Such Mad Notions . . .

Eyeing Definitions

Sam Island

NYT

Some readers may recall that I quoted Professor Lee Jae-Min in a post on legal definitions some time back, specifically, these words:

Suppose legislation, enacted in 1990, contains the term "cellphone." Does it mean a cellphone that we knew as of 1990, a brick-sized portable phone, and its future extensions? Or should the term also cover the new electronic products, sporting "all-in-one" digital capabilities, that we carry in our pockets and bags in 2013? This question relates to what is called "evolutionary interpretation" or "dynamic interpretation" of texts, and poses a new challenge.

At the time, I also made a remark about religious texts:

Imagine how this applies to religious texts in our rapidly changing world. One can't generally even amend them. One is left with reinterpretation.

But even 'science' and 'scientific' texts have to deal with changing reality in, for example, the new edition of the Diagnostic and Statistical Manual of Mental Disorders, though we're probably talking more about shifting social reality, if we read between the lines:

The fact that the world's most powerful psychiatrists (their decisions determine what counts as a mental disorder, and thus what insurers cover and which children receive special services in school) are already building in ways to change the manual is commendable, even its critics say.

But it is also emblematic of the DSM-5's failures, they argue, which include turning normal human behavior and feelings into mental illnesses, and expanding the criteria for disorders until an astonishing one in four U.S. adults has a diagnosable mental illness every year -- and even more do over a lifetime.

Perhaps I should say "bureaucratic" reality, for this redefining of normal extremes as mental illnesses rather than leaving them understood as within the normal range of human feelings serves a bureaucratic purpose, as implied in the above quote from an article by Sharon Begley, "Psychiatrists unveil their long-awaited diagnostic 'bible'" (Reuters, May 17, 2013). As more and more people are redefined as 'ill,' more and more qualify for health coverage. The consequence is costly, probably unnecessary health care as we redefine ourselves as 'victims.' But there's something of a countervailing force to this pathological overlabeling, at least in the sense of lifting the label of victimhood by redefining what has been considered abnormal as normal, as in Blake Charlton's article, "Defining My Dyslexia" (New York Times, May 22, 2013)

[A] group of advocates could alter the definition of dyslexia and what it means to be dyslexic. That's a bigger idea than it might seem. Ask yourself, "What role should those affected by a diagnosis have in defining that diagnosis?" Recently I posed this question to several doctors and therapists. With minor qualifications, each answered "none." I wasn't surprised. Traditionally, a diagnosis is something devised by distant experts and imposed on the patient. But I believe we must change our understanding of what role we should play in defining our own diagnoses.

Before I went to medical school, I thought a diagnosis was synonymous with a fact; criteria were met, or not. Sometimes this is so. Diabetes, for example, can be determined with a few laboratory tests. But other diagnoses, particularly those involving the mind, are more nebulous. Symptoms are contradictory, test results equivocal. Moreover, the definition of almost any diagnosis changes as science and society evolve.

Diagnostics might have more in common with law than science. Legislatures of disease exist in expert panels, practice guidelines and consensus papers. Some laws are unimpeachable, while others may be inaccurate or prejudiced. The same is true in medicine; consider the antiquated diagnosis of hysteria in women. Those affected by unjust diagnoses -- like those affected by unjust laws -- should protest and help redefine them.

The past 50 years provide several examples of such redefinitions. In 1978, Susan Sontag's "Illness as Metaphor" demonstrated how the contemporary understanding and description of cancer unfairly blamed patients. In the next decade, activists began their struggle to enlighten the medical profession and society about H.I.V. More recently, the neurodiversity movement has changed how we understand autism.

I believe that scientific evidence and social observation will continue to show that defining dyslexia based solely on its weaknesses is inaccurate and unjust, and places too grim a burden on young people receiving the diagnosis. A more precise definition of dyslexia would clearly identify the disabilities that go along with it, while recognizing the associated abilities as well. If the dyslexic community could popularize such a definition, then newly diagnosed dyslexics would realize that they, like everyone else, will face their futures with a range of strengths and weaknesses.

Fascinating, this interplay of science, society, bureaucracy, and the transition of time . . . but it isn't a neutral interplay, as we see in the possibly politicized drive to redefine the normal as pathological, countered by the also possibly politicized drive to redefine the pathological as normal. What will be the outcome of redefining everyone as victimless victims? Pathology as power? I think of all sorts of bad puns. The pathology to success! Choose your pathology through life! Find your own pathology!

That way lies madness . . .