I can see your point, but I am heavily supervised by my attending, and also, the way I wrote that sentence about "telling people what they should do about their problems" is not a technical description of my interactions with the patients--it's just my casual spin on what psychotherapy is about in general. This would be opposed to, say, giving patients advice about how to make their problems worse, which we definitely don't do! I'm a med student so I haven't been trained in ANY form of psychotherapy, but I do get to talk to patients, and it does seem that we try to help them find more effective ways to cope with life.
What do you mean by normal "in the statistical sense of the word?" Do you mean that if enough people do something, it then becomes normal? I'm not sure I'd agree because there are some unhealthy behaviors that are very very common, but they're still unhealthy. Are they abnormal because of being unhealthy, or normal because they're common? Alcohol abuse comes to mind--in some communities, it's ubiquitous. Also, "functioning" is a subjective term. But I appreciate your point about traits being healthy in some settings and unhealthy in others.
Anyway, I would be curious about this whether the DSM existed or not. It's more a philosophical question than a clinical one.
And if I am correct, the DSM doesn't go much into NORMAL psychology. I wasn't a psych major and I imagine that normal psychology is a very interesting subject itself. What I find strange I guess, is jumping into this world of abnormal psychology without first learning what's normal. This differs from, say, medical illnesses, where we spend the first year of med school basically just studying the normal state of things.
I find that when I make the abnormal/normal comparison with my psych patients, my fund of knowledge about normality comes from my personal life experience, which seems totally unmedical and subjective to me.
Don't worry, I didn't really think that you "told your patients what do" literally. However, psychotherapy is not advice giving either. Some schools of therapy are more directive than others in term of skills training, but I still would not call it advice giving. I think that's really the domain of "life coaches" and fortune tellers. Have you ever seen a Rogerian therapy session? Talk about non-directive, yikes. I agree that I think it would be difficult to psychotherpay appropriately without training in psychology, especially theories of personality/behavior and advanced understanding of learning theory. I frequently see the psychiatrists' eyes glaze over when I start talking about Skinner, Tollman, Hullian drive theories, reinforcement contingencies, etc.....
But, knowledge of all these principles comes in handy when conceptualizing a treatment plan and hypothesizing what methods will accomplish the desired behavior change in a patient. Psychotherapy is really built upon two things: theories of personality and learning theory. You have to understand it and you haver to understand the principles that drive (and hinder) behavior change. In other words, I think one has to understand the theories that underly
normal personalty, before you can understand pathological personality/behavior. Using yourself as a gauge for normality is a dangerous logical fallacy in this business. Meehl referred to this as the "Uncle George's Pancakes" fallacy. It can easily lead to overpathologizing or underpatholgizing of behavior. And if you use this methods its difficult not to impose your morals onto a patient (either explicitly or implicitly). Meehl (1973).
Why I do not Attend Psychiatric Case Conferences is an absolute riot to read. I have the PDF if you're interested. I would encourage you not to worry so much about what you think is
normal, but instead, what is
adaptable behavior, given the patients desires, goals, environment, culture, morals, limitations, etc. I like to think of our profession as purveyors of adaptable functioning, not necessarily "normality."
Second, yes, I did mean if enough people do it, it is considered normal, in some cases anyway. This is the psychometric definition of normal. Yours is more of a medical model definition, and probably more salient to the work you are used to. However, the psychometric definition is widely used in psychiatry as well. For example, psychiatry does not consider a belief in god a delusion, because it is a social sanctioned belief, and the majority of people have a belief in a hight power. Moreover, in considering the diagnosis of MDE after the death of a spouse, grief reaction needs to be taken into account. This is because it is "normal" for most people to experience many of the criteria of MDE after the death of a spouse. In other words, research has demonstrated that most people do indeed have this reaction, so it is deemed "normal." It really is the intensity and timeline of the disturbance that that creates the conversion to MDE. I agree that the DSM does not delve into much normal psychology. The point was alot of criteria for disorders are aspects of normal behavior, because they happen to all of us. Feeling sad for a while is just a normal part of existing. You would be abnormal if this never happened to you frankly. What creates "depression" in the clinical sense is the combination of sadness with several other symptoms that last for weekends on end and impairs functioning.
