Two Versions of “Pathologizing Normal.”

I recently realised that people with diametrically opposing views on the existence and validity of conditions like autism, appear to make the same argument about the modern trend to “pathologize normality.” So I decided to break-down the argument that is otherwise so briefly summarised in that phrase. At which point it became clear that the “pathologizing normal” argument can stand for (at least) two very different views of humanity and of mental difference; that the seeming agreement on the phenomenon was strictly superficial. So, for the sake of clarity – and the hope of more open dialogue next time I encounter the phrase – I want to attempt to explain these two versions, as I understand them.

The first version goes something like this: There is a modern trend to put labels on completely normal children. On children who are just a little shy or withdrawn, or just full of energy, or just poorly disciplined. These children don’t have ADHD or Aspergers or ODD etc, they’re just the perfectly normal kids we’ve always had in society, but are now receiving these trending labels because of various motivations. Examples of those motivations include parents who refuse to accept their own parenting is at fault, and clinicians who want to make money from providing therapies and drugs to these kids. When it comes to adults seeking and attaining these labels for themselves, it is because these adults want excuses to behave poorly / avoid taking responsibility for their behaviour. The fact is that conditions like these don’t exist. It’s just the pathologization of normal (however undesirable or unpleasant that “normal” may be).

The second version of the argument goes something like this: Conditions like Aspergers, ADHD etc, are real “conditions,” but they are part of the normal human spectrum of experience and existence. These conditions are treated though as if they are wrong and need “correcting:” These people are put on drugs and through endless therapies and in other ways told that what they are is wrong and must change. Instead we should be supporting and encouraging these individuals to be the best they can with their talents, and to work with their challenges in a positive light. We shouldn’t be labeling them as sick or deficient, to do so is to pathologize normal.

This second argument often comes hand-in-hand with an attack on any attempt to define “normal.” They frequently question the validity of a distinction between “normal” and “abnormal,” instead using the word “normal” in this context to capture the point that human experience is brilliantly diverse and valid in all its diversity: That pathologizing people with Aspergers (etc) is a denial and attack on that necessary and natural diversity.

Both versions of the argument have a few things in common: Concern about the impact – and abuse – of labels; concern about the perceived readiness with which professionals turn to drugs to deal with “troubled” people; and concern that various conditions are included in mental health manuals at all (or the ways in which those conditions are defined in those manuals). However the views clearly and seriously diverge when it comes to perceptions about the legitimacy of the conditions at issue, and that is at the very core of the first version of the argument. Furthermore, the seeming agreement on the concerns listed above, is largely superficial.

For example, whereas the first version of the argument would see a label like “Aspergers” to be negative and unhelpful, the second version may see the label as something helpful and positive to be proud of. And whereas the first version argumenters might want conditions like these wiped from the “mental health” manuals altogether (and not continue to exist anywhere else either), the second version arguers may wish the conditions to be less negatively defined and not be considered a type of “disorder” rather than a difference.

So next time you encounter someone who wants to run a short-hand argument that we’re seeing a modern trend of pathologizing the normal – that what was once treated (or should be treated) as normal and natural, has come to be seen as sick and abnormal – before you agree with them and wonder how you disagree on everything else but see eye-to-eye on this, now perhaps you’ll be better able to identify just how deep that disagreement really runs. I, at least, have been in this position in the past and not being able to pin-point the very real difference in views.

I’d be interested to hear whether you have used the shorthand “pathologizing normal,” what you personally meant by it, and why you hold the view. I know some of my commenters in the past have tried to argue that this is a modern trend, I would love to hear whether I’ve captured your concerns, or if there’s a third version of this argument that I haven’t even considered yet.

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8 Responses to Two Versions of “Pathologizing Normal.”

  1. Vicki says:

    I agree with your arguments about the problems inherent in both the above stances. However I have and do use the phrase ‘pathologising normal’ in slightly different circumstances. I acknowledge the validity of and the usefulness of diagnosing AS/ASD/HFA et al. I also disagree with the notion that everyone is on ‘the spectrum’, whilst believing that some traits associated with autism appear in milder forms, (and in less cohesive groups, making for less of a disability) within the neuro-typical population. However, in the wake of greater (and sadly often ill-informed) general knowledge about autistic spectrum disorders there is a tendency amongst many to assume that any child who does not interact with or want to interact with his or her peers must be ‘a bit autistic’. Not only does this devalue the very real difficulties faced by those truly on the spectrum but I also think ‘pathologises normal’, because it assumes that all introverts, the highly-sensitive, or the simply quietly asocial are not functioning normally. I think it is important that the ‘clinically significant’ aspect of an ASD diagnosis is kept in mind.
    I’m not sure if the above is terribly coherent, but I hope you can see what I am trying to explain.

  2. nostromo says:

    When your child is LFA you have the very small ‘luxury’ of escaping the orbit of these arguments; even in the eyes of the most jaundiced punter a child incapable of speech is not normal.

    • I agree absolutely with that comment nostromo. It also follows in part from what Vicki had to say; in that these discussions and concerns will tend to be around the mild end of conditions, and will at times detract from the more serious and very real issues and needs of those on the lower functioning end of the autism spectrum.

      • nostromo says:

        I’d go so far as to say its more acceptable to have a more impaired child. I see this in my own extended family, everyone accepts my son the way he is, but some of them have a problem with the boy in our wider family who has Aspergers. Even when I try and explain he has Autism and how it affects him, they don’t see it.

  3. Word traps like this are unfortunately all too common in all kinds of discussions. We assume we mean the same thing when using the same term, but often we don’t. Thanks for spelling out these different possible positions.

  4. I’m more of the second-version. I recently discovered that a group of people with selective mutism didn’t like my blog post questioning whether SM is “pathologizing shyness.” They seemed to think I meant, it’s not really a problem.

    No, the theory I had was, SM does cause problems, but I think most of the problems stem from people saying there’s something “wrong” with being quiet. That if parents, teachers, peers, etc. just accepted you as shy and quiet, and didn’t badger or ridicule or ostracize you for it, it wouldn’t be seen as a “problem.”

    As I read about SM, it seemed that the reactions of others, just push kids further into their shells, while accepting and encouraging the child leads to overcoming the barriers.

    I can recall being more open and okay with myself as a small child, before people began treating me like there was something “wrong” with me, or like it was a character flaw to be shy and quiet. The more people badger you and cut you off, the more flawed you feel, until it becomes a “disorder.”

    This may not be the case with physical problems or classic autism, or learning disorders. But with social issues, I think the issue is just as much the reaction of others, as it is the person with the disorder. The more you feel “wrong,” the more compounded the problem, because anxiety increases.

    Discovering a disorder fits you, can be taken two ways: You find that your problem is NOT a character flaw, which is a relief, and something you can tell the people who badgered you for all those years. However, you also find there’s something “wrong” with you, when you wanted to be normal.

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