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


Can we be too careful ?

Can we be too careful ?

via Daily Prompt: Careful

I imagine that everyone hopes that they are careful. They believe that they assess risks and take steps to avoid or minimise them. They castigate themselves when they make errors and chide themselves, an others, when they are careless. It is held that there is a duty as we grow up to be careful, childhood is the time when we can be carefree. But can we be too careful ?

I think we all can remember times when our caution made us miss an opportunity, when in hindsight we regretted our hesitation. Certainly we can all recall the old adage “faint heart never won fair lady” and many of us have friends or acquaintances troubled by timid, over-cautious natures who lives are stunted by the problems of excessive care and anxiety. In the world of science, however,  a preferred adage might be “better safe than sorry” where the stakes are higher than winning the hand of the damsel. But is is possible that excessive caution and being too careful can be troublesome here also ?

In the scientific world this might be the case with the “Precautionary Principle“. This was brought in as Principle 15 in the United Nations Conference on Environment and Development in Rio de Janeiro in 1992. It might be well defined as follows :-

‘When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.’

Similar descriptions of the principle have been placed in regulations such as the World Charter for Nature and  E.U.’s Treaty of Maastrich.  A basic tenet of the  this principle is that the ‘duty of care’ or ‘onus of proof’ is on those who those who propose change. Further, we are advised to err on the side of caution, even when there is no scientific evidence of harm.

While appreciation of risk and assessment of risk are a basic, and advisable, scientific task this principle can cause problems.  Were the instruction ” assess and avoid risk” this would be entirely reasonable and right. But avoid risk, even is there is no evidence of risk , is a much more troublesome statement.

Obviously when change is proposed there may well be risks, but after these have been dealt with, it will always be possible to imagine or fear further risks for which there is no scientific basis. People feared train travel would be so fast that it would be damaging to the human body, people feared radio waves would affect the human mind. It would not have been possible to show at the time that these things would not occur. Presently we see the precautionary principle pulled out to protect us from all sorts of risks ; GM crops, Fracking, mobile phone masts, vaccination – “Just because they don’t know it doesn’t do any harm, doesn’t mean it wont.” they cry.

But here lies the inherent anti-scientific nature of this principle. It is not possible to prove the existence of something which doesn’t exist. If someone states that there are spirits form past lives in the ether. I can not prove that they are there. I can say that we have never seen them, I can also say that there is no known mechanism for them to be there. This is what science can do. With regard to harm scientists can say ‘we have never seen it’ and there is ‘no known mechanism’ for it to occur. This would be inadequate for the precautionary principle which would suggest caution and hesitation even though there is no scientific basis for this.

rtx12n8eAll life entails risks. Scientific progress is no different. Each step forward we take carries some risk. However, looking back at our development we live happier, healthier and longer lives now as a consequence of taking these risks and the progress of science. We would have missed major steps if we had been so risk averse. Had we fully comprehended the risks of aspirin we would never have started using it. For every risk we take we must also consider the risk we take by not moving forward. Had Jenner not taken the risks of injecting his fellow countrymen with  cowpox, then smallpox would still blight our lives and would have caused millions of deaths.  Those deaths would be the cost of not taking the risk.

Similarly, this year, two million children will die from nutritional deficiency, entirely needlessly ,because we will not allow the use of “Golden Rice”. We allow them to die because of our fear of the possible ‘risks’ . This is nearing a “crime against humanity” say over one third of all living science Nobel Laureates in their recent letter. I don’t think they are being excessive in their complaint.

Two million children dead while we follow the precautionary principle. Yes, it is possible to be too careful.