Reflection on the Concepts of Psychopathology and Normality

What the Terms Reveal

Psychopathology: the word is out and it is heavy. Heavy with history and images. Heavy with fantasies too, flourishing as best they can in literature, cinema, theatre or the plastic arts. Melancholy, madness, degeneration, hybris, punctuate our narratives and our representations of the human being, in a sort of hallucinating maelstrom more reminiscent of Breugelian visions or Homeric Hades, than of a springtime Eden where innocent young girls frolic.

However, if we refer to the etymology - as we like to do in many of our writings - we discover a language that is more poetic than technical, a language that deserves our attention in the disheveled jungle that is precisely the world of mental illness with which we are all confronted. The term is made up of three Greek elements: psukhê, pathos and logos. Let’s take a quick look at what they mean. Psukhê means “breath, respiration, breath”: It is said of the vital force and life, felt as a breath, of the soul of the living being, the seat of its thoughts, emotions and desires, and which designates by metonymy this being itself: the personal individuality, and any living creature endowed with Conceptual Paper a ‘soul’ (...). It refers especially to the immaterial and immortal part of the being, applying to the separated soul of a dead person, to the more or less material breath dwelling in Hades. The word also referred to a butterfly, precisely a nocturnal species, the moth (even today, the butterfly is called psukhari in Greek), because the butterfly was a symbol of the immortality of the soul for the ancients [1].

Pathos, on the other hand, means “that which happens” “an experience suffered, a misfortune, an emotion of the soul”: It is a word of very general use, derived (...) from pathein, from paskhein “to receive (an impression or sensation), to undergo, to endure (good or bad treatment)” and “to be chastised”.

The etymology of the word is obscure and could be related to an Indo-European root meaning “to bind, to associate”. It is also found in the English path. Finally, we are all familiar with the term logos, which refers to the idea of “speech” or “reason”, but is often translated, notably by Chouraqui A [2], as breath, once again. Still in the evangelical sphere, the Word is mentioned in connection with it, almost exclusively in the prologue of the Gospel of John: In the beginning was the Word and the Word was turned to God, and the Word was God. He was in the beginning turned towards God. All things were made through him, and without him nothing was made.

If we summarize these various sources, we arrive at an eminently interesting understanding of the concept: both allusive and imaginary. Psychopathology would be: “The discourse (logos) relating to what the breath of life - or the butterfly (psukhê) - experiences or endures (pathos).” One notices, at the outset, that there is no reference to dysfunction or disease, which is surprising, to say the least, if not enlightening. In fact, and quite certainly, the etymology has the wisdom to confine itself to the phenomenological dimension of the thing (from the Greek phainomena “what is visible, what appears to the senses”) without any connotation of value or evaluation of this kind.

In our age, which excels in, or even becomes intoxicated with, categorizing human behaviour in pathological terms [3]- one wonders whether there are still some beings who are neither neurotic, nor narcissistically perverted, nor psychotic or psychopathic - it is rather reassuring to note that, in reality, etymology remains below any connotative intoxication in the use of the concept. However, if there is a pathology - for, let us not delude ourselves, the various nosographic designations (i.e. the description and definition of illnesses - nosos) are useful in identifying certain behaviours which, to all appearances, deviate more or less markedly from those considered normal. It is therefore useful to turn now to the latter term, or to what is generally understood by the notion of normality.

On Normality

The term comes from the Latin normalis, from norma “made square” and then “conforming to the rule”, also used in the moral sense of “rule, line of conduct”, associated with the word regula, the rule. It undoubtedly derives from the Greek gnômôn which, in ancient Greece, was the name given to a stake planted in the ground that allowed the movement of the sun to be visualized by its shadow. A sort of sundial, in short. “It is also said, without any value judgment, of the usual, regular state, conforming to the majority of cases.

In such a perspective, being normal corresponds to a way of being adopted by the majority and referred to a rule or a set of prescriptions whose origin or ins and outs it is difficult to define in a clear or exhaustive way. The image of the gnômôn can nevertheless help us: as an indicator of the immutability of the sun’s path, which has been displayed in its formidable regularity since the dawn of time, this stake and its shadow refer us to a kind of universal and, above all, stable reference, given that, wherever on the globe it may be placed, it will be in the same position, and taking into account seasonal variations, the gnômôn will undeniably return a form of truth, given that it refers not to variations in moods or current trends, but to what has always been perceived as an absolute transcendence: the solar star and its ontological reliability, synonymous, as we know, with one of the main and first deities ever recognised by human beings. I recall in passing that etymologically the term God has as its root the Indo-European word dei- “to shine” which, enlarged into deiwo-, was used to designate the luminous sky considered as divine as opposed to men, earthly by nature: It is the oldest Indo-European name for the deity, linked to the notion of light, which is found in Greek in the name of Zeus (genitive Dios) and in dios ‘bright’. The same root was also used to designate daylight and the day.

The etymology, let’s admit it, allows us to dream. And to grasp the extent to which human beings have always thought of the world by means of images and allusions, in other words, what we call metaphors (from the Greek methaphora, “that which transports” or “deports”), and not by claiming to be immediately-without mediation-attached to things as they are. Here we find a famous Kantian distinction between the thing-in-itself-inaccessible by definition-and the for- itself of the thing which, necessarily, can only be evasive and clumsy, groping, given its exile in relation to the essence of what is, i.e. its in-itself, eternally elusive, but always sought after, by all the psyches that have ever existed.

Thus, if we allow ourselves to dream once again, normality is defined by God and one of his most ancient representatives: the solar star and its luminescence. This is worth thinking about. For if this is the case, it is obvious that anything that deviates from it can only be monstrous or deleterious, as Foucault hammers out throughout his magnum opus, History of Madness in the Classical Age [4]. The Hellenist Dodds ER [5], in his book The Greeks and the Irrational, says no different when he writes: In Athens, the mentally ill were still avoided by a large number of people who regarded them as beings subject to a divine curse whose contact was dangerous: stones were thrown at them to keep their distance; and failing that, the simple precaution of spitting was at least taken. And yet, if the madmen were avoided, they were also regarded (...) with a respect approaching terror; for were they not connected with the supernatural world, and could they not sometimes display a power denied to ordinary mortals? [5].

With these few elements, we are faced with a bundle of eminently heuristic meanings that diffuse the problematic that interests us today. As we have seen, from the etymological point of view, psychopathology does not pass any judgement on the content of a behaviour, but is content to position itself from the phenomenological point of view: it is called upon to observe and follow the movements of the soul, movements which appear, in the eyes of reason and theorizing, to be as elusive and difficult to pin down as those of the wind, of breath or of anything that, to our senses, remains immaterial and invisible. From this point of view, normality, the famous Latin regula, cannot be summed up in the peremptory assertion of a kind of behavioural orthodoxy that would constitute the Alpha and Omega of all human behaviour. The spectrum is wide and each of us, in his or her practice or in daily life, is of course a privileged witness to it.

In order to avoid the pitfall of a supposedly omniscient comparatism - in which normality could only be referred to in relation to others - or of a nebulous ideal, unable to specify what it is made of, Bergeret J [6] arrives at the flexibility of a definition that deserves our attention. In all humility, acknowledging the excessive length of his explanation, while recognising that it is difficult to reduce its parameters, he writes: The true “healthy” person is not simply someone who declares himself as such, nor especially a sick person who ignores himself, but a subject who retains as many conflicting fixations as many people, and who has not encountered internal or external difficulties superior to his hereditary or acquired affective equipment, and who would allow himself a fairly flexible play of his impulsive needs, of his primary and secondary processes on personal as well as social levels, taking into account reality, and reserving the right to behave in an apparently aberrant way in exceptionally “abnormal” circumstances [6].

The whole interest of the approach that has just been recalled lies in these few crucial elements that deserve to be underlined: normality is not excluding, since it tolerates intrapsychic conflict, or even defines itself as that which allows, precisely, the existence of such a state. Which is to say that many patients find it difficult to admit that conflict - or ‘war’ in the sense of Heraclitus [7] - is at the heart of being and constitutes its fabric, condition and creative vigour. Indeed, this is found in all of Jung’s work as much as in our most daily clinical experiences, it is indeed because the patient is in debate with himself, that he battles and clashes, within, with contradictory motions that he can and will evolve, in one way or another. Without conflict, there is no conceivable psychic life, nor any kind of evolutionary potential. In the face of current injunctions to achieve happiness for all and emotional stability (found in movements such as mindfulness meditation, positive thinking, etc.), the observation may seem bitter: it is within the internal struggle that human vitality is found, and not elsewhere. Difficult to digest, but certainly useful to remember.

After having examined the contents (intrapsychic conflicts) Bergeret J [6] maliciously insists - and rightly so - on the container. In other words, on the ego complex. Indeed, from all times and in all places, the existence claimed from the creature what is called a “strong self”. Not a hegemonic self, but quite simply and healthily, a structure capable of holding the road by facing the innumerable hazards that will not fail to arise on its way, on its pathos, its path.

As a containing function of various problems, sometimes insoluble - Dürckheim KG [8] liked to repeat that we were conceived to “accept the unacceptable” [8]- the self, indeed, implies certain sine qua non conditions throughout its development, in order to be able to face precisely what will not fail to arrive to it, if not to fall on it as the avalanche does on the head of the walker. As practitioners, we know that many of these conditions have been sorely lacking in some of our patients and that what they come looking for in therapy is precisely another container, one that is undoubtedly more open, more tolerant or warmer than the one to which they have been subjected. In this way, it appears clearly that when it is question of psychological dysfunction, one speaks initially about the self. The ego as incapable of managing, containing or orienting the internal flows, the archetypal or impulsive pushes, the various overflows which do not fail to arise from the maelstrom of which it has just been questioned [9].

In this way, one could advance, without too much risk of being mistaken, that the psychological dysfunction or the pathology occurs when the self, as an envelope, is either torn by one, or a series of events which irremediably deteriorate its cohesion, or reveals itself insufficiently structured to integrate the real in its most usual dimensions. To give a striking example, I have been working for years with a patient, diagnosed as psychotic, who lives in a tent. Summer and winter. Not for lack of means - she made a nice inheritance some time ago - but because of her inability to take the slightest step that would allow her to get out. Her ego, which she describes as non-existent, not having been provided with the initial devices for confronting reality, proves to be totally inoperative when it comes to calling someone on the telephone, carrying out administrative procedures, and so on. Hollowed out on all sides, this structure resembles a container that is constantly hemorrhaging, a hemorrhage that we try, year in, year out, to plug with our tiny cognitive and affective tools.

The question of the self is obviously fundamental for the present reflection, especially when we note that in reality, and for someone capable of authorizing “aberrant behaviours” in the sense evoked by Bergeret J [6], a “strong self” is both the condition for social, professional or affective integration, and the internal organization that can lead the subject to the most absolute individual sterilization.

Thus, situated in this perilous in-between situation, dear to Sibony D [10], we can observe, on the one hand, a psychic entity that is globally adequate in the face of existential vicissitudes and, on the other, a containing function that is incapable of escaping or exceeding its own limits, thus creating, around the psyche, a sort of trap or, worse, a semi- tight cage that does not allow much to pass through nor can it be fertilised by others. This is what I have called, on other occasions [11], the paranoid tendencies of the ego. In a therapeutic situation, it is this kind of complexity that one must face, with all the humility and patience imaginable.