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"Perhaps then it would make sense to think of "schizophrenia" and "depression" (and autism, and Tourette's, and migraine, and ....) not as in and of themselves "disabilities" or "illnesses" but rather simply as brain variations? And reserve the terms "disability" and "illness" for the more extreme versions of these where they become troubling? And treat people not for "schizophrenia" or "depression" (etc) but rather for whatever is in fact troubling? This might more easily allow us to appreciate some of the positive features of brain variation and better focus attention on what needs to be "fixed" (and why). We could acknowledge "neurodiversity" and its value while still recognizing a need for special treatment in cases where its needed, and for reasons that it is needed."

Some further thoughts along these lines, stemming from our discussion last week having to do with "normative reality," "the world is social," and we are a part of the environment people need (want?) to adapt to ...

Do people "need" to adapt to particular "social" worlds? Is it the business of mental health to help/encourage them to do so? There are lots of pretty horrendous examples of problems with this approach, not only in other countries (psychiatric institutionalization in the USSR, for example) but in the US as well (homosexuality, lobotomies, ambiguous sexuality, to mention a few). I, for one, am less comfortable with a mental health approach that uses the ability to deal with "normative" reality" (or "tea kettle" reality) as a goal and more comfortable with one that uses, instead, enhancing the ability of individuals to conceive and revise their own individual stories. This leaves room not only for acknowledging "neurodiversity and its value," but, more explicitly, for including within the mandate for mental health professionals changes not only in individuals but also in cultures. My guess is that more attention needs to be paid not ony to the role of stories in mental health issues but also, in particular, to the problem of conflicts between individual and social/cultural stories, and our tendency to automatically give priority to the latter.

And some further thoughts about more general patterns coming from thinking about depression and schioprenia, together with Tourette's and migraine. One sees, in all four cases

• a continuum from "normal" to troubling
• some positives as well as some negatives
• a complex mix of genetic/environmental/cultural influences
• a research trajectory implying an absence of not only simple causes but also simple cures
• a social/cultural impatience with problems lacking simple causes/cures, and people who present them
• the possibility that troubling "symptoms" are at least to some extent an effort on the brain's part to find an adaptive way to cope with problems, often with a significant story telling element
• in the most troubling manifestations, a commonality of feeling an inability to control one or another aspect of oneself

Maybe this usefully points a useful direction for overcoming some of the troubling fragmentation of current approaches to mental health? Perhaps there actually is some commonality to what otherwise might appear to be a diverse array of independent problems in this realm? And some progress might be made by recognizing such commonalities and using them as a foundation for developing new directions in therapeutic practice, in research agendas, and in social/political policy?