musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Normal is an illusion


When we are very young, asking the question of whether or not we are normal would be unlikely: we are all different. Unless we are twins, we don’t look much like the others with whom we play; we act differently, have varied preferences, and often exhibit our unique personalities when reacting to things we encounter. At first we merely are, and with no compelling reason to suspect otherwise, it is enough.

It’s only later, when we begin to interact more widely with others, that differences become more important. Such things as gender, height, and personality –not to mention skin colour, and ethnic background- can play a role in the way we think about ourselves; can make us wonder whether it is us, or the others, who are normal.

Although my father worked for the railway and our family was transferred to a different city every few years, I spent most of my formative early years in a largely Caucasian neighbourhood in Winnipeg where ‘different’ merely meant stronger, or better at sports than me. At that time, I had very little interaction with black or brown kids simply because very few of them lived in the area. I knew from the occasional school-trips we made to the Museum, that some schools had sizeable First Nation enrolments, but we all misbehaved in the museum, so I’m not sure I could spot much difference: kids are, well, kids. We were all the same; we were all normal.

It was the same in the other places to which my father was transferred; in Québec, the language they spoke made them all just Quebecois in my mind; in Ontario, although most spoke my native English, I was more intrigued by the lilting Jamaican speech of some than their appearance… Different backgrounds, different behaviours, but by and large predictable; by and large as normal as me, a short, bespectacled teenager who couldn’t decide when not to smile…

It was only in my later years that I began to wonder what ‘normal’ meant. Was it group-specific, culture specific, gender specific…? Or was it simply whatever I got used to? My friends were all unusual, I remember -maybe that was the only the criterion I demanded for the normalcy of my companions. Thinking about them now, I realize they were all strange -but so was I… Okay, so am I; I am probably an unlikely template for what is normal. And yet I still have to ask what it is. Is normal a statistical thing -like where you live on the distribution of the bell curve (the highest point of the curve being where most of us are)? Is ‘commonest’ actually another way of describing ‘normal’?

More recently, the question surfaced again after I happened upon an article by Sarah Chaney, at the time a research fellow at Queen Mary Centre in London[i]. ‘Before the early 19th century, the word ‘normal’ was not applied to human beings at all. It was a mathematical term, meaning a right angle… the normal as a generic state of being or behaving simply did not exist. Our modern notions of normal emerged in Belgium in 1835, when Adolphe Quetelet, a 39-year-old astronomer and statistician, began the trend of comparing human characteristics against an average.’ If he plotted the individual heights of thousands of people on a graph it formed a bell-shaped curve, and the heights of the largest number of people fell around the peak at the centre: the bell curve.

There was nothing particularly special about the members of this peak on the curve; there were simply more of them there. It was the average height -the mean height- of the measured population, but not the correct height, or even the desired height. Only when there were extreme deviations from that mean, might it deserve further investigation as to why. Average did not mean ideal, however; and it certainly did not mean normal, either. One of the obvious problems using  this statistical method was with the population measured. One cannot simply use the average height of a group of basketball players on a professional team and apply it to the population as a whole. There is no ‘normal’ height and no certainly ‘ideal’ height for people in general. There may be an average height for a bunch of fishers, teachers, or nurses or whatever category you decide to measure, but so what? None of these is likely to be a homogeneous collection…

I suppose what I’m getting at, is what I started with: we are all different in one respect or another. So what, then, should be regarded as normal? And further, what does it matter?

For some reason, it reminds me of a lecture in some nameless course I was taking in university years ago. I remember it had been held in a cavernous theatre with annoying echoes from the sound system they were using in those days. I even remember the person sitting beside me; James was a tall gangly kid with red hair and he was wearing a brown fluffy sweater that smelled of mothballs. I suppose it was the contrast in our two heights that stuck with me, though: I was rather short; he was rather tall… well, very tall, actually.

At any rate, the professor was saying something about the difference between normal and average, and how the two concepts were often conflated. I don’t think either of us were paying too much attention because James was doodling strange figures in his notebook, and I was still writing an assignment we were supposed to hand in at the conclusion of the lecture. And then, just as the lecture was about to end, I heard the professor say something about the average height of a normal man in Canada being 5’ 7”. He didn’t mention his source, I don’t think.

I remember James stopped doodling, and I stopped writing my as yet unfinished assignment and we looked at each other. “I’m 6 feet two inches”, he whispered.

“And I’m about 5 feet 6 inches…” I whispered back, probably a little disappointed that I wasn’t standard issue.

He thought about this for a moment. “Your numbers are closer to normal than mine, though,” he added, his face a study of concern.

I thought that was a funny thing to take from the lecture. “I’ve always wanted to be taller,” I said, as the class began shuffling to their feet. I thought that might make James feel better, but he didn’t seem at all relieved. “Didn’t the prof say something about ‘average’ being a number and ‘normal’ being a judgment though, James?” I quickly added.

“Must have missed that, G,” he said, looking more cheerful at the thought. “I still wish I’d been given a lower number, though…”

I had to smile at his discomfort. I certainly wouldn’t have refused a few of the numbers he wanted to get rid of…

[i] https://psyche.co/ideas/worried-youre-not-normal-dont-be-theres-no-such-thing

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