One of the trends of recent years has been the increasing medicalisation of our lives. Issues that previously were thought of as aspects of our personality or experience are viewed the rough the lens of health care. This trend has a long and venerable heritage. When Hippocrates wrote “On the Sacred Illness” and proposed fits, due to epilepsy, were due to phlegm from the brain rather then a punishment form the Gods, this was a major scientific advance.In the middle ages the recognition of some forms of mental illness as diseases rather then proof of demonic possession save some unfortunates from the rack and the stake. Shifting behaviours due to disease into the medical arena has been, without doubt, beneficial.
As our scientific knowledge increased more and more conditions were recognised for what they were. Times when people might have been thought to be lazy and slothful (when they had anaemia, renal failure, and so on) are gone and it is recognised that these people in fact suffered from disease or illness. They are taken out of the social realm and placed in the medical realm and thus excused from normal social responsibilities – we do not expect the lame or blind to work the same as others, we accept that those with schizophrenia may at times behaviour oddly or even rudely. This reduction of our responsibilities is beneficial as we are not then punished for behaviours not under our control.
However, this has not always been a change for good. In the nineteenth centuary a medical disorder of drapetomania was proposed by the American physician Samuel A. Cartwright. The essence of this condition was the desire to escape captivity and servitude; the ‘treatment’ was regular whipping to deter slaves from running away. More recently the KGB in the USSR worked with doctors, using the diagnosis of “sluggish schizophrenia” to incarcerate many dissents in mental hospitals. They used the diagnostic label to undermine the behaviours of political dissenters by making them symptoms of medical disorders there was no need to pay any heed to them – disagreement became madness.
It is with this in mind that recent changes concern me. There has been a tendency to identify difference as disorder. The socially awkward man with a liking for habit and routine becomes a man with Asberger’s Syndrome, the clumsy child becomes a patient with ‘dyspraxia’, the shy become ‘socially phobic’, the sad and disappointed become people with ‘minor depressive disorders’, and so on. There is a preoccupation with illness and an acceptance that it is almost universal we all have some disorder !
But this is a dangerous path. Placing people in the role of being ‘unwell’ has a number of risks. These might be outweighed by advantages as mentioned above, such as excusing us from our normal social responsibilities, or giving an explanation of our behaviour, or offering some form of treatment to improve our lot. But recent expansions of the ‘sick role’ seem to offer none of these. Someone who is clumsy knows no more about the origins of their clumsiness after the label of ‘dyspraxic disorder’ has been applied, they knew that their brain was less good than the average in motor tasks and dexterity already. We know no more about the socially awkward obsessive after we have labelled him as having Asberger’s syndrome, we have gained no new insights about him.
None of these, and many other disorders, have, at present, any treatments available for them. The steps one might take to mitigate against their signs and “symptoms” are common sense. Importantly, the steps which might help are not known only to medical professionals they are things we can all work out. Thinking that these disorders are some form of illness or disease limits the sources of help people may receive. People may undervalue the advice of the non-professional and miss possibly useful assistance form their friends, family or themselves.
The exclusion from social responsibility is a double edged sword. While people may feel some relief following being labelled as having some disorder and may benefit that others expect less of them – “I have X disorder, you can’t expect me to do Y” – what if the person want to be able to “do Y” ? The urge to overcome differences, that are seen as a disadvantage, might be suppressed. The socially phobic might not press themselves to gradually expand their repertoire of social activities and thus lead a smaller, less rewarding life than they may have been able to do otherwise.
Worse that curtailing the individual’s attempts to improve their lot is the danger that, now in the arena of healthcare, physicians will try and improve them. Already millions of unnecessary and ineffective prescriptions for medication are given to the mildly depressed or socially anxious (as well as many other dubious ‘disorders’). Each time such a pill is swallowed someone takes a risk of harm without the prospect of any benefit. It is true to say that some people die as a consequence of saying “I have disorder X” as opposed to accepting “this is the way I am”
Society as whole also looses out by this trend. Every time a deviation from the norm is categorised as a disorder we reduce what we consider the range of normal human life. We restrict the range of what is acceptable. While, in our present humane and liberal democracies, this may not be too risky there is no guarantee that this will always be the case.
Illness, ill-health and disorder are the exception we should fight to make sure that they remain so.
Written in response to the daily prompt : Clumsy