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a/typical – towards an inclusive society
Author: Kasia Modlińska
21.06.2021

When we think of atypicality, most of us tend to associate this concept with the Atypical series on Netflix about an exceptional boy on an autism spectrum. The term, however, covers a much larger group of people. Atypical persons are those with some unique characteristics. They are different, peculiar, and rare. However, when we think of atypicality in the context of illness and mental health, we often overlook the social dimension of the concept. Meanwhile the word itself and what it stands for have not only been coined by society but are continuously re-created. Thus the definition of atypicality is subject to ongoing semantic changes and refers to ever new phenomena which result from changing attitudes towards a variety of behaviours, features, and conditions.

In the dominant, that is medical, sense, atypicality means that something is outside the norm. It is put within frames of specific diagnostic categories. Theoretically speaking, these categories are supposed to be a scientific and objective representation of processes which take place in people. Then, quite soon a question comes to mind as to what extent this is the case and what important things we might be overlooking.

Thanks to psychiatry, we do know some biological processes which underlie mental disorders and illnesses. We also have medicines at our disposal, often quite effective ones. Selective serotonin reuptake inhibitors help to treat depression. Lithium salts effectively reduce severe mood swings in bipolar disorder. Neuroleptics reduce productive symptoms in psychotic episodes. Methylphenidate may reduce the need for stimulation in people diagnosed with ADHD. Despite all this, we still have not managed to fully grasp the mechanisms behind the effectiveness of the medications. And at the same time, there are persons who just cannot be helped by any medicines. They, as well as their mental states, are drug-resistant.

DSM-5, which is the American diagnostic classification, lists approximately 157 officially recognized mental disorders and illnesses. In the ICD-11 international classification, which is also used in Europe, there are slightly less of them. However, in both classifications their number is significantly higher than in the previous editions. This fact divides the psychiatric community and has given rise to a serious dispute over the rationale of introducing further categories. There is a loud voice coming from psychiatrists themselves that it is medicalization of ordinary life, meaning that non-medical problems are defined in medical terms, and that treatments are prescribed. The new diagnostic classification has been also accused of leading to pathologisation – that is a process whereby ordinary shyness becomes social phobia, introversion becomes schizoid personality disorder, activity becomes attention deficit hyperactivity disorder, and sadness becomes depression.

In the latest editions of the DSM and ICD, one can clearly notice the social underpinning of the diagnoses. Most often, the financial side is talked about as it is in the interest of the pharmaceutical industry to increase the number of behaviours described as pathological. At the same time, more and more attention is drawn to the cultural context, as diagnostic categories do not reflect mental processes as is arbitrarily assumed by the medical model. New disorders and diseases reflect the dominant system of values. We prefer to think of ourselves as being free from prejudice and able to describe reality as it is, but historically this was different in different times. It is a well‑known fact that in the first DSM classification (published in 1952), homosexuality was classified as a sociopathic personality disorder and that in the DSM-2 (published in 1968), as a sexual deviation. In subsequent editions, the “disorder” was removed. As is well known, homosexuality is at odds with the strongly held Christian ideal of a loving relationship which is prevalent in our culture.

Homosexuality is not the only diagnostic category which features no longer in DSM and ICD due to the cultural context. It is worth reflecting on other diagnostic units which are now used on a daily basis by professionals, and how they relate to views and prejudices taken for granted. One can easily notice some obvious contradictions here. For example, dyslexia violates the belief that everyone should be able to write and read flawlessly; autism violates the belief that everyone should be sociable; depression that everyone should be happy; and psychoticism that everyone should be rational. Perceptions of the characteristics which make up these diagnoses have been different in different historical periods and cultures. Climate activist Greta Thunberg said about herself, “I have been diagnosed with Asperger’s syndrome, OCD, and selective mutism. Basically, this means that I speak only when I think it is necessary. Now, is such a time”.

When we raise the issue of social factors influencing perception of mental disorders and illnesses, we often hear in response that this leads to relativism and, consequently, to conclusion that everyone is healthy. If we were to adopt a zero-sum approach, this might be the case. And then of course we might also assume that the opposite was true. But different perspectives – e.g. medical and social – can complement each other, and in such a case the perspective becomes more multidimensional.

Why is it important to include the social context? Because it makes it so much easier to understand that society plays an active role in creating or reinforcing what we consider pathological. These processes can have different forms and can be coming from a range of sources. Sometimes these are very subtle behaviours, like rolling one’s eyes, giving an ironic smile or offering a comment (often in the third person), such as “why does he/she keep silent?”, “why is he/she so sad?”, “what is he/she so happy about?”. They indicate that the person is outside the norm. But these can also be specific systemic solutions, which result in serious consequences. For example, they may lead to expulsion from school for “inappropriate’ behaviour”, or result in diminishing one’s job opportunities because of discomfort felt at personal recruitment interviews, or not being granted the right to adopt a child because of a depressive episode which an adoptive would-be parent has had. As a result of such incidents, people tend to identify themselves with messages which they hear about themselves. Persons who are otherwise functional and productive may start feeling that they are deficient, not worth too much, or even that, as “others”, they do not deserve to be part of the group.

Every good psychotherapist knows that creating a safe and accepting atmosphere in therapy exerts a healing effect on patients. Often, people who at first seem ill, in non-threatening conditions show themselves from a different side, become lively, creative, smart, empathetic and understanding. It is often only in such moments that they discover their potential and begin to believe that they can become what they want to be. Every good therapist is also aware that a successful therapeutic process helps her, too, as it lets her understand herself better and take satisfaction from being able to give something good to others.

The same applies to society. Separating the privileged social groups from the marginalised ones impoverishes both sides. Isolating others because of their irrational, antisocial or oversensitive behaviour prevents us from giving ourselves an opportunity of gaining a better understanding of both others and ourselves. An education system which segregates children on the basis of their different psychological profiles prevents them from learning from one another and from building tolerance for the diversity, of which they are a part. Unified workplaces and recruitment processes prevent employers from tapping into atypical resources of people who might have a significant impact on the development of their companies. Architectural solutions which have been designed without having in mind people with above-average sensitivities, often prove uncomfortable also for those who are not that sensitive.

Integrating different aspects of mental life is an important determinant of a successful therapeutic process. Likewise, the social system could also be designed to include the most diverse group of persons possible. For this to happen, however, we should begin to see individual differences not through the lens of deficits, but as differentiated and complementary qualities and attributes. This process has been ongoing for some time now in the context of such categories of social diversity as gender, race, sexuality, or religion. Another category which is no less important is psychological diversity, or neurodiversity. Harvey Blume, who has popularised this concept, wrote: “neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general”. This message guides the work of the a/typowi Foundation.

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