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01 February 2012

The Medicalization of Nerdiness

The boundaries of the autism spectrum are likely to be redrawn soon. There is an interesting piece in the New York Times today that explains the personal implications of such diagnoses. Essentially, a young man recounts how he was misdiagnosed by his psychologist mother as having Asperger's. He writes:
Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome.

The definition should be narrowed. I don’t want a kid with mild autism to go untreated. But I don’t want a school psychologist to give a clumsy, lonely teenager a description of his mind that isn’t true.
Let me unpack this for a second.

First, autism is a great example of medicalization. In a previous post cross-posted at Sociological Images, several commenters demonstrated a misunderstanding about the concept of medicalization that I would like to rectify here. Medicalization is simply about the medical field, as an institution, appropriating (or at times creating) some behavior, identity, or condition as "medical"; it makes absolutely no claim as to whether such things belong in the medical realm. In fact, that is beside the point. Pregnancy and childbirth are good examples of medicalization. In the not-so-distant past, physicians had nothing to do with the birthing process. Babies were born in the home under the direction of female family members or, sometimes, professional midwives. Today, most women visit obstetricians and give birth in hospitals. Autism is a great example of this concept, too, because it is recent and still fluid. The term "autism" was first coined just 100 years ago. As noted in the piece I link to above, what exactly this term entails is still actively debated. While I believe that there is likely something biologically and social "real" underpinning this thing we call "autism," that is inconsequential; people who before would have been described as "withdrawn," "bookish," "odd," "nerd," etc. became the domain of the medical field. Medicalization.

Second, this is a great example of how the medical model on which psychology is build is problematic in its ignorance to stigma. As Benjamin Nugent suggests above, we are often preoccupied with allowing one with a treatable disorder to go untreated, what is called a Type II Error or a false-negative. This is indeed bad when dealing with things like heart disease or cancer, but it is different with psycho-social diagnoses like schizophrenia or autism. Heart disease, cancer, and other physical ailments don't usually come with much baggage, but psychiatric disorders like schizophrenia or autism carry stigmas that are difficult--and often impossible--to shed. Those diagnoses are sticky. Because of that, the Type I Error, or false-positive, is much more damaging. If one is treated for cancer but is in reality cancer-free, she will experience some short-term pain but will ultimately survive and be healthy. If one is treated for autism but in reality is just a "nerd," she will never live down the social stigma.

Recommended reading:
Rosenhan, David. 1973. "On Being Sane in Insane Places." Science 179:250-258.

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