abnormality normality and health buck

8/8/2019 Abnormality Normality and Health BUCK

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P s y c h o t h e r a p y Volume 27/Summer 1990/Number 2

ABNORMALITY, NORMALITY AND HEALTHLUCIEN A. BUCKDowling College

Ideally, each participant inpsychotherapy should be accepted as aunique individual with no reference todiagnosis. Mo st forms of psychotherapyare limited by assumptions aboutabnorm ality that focus on pathologywhile ignoring the potential for growththat exists in all. Effectivepsychotherapy requires respect forhuman complexity. Each person needsto be perceived as em bodying a uniquebalance of strengths and weaknesses:t h e potential of normal people cannotb e properly evaluated if theirlimitations are ignored, nor canindividuals diagnosed as abnorm al beunderstood by relying upon a pathologyperspective. "Normalization" psychotherapeutic practices aimedtoward producing normal behaviorcan deprive people of existingstrengths.

Within the context of psychotherapeutic practice,current diagnostic approaches need to be thoroughlyrevised. The reconceptualization must go beyondcontroversies regarding biological versus p sycho -logical origins, evaluations of reliability and va-lidity, and other traditional questions. To beginwith, one-dimensional analysis must be avoidedin favor of t h e com plexity necessary to reflect thefull humanity of every participant in the processof psychotherapystrengths and liabilities canbe detected in all people. It is true that manydiagnostic systems warn against equating the labelCorrespondence regarding this article should be addressed

to Lucien A. Buck, Department of Psychology, Dowling Col-lege, Oakdale, NY 11769.

with the total person, but it is difficult, if notimpossible, to avoid this extension by the therapistand the client. Further, continuity between thosewh o exhibit the highest levels of satisfactions andpersonal achievement and individuals who areoverwhelmed even by the ordinary tasks of lifeneeds to be the central focus of the therapist, i.e .,commonality is more important than difference.While the extreme maladaptation of some humanbeings cannot be ignored, all people need to beviewed as striving to accomplish the same humangoals. Ideally these assumptions could result inthe elimination of specific labels such as autismor schizophrenia. Each person would be assessedin terms of the degree of interpersonal, creativeand intellectual competence demonstrated withthe expectation that weakness in one area is notinevitably connected with failure in all. Movementtoward this ideal requires fundamental changes inthe way many psychotherapists think about peop le.One of the primary implications of this reassessm entis that the health of people previously conceivedof as normal needs to be challengedno longerutilized, even implicitly, as an inclusive modelof desirable behavior.While delabeling is desirable, it is impossibleto challenge the existing diagnostic categorieswithout naming them. Therefore, a variety of terms

will be used in order to communicate within thecurrent framework. As a first approximation, itis possible to conceptualize abnormality, normalityand health as segments along a continuum of in-creasing capacity for managing the essential issuesof living: autonomy, identity, work, creativity,propagation, aging and death. Most individuals,how ever, will not exhibit uniformity in their com-petence. It is likely that only a small proportionof the populationthe healthiest and the mostmaladaptivewill demonstrate accomplishmentor failure over a broad range of abilities. At oneend point are those efforts which are generallyineffective, labeled as strange and peculiar, andtend to be self-destructivethe extremes of ab-

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Lucien A. Bucknormality. Normality reflects a group of reasonablyefficient means of managing the crises of the lifecycle which tends to avoid disaster even whileretreating from co nsum mate fulfillment. The costof this efficiency is a cycle of regularly recurringphysical and psychological ailments: headache,backache, constipation, cancer, anxiety, frustra-tion, alienation, dissatisfaction and loneliness(Costello, 1982; Friedman & Booth-Kewley, 1987;Jourard, 1971; Klerman & Weissman , 1984; Sie-gel, 1986). In contrast, health refers to a varietyof adaptations, so metim es less efficient than thoseof normality, reflecting highly effective means ofliving. Efficiency, in reasonable degrees, enhancescompetence, but, in the extreme, it dehumanizesand limits freedom of choice. While moderationrepresents an available path for the healthy, ac-ceptance of creative and interpersonal risks fre-quently lead to a heightening of anxiety and dis-appointment which are balanced by periods ofdeep satisfaction and intimacy. How ever, the cycleof normal ailments is minimized. It is assumed,however, that abnormality, normality and healthrepresent clusters of options, and not a simpledime nsion the willingness to risk success by thehealthy can lead, at times, to the experience ofgreater pain than is typical of normality.

The style with w hich people within these generalgroups manage life emphasizes the complexity ofthis dimension. Health is best characterized as aprocess of adaptation built upon considerableautonom y capacity for internal locus of choice.Such individuals fit in with social expectations tovarying degrees or radically dissent. W hatever thesimilarity to existing social values, the healthyperso n's choices are a result of a process of criticalanalysiseven agreement with particular normsdoes not, in this case, reflect conformity. Consistentwith this poin t, personal and so cial must be unitedin a fashion that facilitates "free assent" as partof resolving the Eriksonian (1968) crisis of identityformation, and the "healthy autonomy" of Mas-low 's (1971) concept of self-actualization. Valuesare internalized as one's own based on their rel-evance to the unique potential for growth withinthe person and the necessity of adapting to socialconditions, but the term adaptation includes theoption of rebelling against existing traditionsas May (1981) has proposed the possibility forrebellion is "necessary and inevitable for humanfreedom." Therefore, adaptation does not providean appropriate conception of the normal mode ofmanaging life. Normality requires adjustment

conform ity. It allows little room to challenge po-litical or religious ideology; sameness is the modelfor behaving. Choices are left to externalsourcesauthoritarian. Much of this form of ad-justment is captured by May's (1953) character-ization of "The Hollow People." Loyalty, dutyand obligation are the central foci, and these valuesgrow out of discipline rather than a process ofquestioning and challenging. Obedience, for ex-am ple, has been described by Gibson and Haritos-Fatouros (1986) as an essential part of the "ed-ucation " of "ordina ry" people to become torturersduring the Greek dictatorship. Similarly, Lifton(1986), in his examination of the "demonic" ac-tivities of the Nazi doctors, has focused on con-formity to established biomedical and politicalideology by people best characterized by their"ordinariness." The limited autonomy permittedby normality promotes caution leading to anavoidance of riskfailure is minimized comparedwith the healthy , but so is fulfillment. This analysis,as a first approximation oversimplifies the varietyof divergent styles which reflect obedience to au-thority (From m, 1965; M ay, 1981). Th e inferenceto be taken from this discussion, ho wever, is thatnormal human beings can derive considerablepsychological and biological benefit from psy-chotherapeutic intervention. While the healthy haveconsiderable potential for self-initiated growth,this is typically stifled in the normal individual.Abnormal management of the life cycle is bestconceptualized as maladaptation. This, paradox-ically, implies more in common with health thanwith normality. Abnormal modes are not effortsto conform but rather attempts to resist socialregulationto maintain personal integrity. Whilethis parallels the potential for unconventionalchoices in the healthy, most efforts to maintaininterpersonal relationships and to work efficientlyare less adequate than w ith normal people. Insightinto these impoverished efforts has been proposedby a number of clinicians who have overcometheir professional biases sufficiently to develop afacility with intimate contact with those peoplelabeled as schizophrenic: Buck & Kramer(1974-1977), Fromm-Reichman (1959), Laing(1969), Sullivan (1956), Szasz (1970) have dem-onstrated the schizophrenic's continuing strugglewith the problems of living, and with the uniqueopportunity available due to the lack of "conven-tional adjustment." The term abnormality appliesto a variety of indirect means of criticizing andchallenging conformist pressures.

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Abnormality, Normality and Health. . .the person who is normal in terms of being well adaptedis often less healthy than the neurotic person in terms of hum anvalues. Often he is well adapted only at the expen se of havinggiven up his self in order to become more or less the personhe believes he is expected to be. All genuine individualityand spontaneity may have been lost. On the other hand, theneurotic person can be characterized as somebody who wasnot ready to surrender completely in the battle for his self(Fromm, 1965, p. 160).In this sense, it is a question of adaptationasin the healthybut adaptation which fails. Sincethere is less autonomy than with norm ality, cho iceis overwhelmed, and resistance is taken over byautomatic, involuntary, irrational behavior whichis largely determined by factors outside the pe rson'sconscious awareness. Even though such individualsare more open to risk taking than normal people,their efforts typically miscarry and only occa-sionally succeed. The re is no solid locus of cho icewithin, nor readiness for acquiescence to externa lauthority. Nevertheless, their confusion and despairprovide an opening for change for growth. Psy-chotherapy needs to m ake use of the oppo rtunitiesfor healthy movement which can be detected ineach maladaptive style rather than encourag e nor-mal conformity.

Health, normality and abnormality representprocesses which unfold throughout the total lifecyclechange is universal. This assumption,however, is not intended to suggest that all hum anbeings accept the inevitability of change. Normalitycan be characterized as an attempt to create astalemateto maintain sameness. Growth con-fronts one with uncertainty and risk; regressionleads to helplessness and self-annihilation.Nevertheless, one must transform identity in orderto maintain continuity between what one is at themoment and what one needs to becom e in responseto the requirements of the next phase of the lifecycle. Therefore, one must change in order toremain the "same." As Erikson (1974) has phrasedit, " . . . they who cannot choose to be different,cannot decide freely to remain what they are."Normal efforts to hold on to the present, alter theindividual, but this stifles growth rather than pro-viding an adaptation to the new circumstances oflife. In a parallel fashion, the abnormal personattempts to hold on and resist chan ge. In this c aseit is not an attempt to avoid the future, it is aneffort to prevent being overtaken by the pastto stem the tide of regression. The efforts of thenormal stalemate allow for moderate satisfactionand unhappiness, but the fight against deterioration(abnormality) leaves one overwhelm ed by the im-

pending disaster. In contrast to a process aimedtoward withstanding regression or seeking an im-pas se, hea lth is depicted by an openness and flex-ibility that permits growth which fits in with thecoming stages of life even as the past is reconciled.By adapting to the inevitability of change, thecapacity for growth and satisfaction is optimizedconsistent with one's place within the life cycle.Health opens one to the next m om ent it is futureoriented; normality is tied to the present; abnor-mality has difficulty moving beyond the past.Psychotherapy with the maladapted needs to focuson resolving the past, while the task with norm alpeople is to assist with an acceptance of the processof aging.

It is not possible to provide a comp lete ana lysisof the limits of normality or of the strengths ofabnorm ality in a single pap er. In order to illustratethe complexity of these issues, creativity will beexamined in greater depth than the previous points.Growth in autonomy is intertwined with creativeexpression in the healthy . The sense of well-beingand self-confidence resulting from independentchoice enhance a readiness for the risks of creativeexpression. In addition, the self-actualizing processpromotes the curiosity and critical awareness whichleads toward a reassessment of existing artisticand scientific solution s, for exam ple, the problemof three-dimensional representation on a two-di-mensional canvas. Creative risk opens one to fre-quent failure, and requires rebellion against con-temporary standards. May (1975) points out thecourage necessary for the discovery of "new forms,new symbols, new patterns"authentic creativitynecessarily threatens the status quo. The processof healthy growth also allows for access to un-conscious materials that provide the source forbreaking out of stereotyped modesthe flexibilityto permit ego loss and creative fantasy. The self-actualizing person has contact not only with theassets provided by the primary process qualitiesof the unconscious (Kris, 1952), but also withthose of Maslo w's (1971) Being-Cognition whichare enhanced by contact with altered conscious-nesspeak experiences. However, creativity alsorequires the self-control necessary to implementinsight within th e limits of the artistic or scientificme dium technical skill. This merger of creativeuncovering and competence can be found mostfrequently in the healthy.

In contrast, normal people resist tapping intofantasy, walling themselves off from the resourcesof the unconscious. The need to m aintain the safety

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Lucien A. Buckof conformity to social expectations deprives themof curiosity and a capacity for critical analysis.The reluctance of normal college students to pro-duce original poems and to submit them to publicscrutiny has been repeatedly observed by Buckand Kramer (1974). In joint poetry w orships, thelead, characteristically, has been taken by hos-pitalized, schizophrenic people both in the sub-mission of poetry to the group and the discussionof its personal relevance. This disparity has beenregularly acknowledged by the students, frequentlyas a sense of being overwhelmed by the creativesuperiority of the hospitalized people (Buck &Kramer, 1983). Rationality, orderliness, efficiencyand alert, focused attention p rovide fine assets fortechnical proficiency, but this competence is im-itative rather than crea tive. R ebellion against con-formist pressures by the abnormal individual, re-sults in openness to unconscious sources andsometimes leads to considerable creative insight.However, the extreme vulnerability of people la-beled schizophrenic and autistic, for example,sometimes leaves them unable to marshall technicalproficiency. Regressed thoughtdelusions andhallucinationscan be viewed as failed effortstoward poetic expression. The closer to normalitythe particular subcategory of abnorm ality, the lesslikely the creative access. At the extremity ofmaladaptation, there is a deficiency in self-controlboth a lack of the rigid defenses of thenormal and the conflict-free problem solving ca-pacity of the healthy. Nevertheless, many schizo-phrenic and autistic people do demonstrate thetechnical proficiency that is indicative of consid-erable artistic accomplishment. It is pathologyoriented diagnoses that obscuredistorttheauthentic artistic achievements. (Buck, 1983; Buck,Goldstein & K ardeman, 1983; 1985; 1987; Buck,Kardeman & Goldstein, 1984; 1985; Buck & Kra-mer, 1973; Buck & Kram er, 1977; Kramer, 1969).As Anthony (1987) has proposed in regard to thequality of resiliency, creative capacity can beviewed as an ingredient of ego strength. As such,it provides an asset for psychotherapeutic inter-vention. In spite of professional bias, there isevidence to indicate that those labeled abnormalexhibit greater openness to the original than in-dividuals considered normal. T his access, however,needs to be coupled with skill in order to maximizethe therapeutic value of creativity. W ith norm ality,the problem is to facilitate the courage to risk acreative search.

In order to further undermine the pathologyperspective which can obstruct a psychotherapist'sability to grasp the full humanity of people, se-lected, representative examples of the creativecapacity of individuals who have been labeled asoutcasts will be presented. Evidence which refutestraditional diagnostic wisdom regarding intellec-tual, interpersonal and artistic l imitations inschizophrenia can be found in the work of Buckand Kramer (Buck & K ramer, 1974; 1977; 1983;Kramer 1983; Kramer & B uck, 1974). The poetryof a middle-aged, frequently hospitalized manrepresents one of the best illustrations of inter-personal and creative growth.In Praise of Poetry

How it changes the seasons and the stars,How it names thingsgiving them meaning. . .

How it multiplieswonder

and majestyand metaphor.How it elevates the soulHow it penetrates below the surface

where the power is. . .How it gives instant joy to both

writer and reader.How it sometimes is more realthan reality,bigger than life.

How in poetryeverything is possible. . .

. . .when poetry speaks,people listen

and things happen.The creative mastery of language in a relativelyuneducated man who had no prior training as apoet raises doub ts about any research which limitsits focus to thought disorder in schizophrenia. Hisconcern about the world and the values necessaryfor people to live together in humane ways isfound throughout his writing. His empathic re-sponsive ness, not always reflected directly in per-sonal contacts, is surpassed only by the imaginativeuse of words. The importance of poetry to hisidentity as an artist and self-worth as a personwas also evident during group discussions. Therespect he received within the Dowling PoetryWorkshop enabled his creativity and desire forrelatedness to flourish. An atmosphere that en-

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Abnormality, Normality and Healthcourages such originality permits an opportunityfor a balanced understanding of this man (e.g.,his linguistic and cognitive competence) as wellas providing a source for self-examination.Similar to schizophrenia, autistic thinking hasbeen considered concrete and impoverished. Art-work from the West Islip Long Island TalentedHandicapped Artist's Workshop demonstrates theimaginative productiveness which regularly appearsin a flexible, respecting environment (Buck, 1983;Buck, Goldstein & Kardem an, 1983; 1985; 1987;Buck, Kardeman & Goldstein, 1984; 1985). Theseries of paintings produced by a 24-year-old,autistic young man participating in the THAWProgram shows the kind of creative unfoldingtypically found in people categorized by this label.The probing of various, self-initiated, artistic stylesled from a focus on other worlds and outer spaceto a concern with materials from his observationof the world around h im. On e of his earliest paint-ings was called "Unknown Woman." This creationhas the quality of Roman portraiture, but it includesa casual glance and three quarter turn of the h eadthat establishes a more contemporary tone. Earlywork included "Venus" which explored a differentset of technical problems. Black and silver dom inatethe painting heavy, gloomy tones yet the softshading integrated with the balance achieved amongthe forms create a sense of warmth. Equilibriumis built by opposing a large, black, asymmetricalmass in the lower portion of the canvas with thepowerful strokes used to create the atmosphereand the subtle curvature of the stars scattered above .Soon, however, new challenges were explored asexemplified by "Rams on a Mountain" and "FireIsland." Both paintings reflect contemporary subjectmatter, and the keen sense of balance evident inhis other work. These pictures are highlighted bya diagonal perspective focused by a solid, darkform in an upper corner and an animal figure inthe opposing lower corner. The animals are rem-iniscent of the scratchy bu t fluid lines of Picass o'sink drawings. The similarities to various artistictraditions originated from his creative growth ratherthan any familiarity, at this tim e, w ith other paint-ers. As he focused more on his contemporaryexperience, he painted, from memory, "VerrazanoBridge." On his ow n, h e continued to discover anumber of technical innovations: new-found ac-complishments with perspective enabled him tosurmount the boundaries of the canv as. Followingthis period, a series of portraits of individuals

within the program and of black women werecreatedan artistic concern that paralleled hisgrowing interest in people. As is typical of theautistic in the THAW Program, creative unfoldingcontinued: for example, the simultaneous explo-ration of the requirements of abstract ("Diamond")and realistic painting ("Iris"). A firm sense ofidentity as an artist has become evident in hisdedication to painting, and an increased sense ofpersonal worth (in this previously disheveled youngman) has been displayed in his neat appearanceand dress. An increased personal openness hasalso revealed a full range of human feelings, anda command of the English language which con-tradicts past assessments of limited capacity forabstraction. A s with peop le categorized as schizo-phrenic, many autistic are capable of creativeexpression that contradicts traditional assumptionsof rigidity and concreteness. In addition, this artisticunfolding is typically (in the THAW Program)coupled with progress in intellectual and inter-personal areas. Psychotherapists must overcomeself-fulfilling expectation s of limited poten tial insuch individuals in order to permit the conditionsnecessary for personal growth. Each client, evenif diagnosed as autistic, should be thought of ashaving considerable m aturational capacity howeverslow its evolution.Comparable, but even less anticipated, creativedevelopment has been demonstrated in the retardedat the Western Carolina Center in Morganton,North Carolina (Stamatelos & Mott, 1982; 1983).

Black sea and black night.Feel like a bad night.Sad because peoples hearts are brea king.I feel crowded, sad and homesickSometime like a black night.This poem, written by a 28-year-old, mildly re-tarded man, contradicts expectations of creativeexpression in the mentally deficient, but also reflectssymbolic communication which refutes establishedwisdom regarding the capacity for abstraction.W hile the work is representative of mild retardation,Stametelos and Mott (1983) have reported on im-aginative progress with individuals designated asseverely retarded. Much of the concreteness andrigidity typically observed is derived from insti-tutionalization rather than mental deficiency. Someof the feelings and concerns with typical issuesof living are evident in these poe m s, but a broadersampling reveals the full range of human adap-

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Lucien A. Bucktations, e.g., an attempt to work-through the deathof a friend. Consistent with the creative expansion,the growth of an identity based on a sense ofcompetence and worth is clearly illustrated. Theretarded struggle with and attempt to resolve thesame issues of living that are a nucleus for allhuman be ings. Psychotherapists need to be readyto explore concerns with death, loneliness, creativeexpression and other interests of the mentallydeficientthey have a capacity for self-exami-nation and for personal growth. While it is nec-essary to begin at the existing level of strengthand deficit, the ultimate therapeutic achievementneeds to be left open.

While progress has been made, the stigma ofhearing impairmentdeafnesshas still not beenentirely overcome by professional helpers. Thedifficult process of learning to speak with a pro-found hearing impairment leads to linguistic con-creteness and rigidity that has been confused withgeneral cognitive incapacity. H owever, Buck andKramer's (Buck, 1976; Buck & Kramer, 1973;Kramer & Buck, 1976) work has demonstrated acapacity for abstraction and creative expression.In addition, the range of poetry produced by thehearing impaired reflects the same human dimen-sions that all peop le confront: the struggle to achieveautonomy, identity and relatedness. For example:

Peace in one Piece and Guess??Guess who did the first sign of peace with ourfingers,But peace is a piece because there will never bepeaceon earth.Who did it first? H ere you are one who saysPEACE to me,and PEACE back means love.While linguistic and technical difficulties are ev-ident in the poem of this 16-year-old deaf girl,the creative potential is clear. Sometimes, thelanguage deficiencies, freed from conventionalphrasing, offer unique poetic assets. The linguisticconsequences of profound deafness provide,therefore, opportunities for creative expressionsimultaneous with the obstacles to acceptablegrammatic and syntactic communication. Eventhese brief samples provide evidence of access tofeeling, fantasy and concerns about critical humanissues, and recognition of her imaginative potentialled to the beginning consolidation of an identityas a poet. P sychotherapeutic w ork with a hearing-impaired individual should anticipate linguistic

inadequacies, but this is an obstacle for the therapistto overcome. If the psychotherapist is able tograsp the unique linguistic style of the particularpersonwhich can be enhanced by skill withsign languagea full range of human capacitiesand concerns will be found, including artisticstrengths.The elderly are usually not overtly diagnosedas abnormal, but the response of society emphasizesa point of view implying that they have outlivedtheir productivenessusefulness. Kramer's (1979)poetry workshops, however, support a differentpoint of view. In many of the elderly, a self-image of worthlessness has been fostered whichcripples their ability to manage the frequent con-frontations with loneliness, illness and death. Thistoo often deprives the elderly of savoring thestrengths which can be derived from the finalstages of the life cycle. At this time , it is not easyto remain engaged with the essential issues ofliving. However, Kramer has demonstrated thereadiness with which each person can find his orher voice. The struggle to regain active com-munication of one's feelings is not easy.I've tried to put words on paper,but somehow my mind could not focus.I feel it all inside of me,bu t my pen does not seem to know it.Oh foolish me to blame my pen,when I know it's just plainYou know who.Try again I must.Yet, the creativity within and the desire to facethe remaining years in meaningful contact withlife ends by surprising both poet and listener.

A Summer HappeningBare feet quickly hopping over hot tar roads.Stones and shells graze my toes.Their edges bring sharp pain.I smell the sweet salt fragrance of the sea air.I rush to the sea to find relief.There is pleasure and painAs I'm buried in the cool water.As I sink gently to the bottom,I grasp the ocean bed to hold myself in place.Sand and gravel seep thro my grasping fingersAs I search and find a secure rock as an anchor.The amniotic fluid of the earth rocks me, rocks me.The bass voice of the sea is roaring, roaring.Beating, beating torn toms against my eardrums.

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Abnormality, Normality and HealthThe strong current loosens my grip.I'm torn from Earth's w omb again.I'm borne again to the surface.Em pty lungs crying for air.

The grasp of language and the openness of thepoet's feelings are evident, but the expression ofrebirth celebrates a contact with life which hadbeen slipping away. Much of what purports todefine the process of aging needs to be refined toinclude the capacity w hich appears in an en richingenvironment rather than the deterioration whichcomes from living within conditions that producedeprivation. Psychotherapy with people adaptingto the final stages of life needs to go beyondcultural prejudices in order to grasp the creativitypresent. It is necessary to be able to get in touchwith the unique assets of this time of life. Eriksonet al (1986) describe the last stage of the life cycleas one characterized by vital involvementaheightened awareness that emphasizes qualitiesof activity, synthesis, and initiative. In the healthyperson, the promotion of integrity allows for thepossibility of wisdoma "detached concern withlife itself" (1986). This focus can prepare thetherapist for the concern for life and creative en-gagement demonstrated in the poetry presentedabove.ConclusionsThis discussion does not provide a com plete anal-ysis of the multifaceted relationships among he alth,normality and abnormality. B road labels oversim-plify a complexity of similarities and differenceswhich must be applied, in the final analysis, tothe unique individual. The critical point is to focuson the assets and weaknesses to be found withinthe cluster of characteristics representative of eachclassificationof each person. O ne of the primaryimplications is that the psychotherapist needs toplace greater emphasis on the limitations of nor-mality and on the strengths to be found withinpeople labeled abnormal. For example, Taylorand Brown (1988) have proposed that there isconsiderable research that supports a conclusionof "overly positive self-evaluations, exaggeratedperceptions of control, and unrealistic optimism"in the thought of "normal" people. While theybelieve that these "illusions" (Snyder & Higgins,1988 regarding excuse-making as a means ofblocking some aspects necessary for "an accurateview of reality") faciliate success with socially

approved goals, they also point out that peoplewith low self-esteem and depression perceive theworld in a more realistic fashionwith less re-course to illusion. In addition, Cohler (1987) hasreviewed a series of studies that indicate that thereis a subgroup of the children of schizophrenicparents who appear to be "even more effective,creative and competent than counterparts fromfamilies in which there was no history of parentalpsychiatric illness" (pp. 292-293 ). While this canimply a genetic contribution, it is also possiblethat some schizophrenic parentsin spite of, orbecause of their problems provide a health-pro-moting environment for their children. Psycho-therapists need to be ready to observe such talentsin spite of expectations of pervasive pathology.Normality cannot be use d, therefore, as an inclusivebaseline for assessing abnormality. Significantdifference from normality can demonstrate healthor incapacity. In addition, it is necessary to looktoward the commonality among people rather thanthe one-sided emphasis on differencea psy-chology of significant sim ilarities needs to be de-veloped.Adequate recognition of the complexity of hu-man functioning by the psychotherapist includes:helping normal people, if they so choose, to over-

com e the restrictions of obligation and ortho doxy ;and assisting those labeled abnormal to converttheir nonconformist inclinations into a capacityfor healthy choice. The autonomy of the healthyallows for the self-initiated grow th in identity re-quired by the process of aging: in contrast, norm alpeople need to overcome the pull of sameness;and the abnormal individual has to struggle withinterference by trauma from the past. Creativityprovides an enormous reservoir of satisfaction inthe healthy: normality permits technical profi-ciency , but fear of being different blocks the plea-sure derived from originality; the access to creativeexploration (an asset for self-examination) in thoselabeled abnormal is frequently limited by cognitiveor em otional deficits that obstruct the skills requiredfor implementation. Hov/ever, nothing stated inthis paper should be taken to imply that abnormalityis being equated with health, even though someparallels have been discussed. The probing ofthese similarities is intended to challenge currentprofessional bias, and to emphasize that the startingpoint for assessing lack of therapeutic progressshould be to examine inadequacies in the waythat psychotherapists think about people ratherthan automatically propo sing deficits in the client.

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Lucien A. BuckFinally, the limitations of abnormality should notbe replaced by the inhibitions of normality.ReferencesANTHONY, E. J. (1987). Risk, vulnerability, and resilence:An overview. In E. J. Anthony, and B. J. Cohler (Eds.),The invulnerable child. New York: Guilford.BUCK, L.A. (1976). A human context for the cultivation ofpoetic creativity. In A. Nimbark, L. Buck, and F. Silverblank(Eds.), Honeycomb. Oakdale, N.Y.: Dowling College Press.BUCK, L. A. (1983). "Autism" reconsidered: creative andinterpersonal growth. Presented at Symposium, Growingthrough the Arts. Adelphi University, Garden City, N.Y.,September.B U C K , L. A., GOLDSTEIN, F. & KARDEMAN, E. (1983). Artas a means of interpersonal communication in people labeled"autistic." Presented at 41st Annual Convention, InternationalCouncil of P sychologists, University of San Francisco, SanFrancisco, Calif., August .BUCK, L. A. , GOLDSTEIN, F. & KARDEMAN, E. (1985). "Autism"versus "mental retardation." Presented at 109th Meeting,American Assoc. on Mental Deficiency, Philadelphia, May .B U C K , L. A., GOLDSTEIN, F. & KARDEMAN, E. (1987). Crea-tivity and personal growth in a young woman labeled"schizophren ic." Presented at Annual Mid-Winter Meeting,Divisions of Psychotherapy, Independent Practice, andFamily Psychology, New Orleans, March.BUCK, L. A. , KARDEMAN, E. & GOLDSTEIN, F. (1984). "Autism"and the value perspective of the professional h elper. Presentedat 108th Annual Meeting, American Association on MentalDeficiency, Minneapolis, May.BUCK, L. A., KARDEMAN, E. & GOLDSTEIN, F. (1985). ArtisticTalent in "autistic" adolescents and yo ung adu lts. EmpiricalStudies of the Arts, 3, 81-104.BUCK, L. A., KARDEMAN, E. & GOLDSTEIN, F. (1986). Artisticpotential in young adults labeled "mentally retarded." Pre-sented at 110th Meeting American Association on MentalDeficiency, Denver, May.BUCK, L. A. & KRAMER, A. (1973). Opening new worlds tothe deaf and the disturbed. In J. J. Leedy (Ed.), Poetry thehealer. Philadelphia: Lippincott.BUCK, L. A. & KRAMER, A. (1974). Poetry as a means ofgroup facilitation. Journal of Humanistic Psychology, 14,57-71.BUCK, L. A. & KRAMER, A. (1977). Creative potential inschizophrenia. Psychiatry, 40, 146-162.BUCK, L. A. & KRAMER, A. (1983). Th e labeling and delabelingof people called schizophrenic. Unpublished Manuscript.COHLER, B. J. (1987). Adversity, resilience, and the study oflives. In E. J. Anthony and B. J. Cohler (Eds.), The in-vulnerable child. New York: Guilford.COSTELLO, C. G. (1982). Fears and phobias in women: acommunity study. Journal of Abnormal Psychology, 91,280-286.ERKSON, E. H. (1968). Identity: youth and crisis. New York:Norton.ERKSON, E. H. (1974). Dimensions of a new identity. NewYork: Norton.E R K S O N , E. H., E R K S O N , J. M. & KIVNICK, H. Q. (1986).Vital involvement in old age. New York: Norton.FRIEDMAN, H. S. & BOOTH-KEWLEY, S. (1987). The "disease

prone personality." American Psychologist, 42, 539-555.FROMM, E. (1965). Escape from freedom. New York: Avon.FROMM-REICHMAN, F. (1959). Remarks on the philosophy ofmental disorder. In D. M. Bullard (Ed.), Psychoanalysisand psychotherapy: Selected papers of Frieda Fromm-Reichmann. Chicago: University of Chicago Press.GIBSON, J. T. & HARTTOS-FATOUROS, M. (1986). The education

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