On pathologisation

I was sitting in a lecture the other day and the topic was developmental, emotional and behavioural disorders in childhood and early adolescence.

I couldn’t believe my eyes nor ears when the figures were displayed on the board. 20% of children and young people suffer from some mental disorder?!! 30!!? Jesus effing Christ.

Where are those disordered children? Are they really hidden away from us, being home-schooled or taught at specialized institutions? But how can you hide as large a proportion of society as 20-30%. You could not. When I went to school, and I went to more than one and came in contact with at least 100 children and teenagers, almost no one had a psychological disorder. I’m not making this statement as a doctor or psychologist, I’m making this statement as a human being assessing other human beings. Nearly all children and teens I encountered were mentally healthy individuals to me. I was a mentally healthy individual. Some of us had certain qualities that made us different. I was shy. Excruciatingly shy, but I never thought of myself as being mentally disordered. Nor did I think so of anyone else, even if they were hyperactive, highly-strung or uninterested in studying. With the exception of two people, who indeed seemed ‘very different’ on some deeper, fundamental level. In hindsight, they may have had an autism spectrum disorder. That still accounts for roughly 2%.

Furthermore, a large proportion of children, but more so adolescents and adults go through their life undiagnosed. It strikes me as being particularly common with depression, eating disorders and various anxiety disorders. If we add all the undiagnosed people to the list of the diagnosed, wouldn’t that add up to a half of the population? Is it really right to classify half of the population as mentally disordered?

The good and bad of pathologising

I do not think that pathologization is all evil. Its chief merit lies in helping people with personal difficulties find themselves, adjust better and hopefully be more successful in life. Here and there, I’ve spotted the opinion that the label of a specific disorder helps people. Instead of feeling ‘weird’ and all alone, trying to fight for your position in society against overwhelming odds and personal disadvantages, you suddenly belong. The responsibility and the need to fight are eliminated. You have a disorder and that explains all your problems and exempts you from needing to be strong, a social success, or whatever it is your particular disorder keeps you from being, but society expects of you.

All good, isn’t it?

It is and it isn’t. For example, introverts struggle too. And are often glad and relieved to learn more about it. It achieves the same thing for them – they belong, no longer feel weird and learn to adopt (hopefully) a positive attitude to their personality.

Why can’t hyperactivity be just a quality? Anxiety (milder forms)? Depression? Who is shy and who has a social anxiety disorder? Who draws the line? Should we draw the line so that to pathologize a large proportion of society or should we restrict the label of ‘disorder’ to a minority of extreme cases, in the end?

It probably does not require an explanation that I support the latter. Google catatonic schizophrenia and suddenly, nearly everyone with ADHD and mild to moderate depression seems a perfectly healthy human being.

What pathologization achieves is that it limits both the individual with the supposed disorder and the perceptions others have of them. Everything begins to revolve around the disorder.  The person may start avoiding certain situations as incompatible with their disorder (without actual necessity), may restrict their social interactions to people also suffering from the same disorder, may turn down job offers as incompatible with their condition (even if they wouldn’t really be). They may adopt a victim position, alienating others, or they may be treated as a disorder and not as an individual, with many other qualities besides the disorder.

The following is not a mental disorder, but the analogy works very well. A little while ago I read about a woman who had lost her left arm in a work accident. Since then, she has lived the life of a ‘proper’ disabled person, attending disabled person’s Christmas parties and having disabled people as friends. I read this and thought – it is only an arm, for heaven’s sake, she could have lived like anyone else if she wanted to! Maybe not done certain activities and jobs, but otherwise….

What I don’t like about schools

Everyone has different experiences with schools and the education system. Mine is  – all things considered – a neutral one. And yes, I can’t believe I’m saying this! Both the early school years and the later ones at university held for me disappointments and struggles as well as excitement and joys.

The struggles are primarily related to being a shy introvert. I’m fortunate to live in a society where you are not expected to speak a lot in class and can get away with contributing minimally. As a rule. But sometimes there are exceptions and I have received lower grades for my refusal to contribute or my very small contributions. Is this fair? As fair as slower students losing points on timed tests and nervous ones experiencing a drop in their thinking capacity during high-pressure exams.

It may amuse people to know that when I pick my subjects for the next semester, I do not make the choice – provided I have any choice – based on which subjects interest me more, but based on whether there are presentations and whether the grade includes participation in discussions. If it does, there is no way I will elect this subject. I have no problem with class participation in language classes or mathematics, for example. I can easily read out grammar sentences, getting it wrong does not mortify me to the point of wanting the ground to swallow me.

Quite a different matter is any class involving proper discussion or less straight-forward questions (e.g history, politics, sociology). Let us take a classic literature class. I love literary discussions and am always involved in my mind, but I’m not a good contributor. I need time to prepare my answer, so when I’m suddenly asked, I rarely can think of anything to say on spot. Anything sensible, that is. So I say something dumb and not representative of my real understanding of the subject. And then I feel really bad, because no one knows I actually understand. All they have is that impression based on my poor verbal performance. The grade is appropriate too, naturally. Although in my country, many professors and teachers have actually shown understanding and not been as strict as they could have with me. I appreciate you and am grateful.

What I’ve actually started doing to cope with this situation is to try to get through presentations and discussions with extremely low expectations on myself. Otherwise, persistent under-perfomance starts getting to me. I no longer tell myself to do well, I tell myself that it’s a success if you get through the ordeal without any blush-worthy statements.

I wish that one day the education system would learn to offer different assessment methods for introverts and extroverts. The latter love participation and presentations and do very well there, but may not be particularly stellar on paper. Introverts are the opposite. Why not let both types express their knowledge in forms best suited to their temperaments.

Have all these class participation things made me a better public performer? Absolutely not. Every situation is different and while I may eventually get the hang of doing presentations without my hands shaking, spontaneous participation in class will never be my thing and I’ve seen no improvement in that particular arena.