I used to be clumsy but I’m dyspraxic now.

via Daily Prompt: Clumsy

straightjacketOne 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

It is just as important to go out as it is to come in.

It is just as important to go out as it is to come in.

via Daily Prompt: Border

Borders are strange beasts. We all accept them  despite little evidence that they are to our benefit. We often only become aware of them when we realise that they are a problem to us, for example in times of war or civil unrest when we need to move. Borders are there to impede our movement, to keep us where we are whether we want to be there or not. Unfortunately, most interest is focused on the use of border to keep people outside. In Britain and other areas of Europe this has become a major feature of political debate – “How can we secure our borders and keep people out ?

This dislike of movement is against all the evidence which has shown that immigration has a  positive effect on societies – both economically and socially. There is no incentive for people to move to make matters worse somewhere else, that is the role of states with their wars and empire building. We, as individuals, move to be able to improve our lot and, at the same same time, improve the lot, through trade and work, of our new neighbours.

The real concerns, that immigration may have the effect of undercutting the wages of local workers, or that it may overstretch the provision of welfare services, are easily dealt with. The first problem’s solution lies in good syndicalist movements and the organisation of workers. Through effective unionisation and collective bargaining it is possible avoid this potential downside of immigration. Indeed, if immigration improves the economy, as it invariably does, there is more wealth to be distributed; the task is to distribute this more fairly (rather than to allow deleterious effects on the economy, through banning movement. which mean everyone has less).

The second concern, over the utilisation of welfare services such as health or education could again easily be managed. Rather than have these schemes based on taxation and residence, return them to insurance based schemes. People could then make provision for their services whatever their country of origin. Schemes would soon develop which would aid people in their movement, the effects of the local levels of supply and demand would encourage the development of varied services which would meet the local needs. The free market makes better, more appropriate, services for local societies and much more quickly than the cumbersome and slow processes of central national planning.

But to return again to the beginning, border do not just keep people out, they keep people in. According the the Universal Declaration of Human Rights of 10th December 1948 (UDHR) we have the right to leave any country including your own. However, this is a basic right that is largely ignored.  Try and leave your country of residence without a passport and you will find it well nigh impossible legally. No carrier will assist you, you will not be able to start discussion with any other country where you may wish to go.

This right to leave any country forces on nations a negative obligation that they do not impede our movement and that they issue all the necessary travel documents without undue delay. In essence this means that the country issues passports to its citizens. However, this is not done as a matter of course and is not always done without payment. This control over our ability to leave is a restriction on our liberty and something that should not be tolerated. We are free men and women, we are not the property of our state.

Next time you witness refugees fleeing disasters, whether these be natural or, more likely state made, remember how borders are slowing down their flight to safety and making it less likely that they will succeed. Think also on the matter of how you would flee if there were a change in your country’s rulers so that you and your family were at risk, or how you would flee were there a natural disaster or war. Would you be happy to see the barbed wire of the border fence and happy to meet the border guard ?

Borders – we don’t need them.