said, in a rather scornful "it means just what I choose it to mean-neither more nor less. "The question is," said Alice, "whether you can make words mean so many different things." "The question is," said Humpty Dumpty, "which is to be master-that's all."-LEwIS CARROLL ton~:
A second, revised, edition of Normality could not come at a more propitious time. Psychiatry as a medical discipline is in an embattled state. Hardly a day goes by without articles in the press and in scientific journals questioning the core identity of this field. Certain diagnoses, such as homosexuality and behavior disorder of childhood, are questioned as medical entities, while many psychiatric practices ranging from Eel' to psychotherapy art: challenged as It:gililIlalt: medical cnt.crpriscs. 'These
debates are not new, but issues of recertification, PSRO, and insurance coveragc lend urgency to discussions about what should be the content of this medical spccialty. A sense of urgency, however, docs nothing to simplify the conceptual tangle of issues defining the scope of "mental health," "mental illness," or "normality." I nstead , the term "normality" can be encompassed only by Dr. SpnlillK is Associate Clinical Professar 01 Child Psvchiatr», Albert Einstein Collrgr 01 Medicine, Neic York.
584
Book Reviews
delineating the various sign ifica n t contexts in whi ch it is used , for exa m p le , in research in longitud inal development , or as th e end result of clinical treatment. Th e authors first undertook to su r vey the field of "norm ality" in preparation for their landmark stud y of the normal adolescent. Eight years later, they have published this second edition . revising mainl y the chapters that synthesize their review (chap. 6), demonstrate the applicabilit y of their concepts to research investigations (ch ap . ~), and point tow ard future directions (chap. 9) . After surveying various di sciplines-the ps ychoanal ytic. the cross-cuirural. the statistical. the hiolo~ical-~enetic, and the more acad e m ic ps ych ologica l perspectives-the authors arrived at four approaches to normality: normality as health, normality as utopia. normality as average. and normality as transactional systems. In these four perspectives, health is the absence of illness; utopia is the ideal state, for example. "maturity" or "genitality"; auerage is a statistical norm; and transactional systems attempts to introduce the elements of time and change into the concept of normality. This last. "functional perspective," normality as transactional systems. is one favored by the authors . Although they refer to a "three-dimensio na l, field-oriented concept of human behavior ," the authors' description of normalit y as tran sactional systems is too sketch y to evaluate cri tica lly. They present some provocative ideas relating to normal ity as a p,'ocess ,'alhe,' than as a stale or being. bUI rhcsc ideas and
i
h cir iru pljca-
tions are not discussed at a ny length. The authors come to clos er grips with this issue in th e cha p te r on empirical research and normalit y. Here, there is a valuable discu ssion of the problems of choosing normal co n tro ls in research studies. This is followed b y a description of various studies on normal populations. including a summary of their own stud y of adolescents. This chapter al so offers a va lu able outline of the issues involved in doin~ this kind of research, for example, the advantages and limitations of cross-sectional studies, followup stu d ies. longitudinal studies. and predictive studies . In looking toward future stu d ies . the authors wisel y sr ress that they offer no "su bsta n tive" definition of normalit y. No " p ro file " or statistical "a vera ge" will do. They sa y: "T he more we stud y normal populations the more we become aware that healthy functioning is at lea st as complex and varied as our psychopathological entities. Normality and mental health cannot be understood in the abst ract ; rather they depend on the cultural norm, society's expectations and values, professionals' biases. individual differences. and the political climate of the time (e.g ., tolerance for deviance)" (p, 179). This volume, then. offers a rich survey of the field. an attempt at some synthesis of definitions, and a n exposition of the central issues in the stud y of normalit y. The writing is clear and direct. In encompassing such a diverse and conceptuall y loo se area . the authors olTer a valuable orientation to the field . This is recommended reading for eve ryo ne in the behavioral sciences ami is necessary backgrouud for an y in vestigator of the normal.
583
their clarity and application to the principle discussed. Some examples are oversimplified, and this may pose problems for the inexperienced worker in the field. The numerous diagrams are meant to clarify concepts, but often are unnecessary. The major concern for this reviewer is that the reader is offered a sense of simplicity of what are really complex problems. Chapters II and 12 deal with principles of therapy. Pinkerton advocates treatment of the person rather than the problem, both family and community based. He emphasizes the therapeutic value of listening, an approach to treatment that is often forgotten. The last chapter summarizes the biopsychosocial spectrum of forces affecting the child, and presents a philosophy of clinical management emphasizing that regardless of the nature and severity of the problem, the child is indivisible and must be seen as a whole within the context of his family and community.
Normality: Theoretical and Clinical Concepts of Mental Health. By Daniel Offer and Melvin Sabshin, with the assistance of Judith Offer. New York: Basic Books, 1974,270 pp., $8.95.
Reviewed by Edward Sperling, M.D. "When I use a word," Humpty Dumpty said, in a rather scornful "it means just what I choose it to mean-neither more nor less. "The question is," said Alice, "whether you can make words mean so many different things." "The question is," said Humpty Dumpty, "which is to be master-that's all."-LEwIS CARROLL ton~:
A second, revised, edition of Normality could not come at a more propitious time. Psychiatry as a medical discipline is in an embattled state. Hardly a day goes by without articles in the press and in scientific journals questioning the core identity of this field. Certain diagnoses, such as homosexuality and behavior disorder of childhood, are questioned as medical entities, while many psychiatric practices ranging from Eel' to psychotherapy art: challenged as It:gililIlalt: medical cnt.crpriscs. 'These
debates are not new, but issues of recertification, PSRO, and insurance coveragc lend urgency to discussions about what should be the content of this medical spccialty. A sense of urgency, however, docs nothing to simplify the conceptual tangle of issues defining the scope of "mental health," "mental illness," or "normality." I nstead , the term "normality" can be encompassed only by Dr. SpnlillK is Associate Clinical Professar 01 Child Psvchiatr», Albert Einstein Collrgr 01 Medicine, Neic York.
584
Book Reviews
delineating the various sign ifica n t contexts in whi ch it is used , for exa m p le , in research in longitud inal development , or as th e end result of clinical treatment. Th e authors first undertook to su r vey the field of "norm ality" in preparation for their landmark stud y of the normal adolescent. Eight years later, they have published this second edition . revising mainl y the chapters that synthesize their review (chap. 6), demonstrate the applicabilit y of their concepts to research investigations (ch ap . ~), and point tow ard future directions (chap. 9) . After surveying various di sciplines-the ps ychoanal ytic. the cross-cuirural. the statistical. the hiolo~ical-~enetic, and the more acad e m ic ps ych ologica l perspectives-the authors arrived at four approaches to normality: normality as health, normality as utopia. normality as average. and normality as transactional systems. In these four perspectives, health is the absence of illness; utopia is the ideal state, for example. "maturity" or "genitality"; auerage is a statistical norm; and transactional systems attempts to introduce the elements of time and change into the concept of normality. This last. "functional perspective," normality as transactional systems. is one favored by the authors . Although they refer to a "three-dimensio na l, field-oriented concept of human behavior ," the authors' description of normalit y as tran sactional systems is too sketch y to evaluate cri tica lly. They present some provocative ideas relating to normal ity as a p,'ocess ,'alhe,' than as a stale or being. bUI rhcsc ideas and
i
h cir iru pljca-
tions are not discussed at a ny length. The authors come to clos er grips with this issue in th e cha p te r on empirical research and normalit y. Here, there is a valuable discu ssion of the problems of choosing normal co n tro ls in research studies. This is followed b y a description of various studies on normal populations. including a summary of their own stud y of adolescents. This chapter al so offers a va lu able outline of the issues involved in doin~ this kind of research, for example, the advantages and limitations of cross-sectional studies, followup stu d ies. longitudinal studies. and predictive studies . In looking toward future stu d ies . the authors wisel y sr ress that they offer no "su bsta n tive" definition of normalit y. No " p ro file " or statistical "a vera ge" will do. They sa y: "T he more we stud y normal populations the more we become aware that healthy functioning is at lea st as complex and varied as our psychopathological entities. Normality and mental health cannot be understood in the abst ract ; rather they depend on the cultural norm, society's expectations and values, professionals' biases. individual differences. and the political climate of the time (e.g ., tolerance for deviance)" (p, 179). This volume, then. offers a rich survey of the field. an attempt at some synthesis of definitions, and a n exposition of the central issues in the stud y of normalit y. The writing is clear and direct. In encompassing such a diverse and conceptuall y loo se area . the authors olTer a valuable orientation to the field . This is recommended reading for eve ryo ne in the behavioral sciences ami is necessary backgrouud for an y in vestigator of the normal.