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….

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