Emphasize your Strengths, Aim for Your Goals, and Minimize Your Weaknesses
We spend so much of our lives living by what is defined as normal, and pass judgment on ourselves and others based on this—whether we try to be normal, determine that we are better than normal, or condemn ourselves as worse than normal. Yet, if we think about normal, we are usually thinking about where we fall on the bell curve (also called the Normal or Gaussian curve). The most common, or normal, score is in the center of the curve. The measure of how far someone scores from the midpoint, or normal point, is broken down into deviations. 68 percent of the population is expected to fall within 1 standard deviation of the midpoint, either greater than or less than; 95 percent within 2 standard deviations; and 99.7 percent within 3 standard deviations.
We use the curve to evaluate specific attributes, such as happiness. The population of the United States is currently about 324,000,000. That means 97,200 people will fall outside of the curve and be considered abnormal. They would be considered clinically depressed at the low end and, at the high end, someone who could be clinically manic. 103,840,000 people would be at least 2 deviations above or below normal. I was initially thinking how demoralizing it can be if you are considered abnormal because your rating falls outside of the “normal” curve but being labeled a “deviant” doesn’t sound any better.
Now we have social media—an irresistible resource for many of us in defining our perception of normal. When we look at someone’s post we see it as a representation of their everyday life and convince ourselves how great their life is comparing our whole existence to one of their brief and rare great moments. If somebody posts about having a serious illness, or death of someone close to them, we may feel sorrow and empathy for them until we start to see all the supportive comments and wonder if we have a similar tragedy would we have as many people responding to our loss.
A couple of years ago I was working at a local clinic and was scheduled to meet with a new patient for an evaluation, a 35-year-old woman who was accompanied by her mother. To my surprise in walked the same woman I had seen on the street the night before. We had both been walking our dogs and my dog stopped to say hello. It was one of those situations in which your dog goes up to another dog, they play for a few minutes, you have a brief conversation, and then go on your way.
We recognized each other and laughed and I offered for her to see someone else but she didn’t want to wait for another appointment since it took so long to get one with me. Since the only connection to me was that I saw her on the street with her dog, I figured it would be okay to work together.
I reviewed her chart before meeting with her so I knew she was diagnosed with schizophrenia and that she was on an antipsychotic medication. Together we went over her history. She was doing well and seemed to have no active symptoms. As the session came to a close her mother snapped at her: "You’re not telling him about the egg the aliens implanted in your stomach. Tell him about that.”
“Well, that sounds interesting, please, tell me about this egg that is implanted in your stomach.” She explained to me that she doesn’t talk about it because people think she’s "crazy" when she does. It rarely comes up unless someone asks her directly. She went on to tell me that about 20 years ago she was taken by aliens and they put an egg in her stomach and sent her home. She spent many years focusing on this delusion and met with many doctors in an attempt to have it removed. She became so obsessed with this egg that she was unable to finish college. She finally agreed to go to a psychiatrist and that was when she started treatment for schizophrenia.
The reason she had come to the clinic to meet with me, instead of continuing with her current psychiatrist, was that her mother was pushing for her to. Her mother didn’t believe she was getting the correct care since she still believed that she had an egg in her stomach.
During our session, I had learned that she walks dogs for a living. She has her own apartment, which her parents bought for her, and with her dog-walking business she makes enough money to pay all of her bills. She has some friends that she met at the dog run. Her only complaint was that she was depressed that she was unable to have a relationship with a man.
To me, she seemed to be living a relatively full life and would benefit from psychotherapyto deal with her issues with men, but I didn’t think she needed a change in medication, especially because she was doing well on her current medication and tolerating it so well. Her mother was furious with my assessment but my patient was relieved.
Her mother, in front of my patient, said, "How could you say that? The medication is clearly not working. She’s crazy. She believes she has an alien egg in her stomach.” I tried to explain to both my patient and her mother that the problem is not having a belief that can’t be verified; it would be a problem if it was interfering with her everyday life. I went on to explain that many people believe in things that cannot be verified, in fact, many religions are based on beliefs that cannot be verified.
What we identified as the problem to be worked on in the immediate future was her distress about not being able to develop a relationship with a man.
Her mother was correct; as far as I know, aliens don’t implant eggs in people’s stomachs. “I do agree with you, this is not normal compared to the average population. However, your daughter believes it is real and she managed to develop a full life despite this belief.” She was comfortable on her current medication, and it was helping her function, so I didn’t think it was a good idea to change it. Part of our work would be to monitor for a decline in functioning.
Even though this woman was diagnosed with schizophrenia that condition was stable and controlled. If we focused on the delusion as the problem it would have led to trials of numerous medications, with numerous side effects, and likely a significant decrease in the quality of her life. Looking at her as a person, I was able to see that she actually had a pretty good life and enjoyed it.
If she had come to me with the complaint of having difficulty with relationships and didn’t have schizophrenia then the treatment would have focused on her relationship issues. For this woman, she "had schizophrenia" and shouldn’t be labeled as "a schizophrenic," as if that is the only part of her that exists. Having a fixed delusion like this does push her into an abnormal range but it is for that attribute only. The rest of her is a young woman wanting to live a "normal" life.
I treated this woman for about two years, until I moved on from the clinic. From time to time I run into her on the street with our dogs. There has never been a reason to ask her about her thoughts on the alien egg. If she still has that belief it is not stopping her from living a full and happy life. Last time I saw her she was moving in with her boyfriend, whom she met at the dog park. She is living the happy life she hoped for.
Source: photo Courtesy of Pixabay/ quintheislander
Author: Jeff Corbin MD MPH https://www.psychologytoday.com/experts/jeff-corbin-md-mph