Pathologization

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As pathologizing (the etymology see Pathology ) the interpretation is true of behaviors, feelings, perceptions, thoughts, social conditions or human relations as morbid . In a broader sense, pathologization does not only refer to the evaluation of psychological and social phenomena as pathological. Rather, it is also about deviations from the medically defined normal state that do not result in any significant functional impairment, are not perceived as disadvantageous by most of those affected or - like symptoms of aging - are understood as normal physical processes. Pathologization is a partial aspect of a more comprehensive medicalization of society. The strategy of pharmaceutical companies to operate a so-called disease mongering by increasing the frequency ( prevalence ) of diseases is understood as a special form of pathologization .

Since the pathological is viewed as undesirable and should be treated, the pathologization is accompanied by a negative evaluation. It is often criticized that the evaluative components are not brought up as such, but are presented as a medical fact-finding. What is judged as negative in a society is subject to change. In the prevailing understanding, conditions or processes interpreted as pathological can therefore appear as pathologizations after social changes . A well-known example is the pathologization of homosexuality . In National Socialist Germany there was a pathologization of the pluralistic society insofar as the “healthy national body” was demanded due to scientifically untenable racial hygiene .

Analogously, the pathologization of individual components, as it is practiced in some cases in psychiatry ( psychiatricization ), means their detachment from the individual, psychological and social contexts. The pathologized component is interpreted as a disorder that has to be eliminated or suppressed with medication without questioning the patient's identity .

Relativity of the concept of illness

If the health norm were to be defined in a non-judgmental way using the majority or average physical or mental condition of a population , U. common diseases such as dental caries excluded or even all deviations from the average pathologized. In addition, the physical and mental condition of the population is subject to change. Mathematically defined limits that are based on the standard deviation from a mean value often appear to be arbitrary.

Subjective components also flow into the definition of illness. If the health norm is defined purely subjectively by means of individual well-being, general diagnoses can no longer be made, cf. → Disorder of well-being . However, these are necessary to indicate therapies if, for example, effective patient consent is not possible. They are also crucial when questions of liability need to be clarified or an operation has to be financed by health insurance. Often, the subjective assessments of patients about their own health contradict the assessments of health experts. In countries with a high level of literacy and a longer life expectancy, more people assume they are ill than in countries with poor medical care and a high rate of illiteracy.

As pathological in a normative sense one can appearance are that statistically seen at a much earlier occurrence of death leads or changes that will respected by those affected in the long run, and typically as suffering. However, such social assessments are often not clear-cut either. What is assessed in certain societies as Weltschmerz , melancholy or occasionally as grief , in others is considered to be depression in need of therapy . Depending on the definition, there are therefore large bandwidths. For example, the prevalence of social phobia (in other words, a fear of social contact that by definition goes beyond mere shyness ) is given between 1.9 and 18.7%, depending on the diagnostic criteria.

Michel Foucault made an important contribution to the explanation of the functioning of pathologizations as a technique of domination in “Madness and Society” (1961) and “Birth of the Clinic” (1963).

Consequences of pathologization

Although pathologization is often used in a critical sense, the underlying facts are not rated negatively in every case and by all authors. In many cases, an understanding of the physiological mechanisms of action of suffering means that adverse health conditions no longer have to be accepted as fateful, but effective therapies can be developed.

On the other hand, the explanation of adverse conditions or processes leading to diseases can also lead to a passivity that can be disadvantageous for the individual. In an influential criticism of the medical system, the Austrian-American philosopher and cultural critic Ivan Illich wrote : “ People are conditioned to get things rather than to do them… They want to be taught, moved, treated, or guided rather than to learn, to heal, and to find their own way. ”(German:“ People are conditioned to get things instead of doing them… They want to be taught, moved, treated or guided instead of learning, healing and finding their own way. ”) This attitude can lead to this that social or psychological causes are underestimated and that somatic therapies are seen as a panacea for a wide variety of problems. Illich does not advocate foregoing modern technology, but for combining it with the ability for individual and collective self-help .

Cases of criticism of pathologizations

Pathologization of gender and sexual orientation

Feminists and gender researchers often point to a pathologization of the female sex, especially with regard to menstruation , pregnancy and menopause . Homosexuality has also long been viewed as a mental illness since it was classified by the psychiatrist Richard von Krafft-Ebing . However, this pathologization initially led to homosexuals not being punished. It was not until the end of the 20th century that homosexuality was removed from the current classification systems for mental illnesses (see homosexuality ). The biologist Cord Riechelmann also speaks of the pathologization of intersexuality through medicine since the 18th century.

Racial hygiene as a form of pathologizing the "people's body"

Pathologization was of particular importance in National Socialist Germany. The company was here biologistically as " body politic construed" to that of " pests infested" and whether by destruction of these "pests" to "cure".

Antipsychiatry as a fundamental criticism

In the area of mental disorders , especially in the 1960s, antipsychiatry fundamentally questioned the possibility of objective psychiatric diagnoses. As ill would apply which of the social norm differs. The representatives of antipsychiatry saw in the mentally ill victims of social repression who were only made sick ("pathologized") through so-called labeling by diagnosis. Even if the fundamental criticism of antipsychiatry at making diagnoses is considered to have failed, there are still major problems in clearly distinguishing between pathological and healthy mental states.

Pathologization by the pharmaceutical industry and plastic surgery

Recently, the keyword “disease mongering” has been used to refer to the influence of pharmaceutical companies and lobby associations in the definition of diseases. A controversial example from the field of psychiatry is the prevalence of ADHD . In the public discussion, the risk is emphasized here that restless or unfocused or simply lively children would be medically pathologized. There is a "gray area" between intended and improper use of Ritalin , which is mainly due to the lack of clarity in the diagnosis of ADHD and narcolepsy .

Examples of somatic diseases, the frequency of which is highly controversial, are the irritable colon or the restless legs syndrome . In the field of gynecology, the " hypertrophy " of the labia minora is a diagnosis that has been criticized as an indication for plastic surgery. Often insufficient information is provided about the natural variance in appearance, so that patients would decide to undergo an operation because of a misconception about the lack of normality in their appearance.

literature

  • Michael Schetsche: Social Control through Pathologization? Construction and Deconstruction of 'Extraordinary Experiences' in Psychology. In: Birgit Menzel, Kerstin Ratzke (Ed.): Limitless Constructivity? Positioning and future perspectives of constructivist theories of deviant behavior. Leske + Budrich, Opladen 2003, pp. 141-160.

Web links

Individual evidence

  1. ↑ See keyword pathologization in the glossary of Anne Allex, Alice C. Halmi: Stop Trans * -Pathologisierung: Berlin contributions for an international campaign. AG SPAK Books, 2012, ISBN 3-940865-36-2 , p. 11.
  2. ↑ Petra Kolip: Femininity is not a disease: the medicalization of physical upheaval phases in the life of women . Beltz Juventa, 2000, ISBN 3-7799-1068-3 , p. 19.
  3. ↑ Peter Riederer, Gerd Laux: Basics of neuro-psychopharmacology: A therapy manual. Springer DE, 2009, ISBN 3-211-85472-X , p. 7 f.
  4. ↑ Amartya Sen : Health: perception versus observation. BMJ 2002, p. 324, doi: 10.1136 / bmj.324.7342.860 (published April 13, 2002).
  5. ↑ Peter Riederer, Gerd Laux: Basics of neuro-psychopharmacology: A therapy manual. Springer DE, 2009, ISBN 3-211-85472-X , p. 7.
  6. ↑ See for example the controversial discussion in the British Medical Journal on the subject of "non-diseases" and " Disease Mongering ", z. B. Ray Moynihan: Too much medicine? Almost certainly. In: BMJ 2002 (April 13), 324 (7342): pp. 859-860.
  7. ^ R. Smith: In search of "non-disease" . In: BMJ 2002 (April 13), 324 (7342): pp. 883-885.
  8. ↑ Quoted from Ray Moynihan: Too much medicine? Almost certainly. In: BMJ 2002 (April 13), 324 (7342): pp. 859-860.
  9. ^ Ray Moynihan: Too much medicine? Almost certainly. In: BMJ 2002 (April 13), 324 (7342): pp. 859-860.
  10. ↑ Bernhard Borgetto and Martina Klein: Development and dissemination of health-related self-help groups and organizations in Germany In: Rehabilitation and self-help. This., Research report for the Federal Ministry of Health, bundesgesundheitsministerium.de (PDF; 643 kB), pp. 19, 27.
  11. ↑ Petra Kolip: Femininity is not a disease: the medicalization of physical upheaval phases in the life of women . Beltz Juventa, 2000, ISBN 3-7799-1068-3 , p. 19.
  12. ↑ Cord Riechelmann: Nature and Intersexuality Jungle World, April 3, 2014.
  13. ↑ Dominik Groß, Sabine Müller, Jan Steinmetzer: Normal - different - sick ?: Acceptance, stigmatization and pathologization in the context of medicine. Human Discourse - Medical Challenges Past and Present . MWV, 2008, ISBN 3-939069-28-0 , p. 354.
  14. ^ Peter Walkenhorst: Nation - Volk - Rasse: Radical Nationalism in the German Empire 1890-1914. Vandenhoeck & Ruprecht, 2007, ISBN 3-525-35157-7 , p. 96.
  15. ↑ Heinz Schott, Rainer Tölle: History of psychiatry: disease teachings, wrong ways, forms of treatment. CH Beck, 2006, ISBN 3-406-53555-0 , p. 338.
  16. ^ With reference to Willenbring (2009) Cornelia Hoffmann : Discipline difficulties in school: A qualitative individual case study with a focus on group and attachment theory. Springer, 2009, ISBN 3-531-16420-1 , p. 74.
  17. ^ Anne Eckhardt et al .: Human Enhancement. vdf Hochschulverlag AG, 2011, ISBN 3-7281-3396-5 , p. 29.
  18. ^ Anne Eckhardt et al .: Human Enhancement. vdf Hochschulverlag AG, 2011, ISBN 3-7281-3396-5 , p. 26.
  19. ↑ Peter Riederer, Gerd Laux: Basics of neuro-psychopharmacology: A therapy manual. Springer, 2009, ISBN 3-211-85472-X , p. 7.
  20. ↑ Ada Borkenhagen, Elmar Brähler, Heribert Kentenich: Intimate surgery: A dangerous trend. In: Deutsches Ärzteblatt 2009; 106 (11): A-500 / B-430 / C-416
  21. ↑ To the pathologization in journal-ethnologie.de .
  22. ↑ Jillian Lloyd, Naomi S. Crouch, Catherine L. Minto, Lih-Mei Liao, Sarah M. Creighton: Female genital appearance: 'normality' unfolds. In: International Journal of Obstetrics & Gynecology. Volume 112, Issue 5, 2005, pp. 643-646. PMID 15842291 full text ( memento of the original dated November 2, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 171 kB) @1@ 2Template: Webachiv / IABot / www.sindromedimorris.org