At the end of the last chapter we asked the question as to whether there exist any other instances, apart from in the field of addiction, where the notion of disease is used functionally to redefine types of behaviour which might otherwise be viewed in a negative light. In fact, such instances are not difficult to find. One example which occurs with some regularity involves petty theft, where this is perpetrated by a well-known or respected public figure. For example, not so many years ago the unfortunate Lady Barnett was involved in such an affair. Isabelle Barnett, a titled woman held in high regard by members of the public from all walks of life due to her attractive personality and wit on the television quiz 'What's My Line', seemed to most people an unlikely person to be involved in a shop-lifting scandal. Nonetheless, she was convicted of such an offence, and the affair attracted more attention than was warranted simply because she was in the public eye. It appears that Lady Barnett suffered high levels of psychological stress after the incident; in the event, she took her own life some time later in a tragic and grotesque manner. However, whatever the personal reasons behind her unfortunate death, her acts of theft were predictably attributed in contemporary media accounts to a 'condition'; whether this diagnosis helped or hindered Lady Barnett in coming to terms with her behaviour remains a matter for conjecture.
The condition known as kleptomania is defined in terms of a compulsive desire to steal not unlike the compulsive desire to gamble. Kleptomania is in fact very poorly documented; there is little scientific evidence, other than psychiatric and other allegedly expert opinion, to distinguish between kleptomania and ordinary habitual stealing; a fact which mirrors the postulated distinction between heavy and compulsive gambling discussed in the previous chapter. The fact that firm evidence is lacking, however, is irrelevant since the function of the kleptomania label is not to mirror established scientific fact, but rather to make something easier to live with for the time being. Such a strategy, however, provides short-term social advantages at the expense of longer-term solutions, as we shall see later.
By way of contrast, when petty theft is committed by an archetypal 'villain', for example a twenty-year-old unemployed youth with a prior record of football hooliganism, vandalism, stealing or whatever, no one will be in a great hurry to suggest that he is 'suffering' from the 'condition' of kleptomania. The twist in the logic is startling; the 'disease' label is applied to the atypical event, whereas the chronic event is judged culpable. In a medical context, the same criterion would suggest that a single sneeze was pneumonia, whereas a lifetime of emphysema was culpable bad behaviour.
In fact, the medical label in this context has nothing to do with science, and everything to do with social expediency. There is no societal problem, once someone is defined as 'bad', in finding them guilty of doing bad things on purpose. When people socially defined as good do such things, however, a different kind of explanation is required; namely, one that removes the perceived culpability. Unhappily, this is only achieved at the price of imposing the associated and more permanent label 'mentally ill' or 'sick' upon the perpetrator, so there is thus a heavy price to pay in social terms for the absolution of sin by this means. One trades temporary badness for chronic illness.
In a previous chapter we have reasoned against the absurdity of defining entire, integrated sequences of purposive behaviour in terms of the involuntary symptomatology of a supposed disease. Such a definition, whilst meeting immediate social purposes, has unfortunate consequences. The futile search commences for the underlying mechanisms of the postulated disease, when what is required is an understanding of why the social world in which we live, and which we have created, leads a member of the aristocracy to display the same criminal behaviour as a twenty-year-old unemployed youth, and vice versa. By removing the acts of Lady Barnett to a different causal plane, we make it that much less likely that we will come to a realistic and empathic understanding of either the problems of unemployed youth or of Isabelle Barnett, or of the interaction between shoplifting, individual motives, and the economic situation in general.
An even more striking example of 'pathologification' (the tendency to define ordinary, non-pathological bits of behaviour in terms of disease) comes from the wider psychological literature, and concerns reading difficulties particularly amongst children. It is well known that some people having specific and identifiable damage to parts of the central nervous system show accompanying perceptual and cognitive deficits, some of which take very striking forms. Some sufferers, for example, are unable to name everyday objects; others can identify everyday objects by feel with one hand, but not with the other; and others have perceptual problems when viewing certain types of figures, involving confusions with up-down orientation or lateral inversion. Such demonstrable deficits often have clear and indisputable implications for the reading and writing skills of the sufferer, and to the extent that this is the case the label 'dyslexia' is both diagnostically helpful and appropriate.
However, great importance is attached to the ability to read in modern societies, and it is hardly surprising that the label 'dyslexia' has come into everyday use as an explanation for why many children cannot read in a more general sense. It is interesting to examine more closely the way in which the definition of dyslexia has progressively broadened to take in more and more people with reading difficulties, including more and more individuals who do not show any signs of deficit other than difficulty with reading.
Dyslexia as Functional Explanation
Whilst there is argument about the precise mechanisms underlying dyslexia, the central notion is that sufferers from the condition fail to learn to read for reasons which are of constitutional origin. In other words, there is literally something wrong with the person, whether at the level of failure of normal development, stunted growth, specific brain dysfunction or whatever. Miles and Miles write (1983, p.2) 'that some kind of constitutional limitation is involved seems to us to be established beyond any reasonable doubt.'
This 'condition' notion of dyslexia is generally the most favoured amongst workers in this area, and several recent texts are available on the topic (e.g. Coltheart, Patterson and Marshall 1987; Quin and Macauslan 1988; Miles and Miles 1983 op cit).
In the present text, however, we are primarily concerned with the insights provided by attribution theory, a central feature of the argument being that functionality is a feature of the attribution process; that is, we prefer modes of explanation that serve purposes for us. Bearing this in mind, the reader's attention is now drawn to the opening paragraphs (pp2-3) in the Miles and Miles book (op cit) which can be interpreted entirely as explanation which is functional rather than veridical The authors write:'In our view the actual word dyslexia is unimportant, since a word of approximately equivalent meaning would do as well, such as 'specific learning disability'. What is important is the orientation—the particular view of the child's difficulties—which use of the word implies.
It is sometimes said that parents and child are discouraged or demoralized when they are told that the child is dyslexic. In our experience this is almost never the case, at least if the word is properly explained to them. On the contrary they are often very much relieved (sic- author), The reason seems to be that when one gives parents information about typical cases of dyslexia this makes sense of what would otherwise have seemed extremely bewildering…and if one can make it clear that the child is suffering from a recognised disability…this makes it much easier for them to give the appropriate kind of support. Similarly, if teachers can be told, not, 'Here is yet another backward reader,' but rather, 'Here is a child with a disability which requires special understanding, it will be possible for them to help the child in a constructive way'.The quoted paragraphs contain a number of frankly hair-raising ideas. First, there is the suggestion that teachers do not cope 'constructively' with backward readers, but only with those who suffer from a 'recognised disability', the reasoning behind which does not bear close examination. Is it the implication that backward readers do not deserve special understanding, whereas those 'suffering from' dyslexia do because 'it's not their fault'?
Furthermore, we see the actual word dyslexia has no special merit, other than that it cheers people up (they are 'very much relieved'), one of its major virtues being that it makes parents joyful to discover that their progeny's reading problems arise not due to childish indolence, lack of attention or interest or whatever, but because in some sense their child is defective or sick. Whilst this might help parents with their self-presentation problems in the short term, the effects of the label in the longer term remain a matter for speculation and concern.
Finally, just as treatment for alcohol and drug problems is conditional on acceptance of a 'sick' label, so it is apparently with reading difficulties. Better teaching, we are told, is only obtained in return for accepting the 'dyslexia' label. It remains simply to say that deals of this type are not necessarily beneficial in all cases, or in the long term.
All in all, Miles and Miles comments could not have been put better by an attribution theorist; and once again we see clearly how people prefer explanation in terms of mechanism when a high-value issue with moral overtones is involved. Failure to read is after all 'shameful', and any explanation offered has to address that problem and solve it.
When attribution theory works in this way, the bizarre situation arises in which the immediate family of the sufferer rejoices at the news of their loved one's infirmity.
Dyslexia: An Alternative View
In general terms, dyslexia refers to a situation in which a child of normal intelligence, (i.e. with normal performance on various other tasks, or even above-average performance) fails to learn to read. However, within the psychological literature there was at one time a heated debate about whether dyslexia referred to a specific identifiable state which is differentiated from mere reading difficulties; or whether in fact no such distinction exists. Some of these points were raised by Whittaker (1982) during a series of exchanges in the Bulletin of the British Psychological Society. Whittaker upset a number of people with statements like the following:
'It was with some dismay that I saw the announcement of one more international conference on causes, diagnosis and treatment of dyslexia…. The only justification for such a gathering would be if the aim were to reach agreement about abandoning the term dyslexia from all literature, medical and educational.'
And later,
'Dyslexia is a hoax in need of thorough exposure…. Dyslexia was and is a medical term without a sound scientific basis.'
Finally,
'It is hardly anything new that poor readers read with frequent fixations and regressive eye-movements, and previous research has firmly disclaimed such findings as decisive in the diagnosis of dyslexia. But in the 1980's in this country research grants are still going in the direction of efforts to prove the existence of the nebulous concept of dyslexia on such grounds'.
The debate still continues today, but perhaps in a less heated fashion.
Given these disagreements among the experts, it is permissible to entertain the argument that children fail to learn to do all sorts of things, and that the postulation of dyslexia in a specific case may have more to do with the societal value attached to reading than with the scientific defensibility of the definition. Failure to learn to read is symbolic in terms of social value in a way which goes far beyond failure, say, to make model aeroplanes or play hockey. Failure to read requires therefore to be explained in terms that make it easier to live with, and the main function of the dyslexia label is that it does exactly that.
It is a worthwhile exercise to consider the possible reasons why we have a medical condition called dyslexia; whereas there is no medical condition of 'velocoplexia' (inability to ride a bike) despite the fact that a highly convincing case could be made out for the latter based on minimal vestibular dysfunction. The reason is that parents are less sensitive to their children's inability to ride a bike than to their inability to read. Consequently, if dyslexia did not exist, it would be necessary to invent it; which is exactly what has happened according to Whittaker.
Returning now to the areas of 'addiction', 'alcoholism' and 'compulsive gambling' we can see that, regardless of whether disease explanations fit the facts or not, there are reasons supporting the use of these concepts which derive directly from societal values which are second nature, and which are rigorously defended. A crucial facet of 'addiction' which influences treatment offered, outcome success, and all aspects of the substance-abuse system, as well as the nature of the individual cognitions of sufferers, is that it involves behaviour which in terms of conventional societal values needs to be explained as malfunction. It would therefore involve the notion of guilt, for which punishment rather than treatment is generally felt to be appropriate; or worse imply that using drugs was a reasonable adaptation to the world in which we live, should an explanation be offered in terms of personal responsibility or voluntary action.
Addiction is thus driven by a moral, rather than a scientific, consensus. In the absence of such a moral consensus a particular kind of behaviour could not have attributed to it the features that are said to characterise, and that we require from, our addictions. And though people would still encounter the same problems deriving from what Orford (1985 op cit) terms their 'excessive appetites', there would be no such thing as 'addiction' per se.Chapter 11