I received a complimentary copy of this title from the publisher through NetGalley. Opinions expressed are my own.

THIS is the book I've been waiting for! I've long been in search of a book on mental illness that was both historical and helpful. Usually, it's one or the other. Historical feels judge-y and current/"helpful" is all about self-care and yoga.

Mental illness is still heavily stigmatized today. We've made some progress, but not terribly much. This book does a wonderful job of examining that and why it's harmful--through the past as well. I think it's absolutely imperative to treat mental illness as you would any other sickness/condition/disease. The pressure to be "normal" and conform to what society says you should be doing. Somehow, it's acceptable to stay home because of a sinus infection, but not because you're having a bad brain day.

I feel like this is a very important book that most people should read! It really helps in showing that mental illness is in fact and illness and deserves the same consideration as others.

Personally coming from a family tremendously impacted by mental illness and stigma I found this book informatively eye-opening. I honestly was expecting it to be boring and full of medical verbiage that would impede my understanding of the subject. Nothing could be further from the truth. This book is worth a first and second read.

Who do you know that suffers from mental illness?
You can probably think of someone. Possibly many people. But if I had asked you the same question 20 years ago, you probably would have struggled to give an answer. Does that mean that mental illness is more common? No. It means people are more likely to seek help for mental illness and/or are more likely to talk about it. This is because the stigma of mental illness is being reduced in American society pretty quickly. Or, I should say, some mental illnesses. Some still bear the full brunt of stigma as they always have. Buy how has that stigma been reduced? Why are people more open about it now?
Roy Richard Grinker examines these questions in his new book, Nobody’s Normal: How Cuture Created the Stigma of Mental Illness. He achieves this not through looking at today’s culture but looking at cultures and societies that historically produce mental illness stigma. Looking at mental illness and how it was defined through the cultural forces of capitalism, wars, and ideas about the body and mind, Grinker provides deep insight into how people came to be shunned for mental illnesses and thus what we can do about it.
As Grinker points out: “In any given year, nearly 20 percent of American adults — more than 60 million people — meet the criteria for mental illness.” And that’s only in one year. Over a lifetime, it’s estimated that almost half of Americans will experience some form of mental illness. So if mental illness is “abnormal” (the college course on psychological disorders was called “Abnormal Psychology” when I took it about 10 years ago), then what is “normal”? Grinker continues:
Recently, I reeled off some prevalence estimates for my students: between 8 percent and 9 percent of American children have ADHD; in some states the prevalence estimate for autism is over 2 percent; 8 — 10 percent of children have an anxiety disorder; approximately 1 percent of adults have schizophrenia; more than 2.5 percent of adults have bipolar disorder; and the prevalence of major depression for adults between the ages of eighteen and twenty-five is about 11 percent. A student asked in jest, “Isn’t anyone normal anymore?” I answered no. Nobody’s normal. And since we have for so long used the concept of “normal” to decide who we accept into our social worlds and who we reject, it’s about time we recognize that normal is a damaging illusion.
As a counterexample, consider the Jun/oansi hunter-gatherer tribe in Namibia (southwestern Africa). Grinker explains that he meets a boy there named Geshe who nearly died from measles as a toddler and could not speak. Grinker says if he was taken to an American doctor, he would probably be diagnosed with autism because he has all the classic symptoms. The ensuing conversation with Geshe’s father is simply touching.
“Why should we take him to a doctor?” his father asked me. “He survived measles, and he is great herding the goats. He always knows where they are in the day or night.” His father also said Geshe has a great memory, that he finds whatever they lose in the bush, like knives or arrows. When I asked his father if he is concerned about who will take care of Geshe when he and his wife pass away, he looked confused and then pointed to his neighbors. “We won’t all die at once,” he said.
Who says Westerners can’t learn anything from hunter-gatherer societies? As Grinker explains:
The Jun/oansi have fashioned a society that accepts differences we have shunned. No one there expects a condition like schizophrenia or autism to define a person as a whole. No one in these villages expects anyone to live on their own and be completely responsible for their own successes and failures. In Europe and North America, however, we’ve long idealized the autonomous individual, dignified those who produce the most capital, and stigmatized those who produce the least.
This stigma of “lack of production” comes up over and over throughout the book, and it really underscores how much we are affected by our society’s values. Is someone less valuable as a human because they can’t be a productive employee at a job? This doesn’t mean that such a person can do nothing. What if they are an artist or an activist or they do charity work? Just because you don’t fit in well as a wage worker doesn’t mean you can’t be a valuable member of society. And even if one couldn’t do any of that, it never diminishes their value as a human.
What I found most interesting about Grinker’s point of view is that it counteracted the pervasive medical model of mental illness in favor of a more balanced approach. As it turns out, diminishing mental illness to “just like a physical disease” or “a brain issue” isn’t helpful at reducing stigma. He makes an in-depth argument to this point, but his fifth point was the most arresting to me:
(I)t’s as simplistic, and dehumanizing, to reduce a person to his or her brain as it would be to reduce someone to their genes, their ethnicity, religion, sex, or sexual orientation. Given how much we know about the role of social factors in shaping mental illnesses, how could we ever remove culture and experience from the brain? If we did, we’d risk overlooking how poverty, trauma, and other kinds of adversities affect us. Although some clinicians claim that a brain-based model of mental illness would minimize the tendency to see mental illnesses as a reflection of a weakness of character, that claim may now be out of date. Increasingly, we have few expectations that someone can experience the traumas of war or a violent childhood without being profoundly affected, and we more often view someone tackling those effects as resilient. If we describe someone with a mental illness as having a chemical imbalance or abnormal brain circuitry, we risk providing reasons to fear that person, to see them as permanently damaged; it is the person’s brain, and not the social context, that needs to be fixed. And if doctors treat the brain with medicines and the medicines don’t work, or the patient doesn’t tolerate them, then the person may be labeled as a troublesome or noncompliant patient who is causing their own suffering, or they may feel like a failure.
Later, Grinker writes about Brandon Kohrt, a doctor/psychiatrist working in Nepal who was inspired by a group of Dutch mental health professionals, saying that “psychological well-being could not be explained by the presence or absence of a single traumatic event, but had to be understood as part of the total social system in which one lives, including the economy, politics, and gender, among other factors.”
So this is the way out of the stigma of mental illness: a focus on the total social system of the individual that caused the illness, with social AND brain-based solutions in the foreground. The optimism of Grinker peeks through, especially when he writes about short-time Vice Presidential candidate Thomas Eagleton, who was replaced on the ticket after it was made public that he at one time had electroconvulsive therapy (ECT). While the media played up the story and Eagleton was forced out, Grinker relays an interview with Eagleton that shows mental illness stigma wasn’t as widespread as it seemed:
Polls showed that a majority of Americans were sympathetic to Eagleton and critical that McGovern “dumped” Eagleton for reasons of politics and fundraising. Journalists reported that many Americans believed McGovern had been cruel, and that Eagleton had, in contrast, shown strength and integrity and had opened many eyes to the prevalence of depression. Eagleton said, “I’ve come out of it stronger than I went in. I’m at peace with myself. . . . This may be the most important week of my life. I did the job. I took the heat and I endured.”29 And when McGovern went to a preseason exhibition Washington Redskins football game soon after Eagleton’s departure from the ticket, he was booed and jeered. Just a few days later, Eagleton attended a St. Louis Cardinals baseball game and received a standing ovation. A thousand people had been at the airport to greet his plane. In an interview a few days later, Eagleton remembered being depressed when he twelve years old, looking in the mirror every day and wondering, “Will someone find out today?” He said, “So now it’s out. And the wonderful thing is how good almost everyone has been. I mean the man in the street. The kind of person I was afraid would not understand.”
How can a book make you so disappointed in humanity but so optimistic at the same time? It’s the tension at the heart of human nature, and Grinker captures it perfectly. Maybe, with the help of experts like Grinker, we can reduce the stigma of mental illness and save many lives. I recommend Nobody’s Normal as a starting gate in that race.
I received a review copy of Nobody’s Normal courtesy of W.W. Norton and NetGalley, but my opinions are my own.

Nobody’s Normal: How Culture Created the Stigma of Mental Illness is written by Roy Richard Grinker, an anthropology professor at The George Washington University. Autism and cross-cultural psychiatry are listed as areas of expertise on his faculty page. He’s the father of an autistic daughter, who he refers to a number of times throughout the book.

Culture
The book revolves around the idea that mental illness is a product of culture and capitalism.

The first section of the book looks back through history, painting an oddly rosy picture of life for crazy folk back in the day. I spent much of this section being annoyed with what I was reading.

There’s mention of a 15th century “asylum for the ‘insane'” in present-day Morocco, with the odd juxtaposition of them being frequently bound and whipped but also them being surround by fragrant plants and having reassuring conversations with doctors, as if the latter made the former just fine and dandy. Any takers on the whipping?

The author says that in the early 1800s in western Europe, many ill people were kept in chains by their family members, but not because they had something their family members called “mental illness.” To me, that seems like saying people are having legs amputated because of gangrene, but they didn’t have something people recognized as being a thing called gangrene. Whether it’s crazy or rotting foot, not having a medical term to frame it in doesn’t make it less undesirable.

The book opens with a story of someone from the Jun/oansi, a hunger-gatherer people in the Kalahari Desert in Namibia. Someone has schizophrenia-like symptoms, but it’s not seen as “mental illness”; it’s spirits sent by other people, and not the ill person’s fault, so it’s all just wonderful. That’s a nice thought, but the possession by spirits belief doesn’t necessarily translate into positive treatment. It can translate into people being chained to trees for years out of desperation because their family can’t manage them any other way.

Speaking of which, Grinker criticizes a paper published in Nature with a photo showing a Somali girl chained to a tree. He argues that this “conceals the content of her life”, including family, politics, and religion. Yes, there’s content and context that’s not shown, but to suggest that the context is sufficiently enriching to make up for the poor kid being chained to a tree seems unnecessarily Kumbaya.

The author later points out the problem of taking a Western approach to illness in non-Western countries, but, in my mind, he missed the mark with it. Psychosocial interventions like prayer can only do so much, and it doesn’t help the people with mental illness if we encourage more praying and then wash our hands of it all. Culturally appropriate and effective should be able to co-exist.

Family ties
The author’s grandfather and great-grandfather both make repeated appearances in the book. His great-grandfather, who migrated from Prussia to the U.S., became a neurologist. He attributed insanity to an inability to control impulses, especially the desire to shop.

His grandfather did psychoanalysis with Freud as part of his psychiatric training, and in World War II used sodium pentothal (“truth serum”) to help soldiers access their trauma. The book also covers how mental conditions were viewed in WWI, the Korean War, Vietnam, Afghanistan, and Iraq, and how little seemed to be learned from one war to the next about how trauma affects people.

Medicalization
The author described medicalization as an integral component of capitalism, and called the “broken-brain model” an attempt to “give mental illnesses an objective reality apart from culture.” He gave electroconvulsive therapy (ECT) as an example of the problem with the broken-brain model; despite its high level of efficacy, it’s highly stigmatized because it’s rooted in that broken-brain model.

He also discussed how medicalization relates to autism and the anti-vax arguments, as well as chronic fatigue syndrome. He argues that the biological model of CFS/ME is problematic because it gets in the way of psychological interventions that could potentially be helpful. There’s a valid point in there somewhere, but you may find yourself annoyed before he gets to it.

Among the assorted points that I disagree with was Grinker’s argument that it’s actually a good thing that people are saying things like “a little OCD” or “a little bipolar,” as it validates that mental illnesses exist on a spectrum rather than being all or none, and decreases the stigma of those labels. I’m imagining some of my readers being rather unimpressed as they read this.

The author isn’t so keen on the whole brain business, as “neuroscientific approaches to understanding and treating mental illnesses perpetuate stigma by reducing the complexity of illness experience, or our personalities, to the brain.” He then adds that he’s not suggesting that neuroscience can’t come up with new treatments, but it can’t reduce stigma.

Sigh. This was one of many points in the book where there was a valid idea packaged up in a less than palatable way. For the first third of the book, I thought I disagreed with the author entirely, and it was only in the final third that I started to realize what he was actually getting at, and discovered I didn’t disagree with him as much as I thought.

Presenting mental illness to the public as a brain disease is associated with increased stigma; that’s what the research on the matter clearly shows. However, Grinker seems to be implying that biology needs to be tossed out the window. I don’t think that’s actually where he’s trying to go, but he’s pointing a sign in that direction, perhaps inadvertently.

My own theoretical perspective regarding culture tends to be along the more moderate lines of social constructionism; basically, the way we experience reality is socially constructed, and can never be fully separated from the social context. That’s not to say that mental illness doesn’t exist on an objective level, but the meanings attached to it and the way it’s interpreted are inextricably culture-bound. What Grinker was saying probably wasn’t too far off from where I stand, but with less of a space for mental illness on a realist level. Still, I found he was setting off my “this jerk doesn’t think mental illness is real” BS detector fairly regularly. I do think that’s more how he framed things than the essence of his ideas, but it was still there.

The book concluded with Grinker saying he wants readers to take away that stigma can be a conversation starter, not ender. Now that, at least, is a message I can whole-heartedly agree with.



I received a reviewer copy from the publisher through Netgalley.

This book was so much more fascinating than I anticipated. Grinker provided a fascinating history of psychiatry, placing it into a context of contemporary events in a way I hadn't come across before. His emphasis on the role of the military in the shaping of modern psychiatry in America provided new insights.

Grinker managed to convey a huge amount of complex information in a format that I could sit and read as if it were a memoir. His family connections to the history he shared made the topic more approachable and engaging and always felt relevant.

A very good book about mental illness and how it is perceived by lay people and medical people. Very well researched and some good history about the subject. The author is obviously very passionate about the subject, A good fascinating read but not my favorite on the subject.

Thanks to Netgalley, Roy Richard Grinker and WW Norton & Company for an ARC in exchange for an honest review.

Available: 1/26/21