TL;DR

The slogan “Aus der Nähe betrachtet ist keiner normal”—“Up close, nobody is normal”—annoyed me. I read it as dissolving the distinction between ordinary variation and severe psychiatric illness, then built a Karneval roast around that reading.

The roast was sharper than the evidence.

Modern diagnosis does use impairment, distress, duration, exclusions, and syndrome-specific thresholds. But that does not make a continuum framing clinically incoherent. A 2021 systematic review and meta-analysis found that continuum beliefs were generally associated with lower stigma; interventions successfully shifted those beliefs but had mixed effects on stigmatising attitudes [[1]]. The slogan may be incomplete or ambiguous. I cannot defend the claim that it actively harms the people a psychiatric centre serves.

The Reading I Brought to the Poster

I took the slogan’s implied argument to be:

Nobody is normal, therefore the normal/disordered distinction is arbitrary, therefore psychiatric diagnoses are arbitrary.

That conclusion would indeed be bad. People with severe, impairing conditions need their suffering, treatment needs, and claim on resources taken seriously. “Everyone gets depressed sometimes” can be a dismissal, just as casual use of OCD can erase the severity of obsessive-compulsive disorder.

But the poster does not contain my syllogism. A continuum claim can instead mean that symptoms and experiences vary in degree, that categorical labels do not make people a different kind of human, and that a clinical threshold can remain meaningful on a continuous distribution. Blood pressure is continuous; clinical decisions still use thresholds. The existence of a threshold does not require two metaphysically separate species of person.

What Psychiatric Classification Actually Claims

Jerome Wakefield’s harmful-dysfunction analysis combines a factual dysfunction with harm judged in a social context [[2]]. It is influential and contested; it is not simply “the definition psychiatry uses.”

DSM-5-TR defines a mental disorder in terms of a clinically significant disturbance reflecting dysfunction in psychological, biological, or developmental processes, usually associated with significant distress or disability [[3]]. Individual diagnostic criteria vary. Not every diagnosis has one generic “clinical significance criterion,” and neither the manual nor Wakefield makes psychiatric boundaries free of judgment or controversy.

Christopher Boorse’s account of health as species-typical biological functioning is another philosophical proposal [[4]]. It cannot be imported as the uncontested operating rule of psychiatric diagnosis. Statistical deviation, dysfunction, distress, impairment, duration, culture, risk, and values enter different classifications in different ways.

The correction is not that diagnosis has no thresholds. It is that thresholds and continua can coexist.

Concept Creep Is a Different Claim

Nick Haslam describes concept creep: harm-related concepts can expand horizontally to new phenomena and vertically to less severe cases [[5]]. He argues that this expansion has ambivalent implications, including a risk of pathologising ordinary experience.

My original article turned that risk into a demonstrated dilution effect: if a concept covers milder cases, people with severe illness necessarily lose recognition and resources. Haslam’s 2016 paper does not establish that causal chain, and this poster is not evidence that a diagnostic category has expanded. “Nobody is normal” is a continuum message; concept creep concerns changing concept boundaries. They can interact, but they are not synonyms.

Allen Frances’s Saving Normal is a forceful critique of diagnostic inflation [[6]]. It is an argument in a contested nosological debate, not proof that normalisation slogans undermine clinical care.

What the Anti-Stigma Evidence Says

The most directly relevant source was missing from my original roast. Peter and colleagues reviewed 33 studies of continuum beliefs and mental-illness stigma; 13 contributed to meta-analysis [[1]]. Continuum beliefs were consistently associated with lower stigma, including lower perceived difference and, across outcomes and conditions, less desired social distance, dangerousness, unpredictability, and fear, with more prosocial reactions.

That does not prove this poster works. Correlation is not intervention, most studies concerned depression or schizophrenia, and much of the evidence came from Germany and the United States. Experimental continuum messages generally changed continuum beliefs, but their effects on stigma were mixed. The authors emphasise identification—creating a sense of “us”—and recommend further study rather than a slogan-only cure.

Corrigan and Penn’s earlier review distinguishes protest, education, and contact strategies [[7]]. It warns that protest can rebound, education can meet resilient stereotypes, and contact works under conditions such as equal status, cooperation, and institutional support. It does not say that normalisation campaigns reduce perceived severity or treatment support, as I previously claimed.

Kvaale and colleagues found that biogenetic explanations can reduce blame while worsening some other stigma outcomes [[8]]. Biogenetic framing is not a valid proxy for continuum framing. That citation did not support my argument and no longer does that work here.

The Institution Is Not Contradicting Itself

A Sozialpsychiatrisches Zentrum can believe both of the following:

  • mental experiences and symptoms vary continuously across people; and
  • some people cross thresholds at which specialised support is warranted.

There is no contradiction. Services already make decisions using need, impairment, risk, eligibility, and available resources. Saying that users are not a separate human category does not imply that everyone needs the same service.

The heart analogy from my original article survives in reverse. Nobody has an anatomically identical heart, cardiovascular variables are continuous, and specific cardiac conditions still warrant treatment. The continuum does not dissolve the clinical category. It explains why variation and thresholds must be discussed separately.

What I Would Put on the Wall

I still prefer messaging that preserves severity and material need:

Mental illness is real. It does not make anyone less whole, less worthy, or less one of us.

That is a judgment about language, not a finding that the existing slogan is harmful. The evidence gives continuum messages a legitimate place in anti-stigma work, especially when they create identification rather than merely announcing that categories are fuzzy. It also leaves room to say that severe conditions require treatment, accommodation, and resources.

Karneval rewards an overconfident prosecutor. Research requires a less satisfying ending. I went looking for citations to support the roast and found one that required me to retract it.

The poster can stay on the wall.

Clinical and anti-stigma literature checked through 2026-07-11.

References

[1] Peter, L.-J., Schindler, S., Sander, C., et al. (2021). Continuum beliefs and mental illness stigma: A systematic review and meta-analysis of correlation and intervention studies. Psychological Medicine, 51(5), 716–726. https://doi.org/10.1017/S0033291721000854

[2] Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388. https://doi.org/10.1037/0003-066X.47.3.373

[3] American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Association Publishing.

[4] Boorse, C. (1977). Health as a theoretical concept. Philosophy of Science, 44(4), 542–573. https://doi.org/10.1086/288768

[5] Haslam, N. (2016). Concept creep: Psychology’s expanding concepts of harm and pathology. Psychological Inquiry, 27(1), 1–17. https://doi.org/10.1080/1047840X.2016.1082418

[6] Frances, A. (2013). Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. HarperCollins.

[7] Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54(9), 765–776. https://doi.org/10.1037/0003-066X.54.9.765

[8] Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The side effects of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33(6), 782–794. https://doi.org/10.1016/j.cpr.2013.06.002

Changelog

  • 2026-07-11: Reversed the article’s central verdict after adding the directly relevant continuum-beliefs meta-analysis; corrected claims about DSM criteria, harmful dysfunction, concept creep, contact, and biogenetic framing; and removed the unsupported assertion that the slogan harms service users or contradicts the institution’s mission.