 |
Volume 10, Number 1, August 1999 Commentary: Normal vs. Abnormal
Eleanor Stewart Muirhead, Speech Language Pathologist Susan James, RN, PhD Alice Dreger challenges us to re-examine the medical and social practices of fixing, eliminating, or preventing conditions that are considered to be abnormal. She opens with a somewhat tongue-in-cheek example that illustrates how we may be persuaded to view an individual or groups of individuals as abnormal because they have characteristics that do not conform with those of a standard or desired state. While some may consider the Double-X Syndrome to be a frivolous exaggeration, many scholars have commented on this positioning of woman as "other." Viewing a person or group as "other" is not an acknowledgment of the individual nature of each person. Rather, this view results when the focus is on sameness, on a generalized view of how one ought to be. The consequences of the position of Other are far-reaching. Lorraine Code (1991) reminds us that this view forces an oppositional relation. A focus on the outerness of people emphasizes and ultimately causes people to become "essentially opaque to one another" (p. 80). Christine Overall (1988) suggests that differences often become translated as "problems." Writers in disability studies also point to the social construction of bodies as Other (Davis, 1995; Oliver, 1996). They note that the construction of disability is a response to the "Fear, anxiety, and repulsion are psychologically based, socially conditioned responses that lay the foundation for the construction of despised bodies as a response to difference (Young, 1990)." - Eleanor Stewart Muirhead and Susan James dilemma of difference. Fear, anxiety, and repulsion are psychologically based, socially conditioned responses that lay the foundation for the construction of despised bodies as a response to difference (Young, 1990). A variety of culturally mediated images and narratives keep in check the positions held by the individuals or groups considered Other(s). Once cast as Others, people with disabilities experience varieties of interventions (i.e., social, educational, vocational, and medical) that are justified on the grounds of normalization. Like Dreger, disability writers, in critiquing the ableist hegemony, question the authority with which the hegemony seeks to perfect the human body through technologies and ideologies. In her essay, Dreger has people with intersexed bodies cast as "Others." She acknowledges this to be a social construction but does not suggest, except by contrast to the category woman, how this particular otherness came about. It is, therefore, useful to comment on the pursuit of normality by questioning origins of the category "Other." In tracing the linguistic development of the word "normal," we can expose the instability of the concept on which many interventions, including the surgical treatment of intersexuality, rest. The word has its English language origins in the seventeenth century when "normal" served to label the carpenter's tool, also called a perpendicular. Early meanings of the word were attached closely to measurement. Notions of measurement carried through to the nineteenth century in the sciences of chemistry and physics in terms such as "normal reaction" referring to the expected chemical reaction and "normal state" referring to the usual state. The turn in meaning in the mid-nineteenth century reflected a shift from measurement of external physical phenomena to measurement of the human body and its characteristics. Beginning in the 1840s, the word "normal" came to mean "constitutive, conforming to, not deviating or differing from the common type, regular or usual" (Oxford English Dictionary). But it is this use of "normal" in reference to the human body and its characteristics that has significance for the creation of the category of Other and the construction of deviance. Several important developments, including the use of "medical statistics" paralleling the shift in the meaning of "normal," occurred in the mid-nineteenth century. Medical statistics sought to ascribe numbers to bodily characteristics. Borrowing from error theory in astronomy, the French statistician Quetelet proposed that human characteristics, like height and weight, fall into a distribution and could be averaged to create l'homme moyen, the average man. The concept of the average man that emerged from statistical science can be contrasted with the classical philosophical aesthetic concept of the ideal body. The idea of normal was also given force by another mid-nineteenth century trend, the eugenics movement. Key figures in the eugenics movement were also keenly invested in the development of statistics. With the idea of normal, came the inevitable class of non-normal, non-average. The aim of eugenics was to improve humans so that deviations from the norm were diminished. Often with support of the new science of statistics, ?genicists found justification for their efforts to perfect the body through the elimination of nonstandard persons. Lennard Davis, in his book, Enforcing Normalcy: disability, deafness, and the body, noted with irony that in aiming to eliminate nonstandard persons, eugenicists violate the principle of the normal distribution, that is, that most fall outside, or deviate from the average. Evolutionary theory, another mid-nineteenth century trend, also provided an impetus for the new interpretation of "normal." The theory proposed the notion of natural selection whereby only those who adapted to their circumstances would survive. Normal equated with average. The desired body was not just aesthetic but one that embodied the physical and moral characteristics of the middle class male. Then the ideal body was replaced by the equally unattainable, though sought after norm. In the classical world, the ideal body was one that was constructed from ideal parts. It was the body of the gods ?ttainable for ordinary people. In the classical depiction of the body, we are all less than ideal (Davis, 1995). The notions of normal promoted by these trends created the imperative to perfect the human body. Assumptions were that the body was in fact "perfectible" and that if it were possible to measure all attributes of humans, the resulting data would conform to a normal distribution, the characteristic bell curve. While the category "normal" and its implied cognate "abnormal" dichotomize the subject, a tendency illustrated by other similarly dichotomized terms such as "able" and "disabled" and "male" and "female," the division is artificial. This artificiality can be exposed, as Lennard Davis offers, by destabilizing the term. For example, Davis demonstrates this by noting all the conditions of the body that are classified as disabling. He notes the fluidity inherent in the move from familiar disability categories such as blindness, paraplegia, and deafness to less familiar ones such as obesity, MS, and AIDS. At what point does "able" cross over to become "dis-able"? Are there conditions of the body that are exempt from potential pathologizing in this way? Susan Wendell supports the argument for destabilizing "normal" by noting that disability categories shift over time. With the ever-increasing pace of work in Western societies, Wendell suggests that new classes of disabled people will be created (eg., people affected by chronic illnesses such as chronic fatigue syndrome, arthritis, or heart conditions). Another interesting example of a bodily characteristic whose meaning has evolved over time is menstruation. At one time, menstrual blood was considered to be powerful magic, dangerous for men to see, touch, or even be near. Many religions and cultures developed strong menstrual taboos reflecting the fear surrounding this abnormal state of blood loss among women. In the Book of Revelation in the Bible, this blood is described as the product of women's destruction or murder of saints, prophets, and martyrs (Brooke, 1995). In the middle ages, approximately 9 million women were murdered as witches, many because of the "magic" of blood loss in cycle with the phases of the moon. In modern times, menstrual taboos continue. In the media, women are reminded daily that they are not fresh and clean when they menstruate. They are offered menstrual products that will allow them to continue with "normal" life during their period of blood loss. Premenstrual syndrome has become an illness (a very lucrative one for the biomedical industry, by the way) suffered at least once a month by every woman. Dreger's choice of genital variation as an example of how normal-abnormal categorization may be harmful is another interesting illustration of the slippery nature of the concept "normal." Of all the possible external physical variations, this particular one is generally far from the eyes of the public. Unlike our immediate recognition of a person using a wheelchair or a seeing-eye dog, we would not recognize the man with the tiny penis or the woman with the enlarged clitoris as we walk through the mall. And yet, the medical science proposed (Dreger, 1998) is to "repair" these anomalies in early infancy. In this case, even the test of whether a condition will "work" or not is not considered. In early infancy, we have no idea whether the small penis will function or if the enlarged clitoris will become problematic. We only know that it does not "look right." And, perhaps because this is the part of the body most closely tied with the social construction of gender ? optics of maleness and femaleness ? variations make us uncomfortable. A man must look like a man! And a woman better not look like a man! Tied in with this obsession with the appearance of "normal" sexual parts is a strange suppression of sexuality. How can we open a discussion about whether or not variation of genitalia is "normal," when we have little ability to discuss the structure and function of genitalia beyond the walls of anatomy and physiology classes. Curiously, function, the touchstone for rehabilitation for people with disabilities, is not the focus of efforts to normalize the intersexed body. Instead, function is sacrificed to appearance from the point of view of the observer. What are the implications from feminists and disability writers for those who are the topic of Dreger's concern, people who are intersexed? To begin with, Dreger's example of the Double-X Syndrome is a fine illustration of the problems inherent in categorizing persons or characteristics as normal and abnormal. Over time, we have seen dramatic changes in the categorization of characteristics or groups of people as normal and abnormal. Sometimes the re-categorization is a result of a more complete understanding of a collection of characteristics. More often, re-categorization results from shifting social values. Re-categorization also affords the opportunity for interventions that support certain aims, including economic and social aims. In industrialized societies, the production of disabilities is tied to the massive human services industries (Albrecht, 1992).
The SolutionMenstruation is an interesting example of "normal/abnormal" dichotomy. Our understanding of physiology should categorize menstruation as a "normal" state, as opposed to the taboos which label the abnormal. And yet, perhaps because half the population has not even the potential to menstruate, it continues to be a pathology that requires repair. There are many examples of characteristics now considered "normal" those were at one time abnormal (e.g., red hair as a sign of a witch). Clearly, merely expanding the boundaries of "normal," as Dreger suggests, will not create any long-standing solution to how we ought to act in the face of individuals or characteristics that do not fit well with our values and beliefs about what is "normal." In a way, the instability of "normal" over time is precisely the process that Dreger suggests. Over time, there is a contraction and expansion of the boundaries of what is normal ?ther this comes with new technologies, new knowledge, economic potential, or a new cosmology. As long as there are boundaries delineating normal and abnormal, at some point, a person or a characteristic is defined as being abnormal and therefore, the person to whom this definition is attached is viewed as a problem that needs to be fixed. However, as we have discussed, we need to begin not with the expansion of the category "normal" as Dreger suggests. Rather, we should question the category itself. Locating the deviance in the individual body, as we do when we mark an individual or a group as Other, deflects the critical attention away from the social structures and practices that serve to perpetuate oppression. Dreger offers other solutions to the dilemma of difference posed by the intersexed body. She suggests that the received narrative of the intersexed body, the highly pathologized one that is presented in textbooks, be resisted and finally replaced with the narrative generated by the people who are intersexed. In this manner, people who are cast as Other reject the hegemonic dialogue. As demonstrated by feminists and gay rights activists, the groundwork of consciousness raising will succeed eventually in displacing the hegemonic dialogue and will facilitate the emergence of positive self-identities (Young, 1990). This is the strategy taken by disability activists who reject the tragedy principle and the individual adaptation model that guides intervention. Just as Dreger points out, it is an unproven assumption that any individual or group considered "Other" want to be changed to conform, that "disabled" people want to be like the "able-bodied." Normalizing technologies and ideologies can be and are rejected by disabled people as positive self-identities and groups of cultural identities emerge to unify against their categorization as abnormal. n
References
|
|
Search our resources
(Books, articles, videos)
Updated February 6, 2012
het10-01a