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The Other Side of Normal: How Biology Is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behavior
Psychiatry has ignored the normal. The focus on defining abnormal behavior has obscured what turns out to be a more fundamental question—how does the biology of the brain give rise to the mind, which in turn gives rise to everything we care thoughts, feelings, desires, and relationships?
In The Other Side of Normal, Harvard psychiatrist Jordan Smoller shows us that understanding what the mind was designed to do in the first place demystifies mental illness and builds a new foundation for defining psychiatric disorders—from autism to depression. Smoller argues there are no bright lines between normal and abnormal. Psychiatric disorders are variations of the same brain systems that evolved to help us solve the challenges of everyday life.
How do we become who we are? Smoller explains where our personalities come from, and how the temperaments we had as infants actually stay with us into adulthood. Why do we choose to date, love, and marry the people we do? Why do some of us form healthy relationships while others form unstable ones? Our relationships are shaped by the biology that drives two maternal-child bonding and child-parent attachment.
Along the way, Smoller tackles an even greater question—what do we mean by "normal"?—as he explores the puzzles behind the epidemics of multiple personalities and koro, the shocking phobia that one's penis is shrinking. He also looks at the controversial history of psychiatric classification and the explosive debates over how much early experiences influence our minds and to what degree genetics affect our temperaments, personalities, and emotional lives. Throughout this examination, Smoller explores the hidden sides of such questions How are trust and love rooted in biology? How much does sexual attraction stem from biology rather than culture? And what can the scientific study of normal behavior tell us about what it means to be human?
Based on the author's groundbreaking research and personal experiences treating psychological disorders, The Other Side of Normal changes the way we think about the human condition.
In The Other Side of Normal, Harvard psychiatrist Jordan Smoller shows us that understanding what the mind was designed to do in the first place demystifies mental illness and builds a new foundation for defining psychiatric disorders—from autism to depression. Smoller argues there are no bright lines between normal and abnormal. Psychiatric disorders are variations of the same brain systems that evolved to help us solve the challenges of everyday life.
How do we become who we are? Smoller explains where our personalities come from, and how the temperaments we had as infants actually stay with us into adulthood. Why do we choose to date, love, and marry the people we do? Why do some of us form healthy relationships while others form unstable ones? Our relationships are shaped by the biology that drives two maternal-child bonding and child-parent attachment.
Along the way, Smoller tackles an even greater question—what do we mean by "normal"?—as he explores the puzzles behind the epidemics of multiple personalities and koro, the shocking phobia that one's penis is shrinking. He also looks at the controversial history of psychiatric classification and the explosive debates over how much early experiences influence our minds and to what degree genetics affect our temperaments, personalities, and emotional lives. Throughout this examination, Smoller explores the hidden sides of such questions How are trust and love rooted in biology? How much does sexual attraction stem from biology rather than culture? And what can the scientific study of normal behavior tell us about what it means to be human?
Based on the author's groundbreaking research and personal experiences treating psychological disorders, The Other Side of Normal changes the way we think about the human condition.
643 pages, Kindle Edition
First published May 8, 2012
286 people are currently reading
1477 people want to read
About the author
Jordan Smoller
3 books5 followersJordan Smoller is associate professor of psychiatry at Harvard Medical School and associate professor in the Department of Epidemiology at the Harvard School of Public Health.
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Displaying 1 - 30 of 68 reviews
February 16, 2022
This book explores the idea that to fully understand mental illness, we need to start by understanding the normal – what the brain was designed to do. Smoller believes the current model (that defines mental illness based on the abnormal) is contributing to the explosion in cases in recent years, perhaps resulting in treatments that are unnecessary and potentially damaging. Do we really have that many more cases of mental illness now or is it artificially inflated by attributing a deficit or disorder to something that is within the range of normal functioning?
The author is Professor of Psychiatry at Harvard Medical School and serves as a Trustees Endowed Chair in Psychiatric Neuroscience at Massachusetts General Hospital. Smoller asserts: “The best way to understand the abnormal is to study the normal. Rather than simply starting at the edges and working our way back, our goal should be to illuminate the full and vast distribution of normal. As we fill out the center, we can see its connections to the extremes—how and where the functions of the mind can be perturbed or disrupted.”
The current strategy (focusing on the abnormal) has been pursued for most of the past century. Smoller would like to turn this on its head and instead focus on the normal by asking such questions as: “What were the mind and the brain built to do? How do mental and neural functions develop? How are they organized? By understanding the basic architecture of the mind and the brain and how they make sense of the environment and experiences they encounter, we can begin to see where the dysfunctions are likely to occur and how they emerge from the normal spectrum of human experience.”
He examines the interactions between nature and nurture and argues that both are important – it never has been one OR the other. He provides evidence, cites the results of numerous studies to support his ideas. He emphasizes the promising results of research into brain chemistry and epigenetics.
Dr. Smoller addresses these issues in clear terms, such that it is easily consumable by anyone with a basic level of knowledge in psychiatry. I do believe one should come to the table with an avid interest in the topic – it’s not a book to just pick up and read on the spur of the moment. It requires focused concentration. It is written clearly, logically, and elegantly. I very much enjoyed reading the author’s insights.
The author is Professor of Psychiatry at Harvard Medical School and serves as a Trustees Endowed Chair in Psychiatric Neuroscience at Massachusetts General Hospital. Smoller asserts: “The best way to understand the abnormal is to study the normal. Rather than simply starting at the edges and working our way back, our goal should be to illuminate the full and vast distribution of normal. As we fill out the center, we can see its connections to the extremes—how and where the functions of the mind can be perturbed or disrupted.”
The current strategy (focusing on the abnormal) has been pursued for most of the past century. Smoller would like to turn this on its head and instead focus on the normal by asking such questions as: “What were the mind and the brain built to do? How do mental and neural functions develop? How are they organized? By understanding the basic architecture of the mind and the brain and how they make sense of the environment and experiences they encounter, we can begin to see where the dysfunctions are likely to occur and how they emerge from the normal spectrum of human experience.”
He examines the interactions between nature and nurture and argues that both are important – it never has been one OR the other. He provides evidence, cites the results of numerous studies to support his ideas. He emphasizes the promising results of research into brain chemistry and epigenetics.
Dr. Smoller addresses these issues in clear terms, such that it is easily consumable by anyone with a basic level of knowledge in psychiatry. I do believe one should come to the table with an avid interest in the topic – it’s not a book to just pick up and read on the spur of the moment. It requires focused concentration. It is written clearly, logically, and elegantly. I very much enjoyed reading the author’s insights.
January 17, 2014
Thorough overview of the current science and thinking about the brain and behavior. Asks the great question: what is the purpose of the brain? The answers to that are what define "normal." I loved this for its easy-to-understand explanations of difficult-to-understand science. Also, loved the humor and stories.
February 2, 2017
Historically, psychology has been the study of the abnormal. The thesis of this book is that the time has come to turn this formula on its head: the best way to understand the abnormal is to study the normal.
One insight from the French physician François-Joseph-Victor Broussais around 1800 was that normal is a spectrum of variability. A bell curve has a “normal” distribution. That’s what normal means. There is no sharp distinction between normal and abnormal, although you can talk about standard deviations. Our goal should be to illuminate the full and vast distribution of normal. As we fill out the center, we can see its connections to the extremes – how and where the functions of the mind can be perturbed or disrupted.
For example, disgust is a normal biological function that we have developed in order to avoid disease. OCD is not something entirely abnormal; it’s just a dysfunction in the normal way of expressing disgust. In general, in order to understand dysfunction, you need to understand what normal function is being “dys-ed.”
What is mental illness? Francis Galton (Darwin’s cousin) invented the concept of nature vs. nurture. To understand mental illness, it is important to figure out whether the cause is biological or whether it is just an artifact of the person’s culture. In 2007, researchers used the internet to confirm that repressed memory did not used to exist either in fiction or non-fiction, so the idea that dissociative amnesia causes multiple personality is culturally created, not a natural human phenomenon. Some mental conditions are culture-specific syndromes; they are not universal human conditions. For example, the Chinese have had epidemics of Koro, which is essentially fear that your penis is disappearing.
The author likes Jerome Wakefield’s definition of mental illness: “harmful dysfunction.” “Harmful” means that according to our normative judgments or social norms, something bad is happening. Dysfunction means there is some biomedical cause for the harmfulness.
The DSM attempts to define mental illnesses, but there is unavoidably a certain amount of arbitrariness in the definition. For example, the DSM defines depression, and it now contains the caveat that a person does not have depression if the cause is bereavement. But what if you lose a job that means everything to you; like bereavement, isn’t it “normal” to be depressed?
We’re born with (1) the motivation to get our basic needs met; (2) an inclination to seek help and avoid harm; and (3) adaptability/plasticity.
Jerome Kagen has studied temperament and constitution. Some people are naturally inhibited: shy, timid, fearful, anxious, cautious, socially avoidant. Others are uninhibited: bold, sociable, outgoing, impulsive, risk-takers. This is based on the natural functioning of the amygdala in the brain which creates our fight-or-flight impulse. A naturally shy person may become anxious as an adult, and this could be exacerbated by a controlling and overprotective parent.
The Big Five personality traits are: (1) neuroticism, (2) extraversion, (3) openness to experience, (4) agreeableness, and (5) conscientiousness.
Personality is determined in part by nature, the genes that you are born with. For example, people with Williams Syndrome are sociable; they have no social anxiety. Genes can influence a person’s propensity to have anxiety and depression. There are two variants of the SLC6A4 gene, and this affects serotonin transmission. And a drug that acts as a selective serotonin reuptake inhibitor can reduce anxiety and depression.
Personality is also determined by nurture. A person’s environment affects how a gene is expressed, so it is even possible for one identical twin to become schizophrenic while the other one does not. (This idea was taken a bit far during the craze for “Baby Einstein” videos that were supposed to have a “Mozart effect” on babies and make them smarter. Experiments showed that there could just as easily be a “Blur effect” by listening to the mediocre UK band named “Blur.”) We now understand that in addition to a person’s genome, a person also has an epigenome that is the person’s genome as modified by their environment. There is even evidence that the epigenome is passed on to the next generation, so we may inherit our ancestors’ environmental effects to some extent.
The effect of the environment varies greatly depending on the developmental stage of the individual. In the first two years of life, babies probably can’t benefit from watching any type of video, but they are in a phase of life where their brains have a greater ability to acquire language than when they are older, so they do benefit by being exposed to people talking to them.
Brains have plasticity that is: (1) experience-expectant and (2) experience-dependent. Babies are experience-expectant when it comes to learning language, including the meaning of facial expressions, and a baby’s environment can affect how the baby processes both kinds of human communication. Babies can learn any language, and they soak up the spoken and body language of their parents, but when they’re older learning other languages is much more arduous.
Animal studies have shown that neurogenesis (generating neurons that build the brain) is crucial for the normal ability of the hippocampus to buffer the effects of stress by keeping stress hormone levels (cortisol) from going out of control. Drugs like Prozac and exercise stimulate neurogenesis in the hippocampus. These things make us more resilient in the face of stressors.
The human body has evolved to be efficient at extracting as much oxygen as a person can use from normal, ambient air. Therefore, it doesn’t do anything for a typical, healthy person to breath oxygenated air, such as the air in a 1990s oxygen bar. Likewise, most of the products marketed to make your baby smarter or happier don’t do anything. They already have what they’re experience-expectant selves are expecting. You can enrich someone who’s deprived, e.g., with early intervention. But enriching someone who is already rich (e.g., in exposure to language) doesn’t do anything.
So what if a person was deprived as a child? The person can still make up for it because of the brain’s experience-dependent plasticity. Example: cabbies in London are required to acquire “The Knowledge,” encyclopedic knowledge of London’s streets. This makes the gray matter in the posterior hippocampus of their brains thicker and improves their ability to process spacial memory in general. Likewise, for ballet dancers, golfers, basketball players, and people who learn new languages or musical instruments.
People with prosopagnosia cannot recognize other people’s faces, while others have an amazing ability to recognize the faces of people they’ve seen before – and this appears to be a genetic trait.
Unlike other animals, two humans can have joint attention, one points to something and communicates to the other: “pay attention to that.” Only humans have the motivation to share information and teach. Only humans speak, point and smile.
Humans can think about thinking, and we can understand that another person believes something that we know is not true. A three-year-old human can do this, but no animal can. Humans have a natural ability to read the minds of other people based on the other person’s body language and facial expressions. We have a “theory of mind” – which is an ability to understand how other people’s thoughts and beliefs differ from our own. Theory-of-mind abilities are based on cognitive empathy, which is processed in a person’s prefrontal cortex.
Another part of the brain contains the mirror neuron system that gives people emotional empathy, which causes people to feel what others are feeling. Psychopaths have cognitive empathy, which allows them to manipulate others, but they lack emotional empathy, so they feel nothing when they inflict pain on others. People with Williams Syndrome are the opposite; they lack cognitive empathy but have an unusually elevated amount of emotional empathy.
People with autism have difficulty cognitively understanding that other people feel different things, because they have different experiences and perspectives, i.e., they have difficulty with cognitive empathy. Autistic people do not lack emotional empathy, but they may lack the ability to understand and express emotion and to respond to other’s emotions in a socially appropriate way.
Like all animals, humans have evolved to be successful at reproducing. In the case of humans, this is facilitated by feelings of attachment and trust between mates and their offspring. Hormones such as oxytocin play a role. Securely attached children become secure adults, but neglectful or stressed or unavailable parents can increase a child’s stress hormone level and decrease the child’s ability to form stable attachments. The author believes that borderline personality disorder (BPD) is caused by a dysfunctional attachment system. The stereotype of a person with BPD is Glenn Close’s character in the movie Fatal Attraction.
Prior to the advent of human civilization, human females would have looked for a man who has resources to invest in their offspring and a disposition that suggests they’re willing to be a provider and partner. Males would have looked for multiple female partners who are young, healthy and fertile. (Just because we have this evolved predisposition doesn’t mean that’s how we ought to behave.) Average features signal heterozygosity, greater diversity of genetic variants. Human genomes have a huge variety of major histocompatibility complex (MHC) variations to combat pathogens, and people tend to mate with someone with complementary (dissimilar) MHC genes. Through smell, people tend to detect genetic diversity and avoid inbreeding.
People are attracted to traits such as (1) averageness (which signals healthy genetic diversity), (2) symmetry, and (3) masculinity/femininity, and people are attracted to each other when the woman is in the part of her menstrual cycle when she can conceive. When a woman is on the pill, the natural tendencies of attraction are altered, which could actually cause her to choose a stable partner over someone she thinks is “hot.”
Paraphilia means abnormal sexual desires. But atypical desires are not going to result in a diagnosis unless they are leading to clinically significant distress or impairment in social, occupational or other important areas of functioning. In some cases, the diagnosis of a disorder boils down to another person’s sensitivities. Some have proposed that the next edition of the DSM include “hypersexual disorder,” which could include, for example, someone who loses a job and spouse and gets STDs because the person is constantly seeking out pornography and sex.
Like Pavlov’s dogs, we have learned to associate certain things with fear. But we also experience “fear extinction” when we learn that the conditioned stimulus does not correlate with the thing that we fear. In both fear and anxiety, stress hormones like cortisol and adrenaline are released; the sympathetic nervous system triggers fight-or-flight responses; and regions of the cortex generate fearful thoughts.
People who have PTSD fail to experience fear extinction. For example, a loud noise might be a conditioned stimulus that is associated with a traumatic experience, and then the person continues to experience terror when the person hears a loud noise no matter how many times the loud noise is not accompanied by anything bad happening. Many experience trauma, but only some experience PTSD, and this is due in part to genetic variations that affect the ability of the brain to extinguish fear.
Behavioral therapy, including cognitive behavioral therapy (CBT), is effective in treating fear and anxiety disorders, and by understanding the brain’s fear extinction mechanism, we can develop drugs that mimic this mechanism and can “turbocharge” these therapies so they are more effective.
When you remember something, you don’t remember what originally happened; what you remember is what you remembered the last time you remembered it. Each time you remember something, you pull it out of your long-term memory, hold it in your short-term memory, and then it gets reconstituted into your long-term memory (possibly altered). One way of alleviating the fear and anxiety caused by traumatic memories is to remember the traumatic event and then immediately interfere with the reconstitution of the long-term memory – it is possible that drugs can help do this.
Tons of information in this book, most of it directly or indirectly related to the author’s thesis. To me, all of this neurobiology stuff is interesting, but I think it can only lead to a partial understanding of human nature. Science can help us make normative judgments, but I still think we need to rely mostly on the humanities, such as philosophy, literature and religion, to determine what should be considered normal and abnormal behavior.
One insight from the French physician François-Joseph-Victor Broussais around 1800 was that normal is a spectrum of variability. A bell curve has a “normal” distribution. That’s what normal means. There is no sharp distinction between normal and abnormal, although you can talk about standard deviations. Our goal should be to illuminate the full and vast distribution of normal. As we fill out the center, we can see its connections to the extremes – how and where the functions of the mind can be perturbed or disrupted.
For example, disgust is a normal biological function that we have developed in order to avoid disease. OCD is not something entirely abnormal; it’s just a dysfunction in the normal way of expressing disgust. In general, in order to understand dysfunction, you need to understand what normal function is being “dys-ed.”
What is mental illness? Francis Galton (Darwin’s cousin) invented the concept of nature vs. nurture. To understand mental illness, it is important to figure out whether the cause is biological or whether it is just an artifact of the person’s culture. In 2007, researchers used the internet to confirm that repressed memory did not used to exist either in fiction or non-fiction, so the idea that dissociative amnesia causes multiple personality is culturally created, not a natural human phenomenon. Some mental conditions are culture-specific syndromes; they are not universal human conditions. For example, the Chinese have had epidemics of Koro, which is essentially fear that your penis is disappearing.
The author likes Jerome Wakefield’s definition of mental illness: “harmful dysfunction.” “Harmful” means that according to our normative judgments or social norms, something bad is happening. Dysfunction means there is some biomedical cause for the harmfulness.
The DSM attempts to define mental illnesses, but there is unavoidably a certain amount of arbitrariness in the definition. For example, the DSM defines depression, and it now contains the caveat that a person does not have depression if the cause is bereavement. But what if you lose a job that means everything to you; like bereavement, isn’t it “normal” to be depressed?
We’re born with (1) the motivation to get our basic needs met; (2) an inclination to seek help and avoid harm; and (3) adaptability/plasticity.
Jerome Kagen has studied temperament and constitution. Some people are naturally inhibited: shy, timid, fearful, anxious, cautious, socially avoidant. Others are uninhibited: bold, sociable, outgoing, impulsive, risk-takers. This is based on the natural functioning of the amygdala in the brain which creates our fight-or-flight impulse. A naturally shy person may become anxious as an adult, and this could be exacerbated by a controlling and overprotective parent.
The Big Five personality traits are: (1) neuroticism, (2) extraversion, (3) openness to experience, (4) agreeableness, and (5) conscientiousness.
Personality is determined in part by nature, the genes that you are born with. For example, people with Williams Syndrome are sociable; they have no social anxiety. Genes can influence a person’s propensity to have anxiety and depression. There are two variants of the SLC6A4 gene, and this affects serotonin transmission. And a drug that acts as a selective serotonin reuptake inhibitor can reduce anxiety and depression.
Personality is also determined by nurture. A person’s environment affects how a gene is expressed, so it is even possible for one identical twin to become schizophrenic while the other one does not. (This idea was taken a bit far during the craze for “Baby Einstein” videos that were supposed to have a “Mozart effect” on babies and make them smarter. Experiments showed that there could just as easily be a “Blur effect” by listening to the mediocre UK band named “Blur.”) We now understand that in addition to a person’s genome, a person also has an epigenome that is the person’s genome as modified by their environment. There is even evidence that the epigenome is passed on to the next generation, so we may inherit our ancestors’ environmental effects to some extent.
The effect of the environment varies greatly depending on the developmental stage of the individual. In the first two years of life, babies probably can’t benefit from watching any type of video, but they are in a phase of life where their brains have a greater ability to acquire language than when they are older, so they do benefit by being exposed to people talking to them.
Brains have plasticity that is: (1) experience-expectant and (2) experience-dependent. Babies are experience-expectant when it comes to learning language, including the meaning of facial expressions, and a baby’s environment can affect how the baby processes both kinds of human communication. Babies can learn any language, and they soak up the spoken and body language of their parents, but when they’re older learning other languages is much more arduous.
Animal studies have shown that neurogenesis (generating neurons that build the brain) is crucial for the normal ability of the hippocampus to buffer the effects of stress by keeping stress hormone levels (cortisol) from going out of control. Drugs like Prozac and exercise stimulate neurogenesis in the hippocampus. These things make us more resilient in the face of stressors.
The human body has evolved to be efficient at extracting as much oxygen as a person can use from normal, ambient air. Therefore, it doesn’t do anything for a typical, healthy person to breath oxygenated air, such as the air in a 1990s oxygen bar. Likewise, most of the products marketed to make your baby smarter or happier don’t do anything. They already have what they’re experience-expectant selves are expecting. You can enrich someone who’s deprived, e.g., with early intervention. But enriching someone who is already rich (e.g., in exposure to language) doesn’t do anything.
So what if a person was deprived as a child? The person can still make up for it because of the brain’s experience-dependent plasticity. Example: cabbies in London are required to acquire “The Knowledge,” encyclopedic knowledge of London’s streets. This makes the gray matter in the posterior hippocampus of their brains thicker and improves their ability to process spacial memory in general. Likewise, for ballet dancers, golfers, basketball players, and people who learn new languages or musical instruments.
People with prosopagnosia cannot recognize other people’s faces, while others have an amazing ability to recognize the faces of people they’ve seen before – and this appears to be a genetic trait.
Unlike other animals, two humans can have joint attention, one points to something and communicates to the other: “pay attention to that.” Only humans have the motivation to share information and teach. Only humans speak, point and smile.
Humans can think about thinking, and we can understand that another person believes something that we know is not true. A three-year-old human can do this, but no animal can. Humans have a natural ability to read the minds of other people based on the other person’s body language and facial expressions. We have a “theory of mind” – which is an ability to understand how other people’s thoughts and beliefs differ from our own. Theory-of-mind abilities are based on cognitive empathy, which is processed in a person’s prefrontal cortex.
Another part of the brain contains the mirror neuron system that gives people emotional empathy, which causes people to feel what others are feeling. Psychopaths have cognitive empathy, which allows them to manipulate others, but they lack emotional empathy, so they feel nothing when they inflict pain on others. People with Williams Syndrome are the opposite; they lack cognitive empathy but have an unusually elevated amount of emotional empathy.
People with autism have difficulty cognitively understanding that other people feel different things, because they have different experiences and perspectives, i.e., they have difficulty with cognitive empathy. Autistic people do not lack emotional empathy, but they may lack the ability to understand and express emotion and to respond to other’s emotions in a socially appropriate way.
Like all animals, humans have evolved to be successful at reproducing. In the case of humans, this is facilitated by feelings of attachment and trust between mates and their offspring. Hormones such as oxytocin play a role. Securely attached children become secure adults, but neglectful or stressed or unavailable parents can increase a child’s stress hormone level and decrease the child’s ability to form stable attachments. The author believes that borderline personality disorder (BPD) is caused by a dysfunctional attachment system. The stereotype of a person with BPD is Glenn Close’s character in the movie Fatal Attraction.
Prior to the advent of human civilization, human females would have looked for a man who has resources to invest in their offspring and a disposition that suggests they’re willing to be a provider and partner. Males would have looked for multiple female partners who are young, healthy and fertile. (Just because we have this evolved predisposition doesn’t mean that’s how we ought to behave.) Average features signal heterozygosity, greater diversity of genetic variants. Human genomes have a huge variety of major histocompatibility complex (MHC) variations to combat pathogens, and people tend to mate with someone with complementary (dissimilar) MHC genes. Through smell, people tend to detect genetic diversity and avoid inbreeding.
People are attracted to traits such as (1) averageness (which signals healthy genetic diversity), (2) symmetry, and (3) masculinity/femininity, and people are attracted to each other when the woman is in the part of her menstrual cycle when she can conceive. When a woman is on the pill, the natural tendencies of attraction are altered, which could actually cause her to choose a stable partner over someone she thinks is “hot.”
Paraphilia means abnormal sexual desires. But atypical desires are not going to result in a diagnosis unless they are leading to clinically significant distress or impairment in social, occupational or other important areas of functioning. In some cases, the diagnosis of a disorder boils down to another person’s sensitivities. Some have proposed that the next edition of the DSM include “hypersexual disorder,” which could include, for example, someone who loses a job and spouse and gets STDs because the person is constantly seeking out pornography and sex.
Like Pavlov’s dogs, we have learned to associate certain things with fear. But we also experience “fear extinction” when we learn that the conditioned stimulus does not correlate with the thing that we fear. In both fear and anxiety, stress hormones like cortisol and adrenaline are released; the sympathetic nervous system triggers fight-or-flight responses; and regions of the cortex generate fearful thoughts.
People who have PTSD fail to experience fear extinction. For example, a loud noise might be a conditioned stimulus that is associated with a traumatic experience, and then the person continues to experience terror when the person hears a loud noise no matter how many times the loud noise is not accompanied by anything bad happening. Many experience trauma, but only some experience PTSD, and this is due in part to genetic variations that affect the ability of the brain to extinguish fear.
Behavioral therapy, including cognitive behavioral therapy (CBT), is effective in treating fear and anxiety disorders, and by understanding the brain’s fear extinction mechanism, we can develop drugs that mimic this mechanism and can “turbocharge” these therapies so they are more effective.
When you remember something, you don’t remember what originally happened; what you remember is what you remembered the last time you remembered it. Each time you remember something, you pull it out of your long-term memory, hold it in your short-term memory, and then it gets reconstituted into your long-term memory (possibly altered). One way of alleviating the fear and anxiety caused by traumatic memories is to remember the traumatic event and then immediately interfere with the reconstitution of the long-term memory – it is possible that drugs can help do this.
Tons of information in this book, most of it directly or indirectly related to the author’s thesis. To me, all of this neurobiology stuff is interesting, but I think it can only lead to a partial understanding of human nature. Science can help us make normative judgments, but I still think we need to rely mostly on the humanities, such as philosophy, literature and religion, to determine what should be considered normal and abnormal behavior.
May 26, 2013
A decent pop psychology read with a solid premise that is at the heart of the debate of psychology now (particularly with the release of the DSM-V): that we much define abnormal by first defining normal, rather than the other way around. Smoller brings the neuroscience and biology underpinning psychology down to a layperson's level, which is good for those who have a general interest in the topic. For those who are more versed and looking for something deeper, they probably won't find it here.
The book serves as a great summary, but remains fairly basic (probably because his main audience was someone not in the field of psychology). As a former physiology student, I found that in many cases, I could guess what experiment/example he was going to talk about next before he even got there. This makes it a good read for those who just have a general interest in psychology, but for those in the field, they may find themselves a bit bored with it, even if it has a worthy premise that should be expanded on more deeply.
The book serves as a great summary, but remains fairly basic (probably because his main audience was someone not in the field of psychology). As a former physiology student, I found that in many cases, I could guess what experiment/example he was going to talk about next before he even got there. This makes it a good read for those who just have a general interest in psychology, but for those in the field, they may find themselves a bit bored with it, even if it has a worthy premise that should be expanded on more deeply.
Read
June 2, 2013I am literally 2 pages into the book and I think it's pretty good. It has helped me formulate a few questions that I may not have otherwise asked. Like, "How can a person study the brain if that person essentially has to use their brain to do it?"
Also, I like how the prologue was very upfront on how parts of the reading may seem obvious and very "duh!" but in my opinion that shouldn't discount the entire material.
After I read more I think I'll write a more specific review.
Also, I like how the prologue was very upfront on how parts of the reading may seem obvious and very "duh!" but in my opinion that shouldn't discount the entire material.
After I read more I think I'll write a more specific review.
January 4, 2024
A very comprehensive read, learned a LOT
April 2, 2025
Smoller does an excellent job at explaining his philosophy of psychiatry (essentially the idea that by only focusing on perceived abnormalities of the mind professionals can misunderstand what causes psychological disorders and how to treat them). His chapters, each exploring biological and neuroscientific "normality" related to various topics, tie in nicely with this thesis. Smoller also does a good job keeping his language accessible while also adequately explaining the neuroscience and biology behind his findings.
I'd recommend this book to anyone interested in psychology and psychiatry (With the caveat that this book is 13 years old at this point. This is not normally a big deal, but scientific understanding shifts quickly.)
I'd recommend this book to anyone interested in psychology and psychiatry (With the caveat that this book is 13 years old at this point. This is not normally a big deal, but scientific understanding shifts quickly.)
December 15, 2020
An enjoyable work. Moves along without getting too bogged down. Some older, often repeated research results mixed in with more recent data. Readable and interesting.
April 21, 2012
In The Other Side of Normal, Jordan Smoller manages a remarkable balance between scientific detail and easy comprehension. Smoller brings to light the amazing way our brains are built to function... and how they can go wrong.
I found this book fascinating because it details just how nature and nurture can effect each other and our brains. It's most certainly not an either/or thing. Both are pieces in the detailed puzzle that forms our emotions and personalities. Smoller gives vivid examples and has a subtle sense of humor that lightens what could otherwise be heavy reading. As someone who struggles with social anxiety, the science of fear and what can cause the more extreme anxieties was both intriguing and relieving!
The only bit of a downside is that Smoller is a distinct believer in evolution and brings this into his writing, however, even I as a Creationist, could easily adapt what he said to my beliefs. Whether we evolved this way or were created this way, it's pretty amazing!
I found this book fascinating because it details just how nature and nurture can effect each other and our brains. It's most certainly not an either/or thing. Both are pieces in the detailed puzzle that forms our emotions and personalities. Smoller gives vivid examples and has a subtle sense of humor that lightens what could otherwise be heavy reading. As someone who struggles with social anxiety, the science of fear and what can cause the more extreme anxieties was both intriguing and relieving!
The only bit of a downside is that Smoller is a distinct believer in evolution and brings this into his writing, however, even I as a Creationist, could easily adapt what he said to my beliefs. Whether we evolved this way or were created this way, it's pretty amazing!
May 15, 2017
The Other side of Normal was actually a fun read. It was fast paced and interesting. Dr Smoller has a way with words and explains some intricate concepts of neuroscience beautifully. His chapter on Fear - Remember to forget-sets up his argument, to study the normal or range of human behavior that doesn't cause functional dysfunction ,on shaky grounds though, at least for me. He delved too eagerly into psychopharmacology for my interest instead of dwelling on the intricacies of the argument and range of what is "normal " in people who have undergone severe trauma.
All in all, Dr Smoller does a great job capturing his audience and keeping them interested in the subject matter.
All in all, Dr Smoller does a great job capturing his audience and keeping them interested in the subject matter.
November 20, 2014
For the first time, I find the biological mechanisms of psychiatric behaviour clearly illuminated. Dr Smoller managed to weave together various aspects - molecular biology, evolutionary biology, neuroscience - to explain how the functioning of the brain can go awry. I had readily dismissed pathologies of the mind as subjective and sometimes even self-indulgent practices, and Dr Smoller was able to salvage some of psychiatry's glories and wonders through this book. I had enjoyed this book very much.
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May 8, 2013591.5 S6665 2012
August 1, 2013
One of my favorite books ever! Very interesting & well-written. I might have to read it again soon because I'm a little sad to be finished with it.
Want to read
April 23, 2012I won this book from First Reads. Looks like a good book. Thank you.
Want to read
June 5, 2012Heard author on Diane Rehm show.
August 29, 2024
The enduring question of are we a product of our nature or nurture is given new life in Jordan Smoller’s The Other Side of Normal: How Biology is Providing the Clues to Unlock the Secrets of Normal and Abnormal Behaviour.
Thankfully, Smoller puts it into the context of biology. Not only are we the product of both, but Smoller elaborates on the ways nurture influences nature, whether it concerns the impact the environment has on the expression of genes, or in the emerging science of epigenetics, and how we can use chemistry to safely modify natural processes.
I really liked this book. It’s rarely as funny as Robert Sapolsky’s Behave: The Biology of Humans at Our Best and Worst, but when it is funny it hits the mark.
Smoller attacks the continuum of normal vs. abnormal behaviour not to provide a new straw man for anti-psychiatry forces. Rather, he helps us see where biology slips from its evolutionary moorings into unchartered and potentially destructive waters.
Smoller assures us that psychiatry based on biology can help alleviate pain without forcing behaviour into the straight jacket of conformity. Not every child on the autism spectrum needs “curing”, for example.
I found his discussion managing the pain of post-traumatic stress sufferers most interesting. As I myself am a sufferer, I see the importance of understanding where fear comes from.
The discussion of what is normal peculiarly affects politics and social mores. Although we like to guess, we do not know where homosexuality comes from. And we have plenty of insurance companies who rely on definitions of normal to tell us when they can pay when they won’t pay for mental health services.
These are important issues and Smoller is a great guide.
Thankfully, Smoller puts it into the context of biology. Not only are we the product of both, but Smoller elaborates on the ways nurture influences nature, whether it concerns the impact the environment has on the expression of genes, or in the emerging science of epigenetics, and how we can use chemistry to safely modify natural processes.
I really liked this book. It’s rarely as funny as Robert Sapolsky’s Behave: The Biology of Humans at Our Best and Worst, but when it is funny it hits the mark.
Smoller attacks the continuum of normal vs. abnormal behaviour not to provide a new straw man for anti-psychiatry forces. Rather, he helps us see where biology slips from its evolutionary moorings into unchartered and potentially destructive waters.
Smoller assures us that psychiatry based on biology can help alleviate pain without forcing behaviour into the straight jacket of conformity. Not every child on the autism spectrum needs “curing”, for example.
I found his discussion managing the pain of post-traumatic stress sufferers most interesting. As I myself am a sufferer, I see the importance of understanding where fear comes from.
The discussion of what is normal peculiarly affects politics and social mores. Although we like to guess, we do not know where homosexuality comes from. And we have plenty of insurance companies who rely on definitions of normal to tell us when they can pay when they won’t pay for mental health services.
These are important issues and Smoller is a great guide.
January 24, 2018
Splendid survey of psychiatry today
As a psychiatry student in the 60s I marvel at how this science has advanced since then. How biology and knowlege about the brain and genetics all have made progress in understanding human nature and nurture is simply stunning. What I miss is perhaps a deeper understanding of how the prenatal environment, in the womb, might influence the devellopement of an individual.
As a psychiatry student in the 60s I marvel at how this science has advanced since then. How biology and knowlege about the brain and genetics all have made progress in understanding human nature and nurture is simply stunning. What I miss is perhaps a deeper understanding of how the prenatal environment, in the womb, might influence the devellopement of an individual.
August 10, 2018
This book was very useful. Knowing people who struggle from mental illness, this helped me understand why these "abnornmalities" happen. I used quotes there because I was surprised how many behaviors were not "abnormal" at all, but extreme responses of the brain's survival systems. I did have to read this book in small doses because it was a little bit dense. Though it was made for people new to pyschology, I will admit it took me a while to understand some parts.
September 27, 2018
This book is great and not easy. It explains the nature vs nurture debate through discussing some clinical trials and lab experiments . It proves that genetic features and experience complete each other and show why we behave as we do
and how our genes and environment influence our life .
I got benefit and enjoyed reading it.
and how our genes and environment influence our life .
I got benefit and enjoyed reading it.
September 29, 2018
The premise is that "normal" is a continuum, not a fixed dot on a chart. I enjoyed brushing up on psychology in general and on recent research that was new to me. Some of the anecdotes were familiar from the news headlines, but this book allowed me to get a taste of the studies and results in a conversational setting. A fun read.
June 20, 2020
Though this is up my alley, I was not engaged enough to finish it. One reviewer's "enthralling" is another reader's "meh."
There are insights, but I guess I wanted something more basic, or applicable, or something intangible. This is my fault. Never blame a book for not meeting your expectations for it.
It's a perfectly cromulent study of human psychology.
There are insights, but I guess I wanted something more basic, or applicable, or something intangible. This is my fault. Never blame a book for not meeting your expectations for it.
It's a perfectly cromulent study of human psychology.
October 19, 2021
This was a DNF at about half way through the 400 pages. I just didn't find it engaging enough. Part of the problem is that my career was as a psychologist, so little of this was particularly new or novel to me.
June 10, 2025
Sometimes the author tries to give evidence and more details that make the book slip into a college textbook.
It is just a revision of similar books written about mind and the environment it functions in.
Nothing special but not boring...
It is just a revision of similar books written about mind and the environment it functions in.
Nothing special but not boring...
June 24, 2018
It was not what I thought it would be. Lots of experiments, research........all uninteresting.
November 18, 2018
Fascinating
Interesting, clearly written account of research that clarify and deepen our understanding of both "normal" and "abnormal" with hopeful conclusions.
Interesting, clearly written account of research that clarify and deepen our understanding of both "normal" and "abnormal" with hopeful conclusions.
November 21, 2018
Wonderful book!
The book gave us a new concept about normal and abnormal. Highly recommend for the ones who love psychology and psychiatry.
The book gave us a new concept about normal and abnormal. Highly recommend for the ones who love psychology and psychiatry.
February 25, 2021
Eye-opening
October 4, 2025
it tries to explain our normal behaviour ranging from fear to love to hate.
November 3, 2015
I will have a special spot for this book on my list of favorite psychology/biology books of all time. When I went into this book, I expected to understand the topic because I have read over 20 books similar to this one but I also thought terms would be overly emphasized to make the language sound like pretty prose making it too complex rather than complex yet engaging. However, I found it to be the second. I am an avid neuroscience person which can be the reason why I didn't find any of the neuroscience and psychology topics to be hard at all, but I also think that writing style was made for everyone to enjoy. The author starts his essay topics with catchy sentences- sentences that go along the stream of pop culture and then connect to science. It is a way of drawing in the reader of all backgrounds while maintaing the essence of high level prose. It's a difficult task that the doctor demonstrates to be easy. The most astonishing fact about this book was the idea that even psychiatrists are aware of the limits of genetics in understanding the "entire," genome in explaining mental disorders and how what we consider abnormal is many times an exaggerating of normal. He concludes with a defense of the DSM that makes perfect sense while still critiquing its negative sides. The topics covered in this book range from memory, learning, cognition, anxiety, to biology and medicine. I loved it and couldn't put it down. 5 stars all the way!
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