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I have the honor of personally meeting one of the most eminent Mexican psychoanalysts, Dr. Emilio Rivaud, with whom I attended therapy for years and am now in a relationship of friendship. From my sessions with him, I remember one day when, being especially anxious, I asked him if he could give me “my diagnosis.” Emilio was blunt: “Why do you want a diagnosis? Do you want a middle name in addition to the one you already have?” The answer shook me: Andrés Bipolar Barrios? Obsessive Garcia? Andrésdepressive G.B… ?
Can a diagnosis adhere to one’s personality as well as the name that identifies and frames us immediately? If this sounds exaggerated, consider remembering all those children and young people who walk around in their schools, parties, and almost wherever they visit, introducing themselves thus: “Hello, I am so-and-so, and I have ADHD” (Attention Deficit Hyperactivity Disorder), as if the reduction to a scientific category were intrinsic.
The following reflections are just some coordinates I draw to understand the serious problem behind this phenomenon. Let me make a slight digression and cite a couple of cases that will help me explain. Something that might sound similar, but in no way is, is the current practice of people who present themselves to others identifying as members of the LGBT community: “I am Armando, and I am gay,” “My name is Dolores, and I am non-binary.” We have all heard it. To some of us, it sounds weird, hasty at best, defensive, and aggressive at worst. However, it is essential to point out how, in these cases, such a characterization is necessary and legitimate in our days and serves those who use it (usually victims of discrimination) not only to dignify themselves but to advise the interlocutor. Several things, to me, seem all positive: their belonging to a group with a solid social presence, the pride that this makes them feel, and their absolute intolerance to any rejection towards them or towards people of the same group. However, it is also important to note that for the majority of its members, the condition of belonging to that group does not involve (not yet, fortunately) their entire personality, not like other groups. (A case familiar to us is some religious communities, which characterize their members definitively, sectarianizing them and separating them to a large extent from “the world.” Lesbian or transgender is not a proper name, a diagnosis, or the title of a sect (not yet, I insist; whether it becomes so will depend on the response we give as a society to the demand of that group crying out to be included without reservation).
Think of the wardrobe that many LGBT people wear both for pleasure and to distinguish themselves simultaneously to mark clear limits. Their wardrobe is still a choice, a practice to dignify an identity (I would use the word “fashion,” but Hegel, the German philosopher, warns us, “Stop calling ‘fashion’ the attempts of the human being to evolve”). Those heterodox locker rooms that are beginning to be seen more and more in the corridors of schools and many other places, fortunately, are not (yet, I say it for the third time) a “uniform,” an institutionalized attire like religious garments (or military, which is another excellent example).
Returning now to children who call themselves ADHD, they do not dignify themselves by giving themselves that name; they point to themselves as victims of a supposed “disease,” which unfortunately is nothing but their personality (in some way, their own nature) seen from the outside: marked, usually stigmatized, and finally identified with a name (a name they assign to themselves).
The same happens, unfortunately, with the increasing number of children and young people who begin to identify themselves as members of the Autism Spectrum to the extent that they present themselves as such to others. Sadly, that difference they so well recognize does not include the possibility of forming a community with their peers. Many, as we know, isolate; others strive to belong to the environment, understanding that if it does not accept them as equals, it considers them different, disruptive, and disconcerting. Unfortunately, they do end up constituting one of those groups that wear a special uniform because, as they do not find an external outfit to stand out, they uniform themselves in the way their diagnoses establish. That is, they wear as actual garments their descriptors “hyperactive,” “excitable,” impulsive,” “irritable,” “aggressive,” “careless,” and “distracted,” and display a bored, anxious, angry, depressed mood, and many “etceteras” that dictate the labels.
I do not want to fall into the error of saying that before the diagnoses existed, we did not call children who behaved like these little ones “Asperger’s,” “attention deficit,” or “hyperactive;” instead, we called them “restless,” “rude,” “troublemaker,” “shy,” “forgetful,” and other picturesque names. The diagnoses, and the pro-scientific culture to which they belong, have undoubtedly undergone tremendous advances, helping, for example, to stop cutting all people with the same scissors and to start attending to children according to their individual needs (which can be enormously varied, as we well know).
What I disagree with is what some UNAM experts call “the pathologizing of everyday life,” which is nothing more than transferring scientific categories to everyday life. My memories tell me that part of the responsibility for this was the previous boom that also gave enormous diffusion to certain psychological and psychiatric theories and allowed us to refer to others with beautiful phrases like, “You are neurotic,” “He is hysterical,” “You are psychotic,” or others like “Your subconscious gave you away,” and similar things. No way! This is the creation of culture and the appropriation of language (after all, this is nothing but a reflection of the “scientification” of the current world and the appropriation that the scientific mentality makes of almost everything that happens).
I will risk repeating here that caricature of science as a religion and the scientific community as a genuine clergy. This caricature shows that at the top of the hierarchy are the great theologians of the pure sciences (physical and chemical); they are followed by those who deal with earthly matters (biologists, geologists); then come those who, without leaving the laboratory, attend to the human (physiologists, neuroscientists); and finally, the broad clergy that does have contact with the flock (doctors, psychologists, psychiatrists). The uniform of all these (from the purest to the most mundane) is the white coat, which in the case of the ordinary clergy who serve the population, clearly endows them with a beatific aura but also with the necessary distance for their scientific role. (The reader will agree that an essential ingredient of the success of that wonderful character of the series Dr. House was that he refused to wear the gown, exhibiting an attitude of treating patients like any other person, in his case, with a self-confidence that seemed cruel to many).
It is impossible to understand how members of the medical profession would do their jobs if they could not place their patients in specific categories of physical and mental health or give them care according to defined protocols. Treating each patient as an integral and unique human being, as the new humanist vision demands, seems to me that, for the moment, it is only an ideal. (My father, who was a doctor, often repeated that saying that those of his profession had chosen to be doctors because they had not been able to become saints). Certainly, each professional can approach that ideal, more or less, according to the time and resources they have, but medical action, for now, requires mediating categories that allow standardizing treatments. However, this does not mean that the patients should be reduced entirely to these categories, much less that they should appropriate them to enclose their whole being. Serious attempts begin to speak of “people living with diabetes,” “with hypertension,” or “with cancer,” especially so that people stop identifying with their disease and can either leave it behind or take it as one more of their personal characteristics (one that, like others, they must attend to).
Likewise, people do not have to identify with their “mental diagnoses,” either. In fact, these have the aggravating factor that they appropriate not only the body (as physical diagnoses do) but the entire personality. They tend to mark the whole individual with an inescapable seal, a persecuting reminder that dictates their physical, mental, and social development, sometimes forever.
Regarding schools, in these, the diagnoses provide the psychology department with definitive parameters to serve students. However, no one else needs to know them, neither the teachers, the classmates, nor the student himself: there should be no discriminatory category among those present in the classroom.
And as for families, I suggest being clear that getting a diagnosis for their children is a double-edged sword. For many parents – those who, due to their burden of responsibility in other areas (work, home, other children), cannot give special attention to hardly anyone, not even themselves – a diagnosis can be a kind of blessing insofar as it allows others to give their diagnosed child some of the careful attention required. (Of course, psychologists must take care that the fatigue of parents and teachers is not the real reason a child* is labeled “hyperactive:”). Let’s start by noting that any diagnosis is a standardization. In the case of some children, it can be a laudable goal, like a list of values to be achieved. (Unfortunately, a diagnosis can keep the young person out of some schools, which will argue that they are not trained to attend to them. But when a school accepts such a child, the standard can result in them being given some due care, or at least their differences are respected.)
However, for families with the conditions to give each of their children the care they require, the diagnosis/standard can be ultimately counterproductive, pressuring them to reduce the child to a category that limits his life, while a treatment without labels could help the child flourish fully. Let’s look at it this way: if a fashion suddenly emerged that forced us all to go to the nutritionist to regulate our diet scientifically, this fashion could be beneficial for those who always eat poorly but not for those who are naturally accustomed to eating healthily.
I conclude by mentioning that these days I have learned that in the COVID-19 vaccination campaign, there is a particular registration item for children and adolescents with disabilities, which allows them and their families to avoid long queues, for example. I fully understand the risk of contagion that living with crowds poses for children who live with motor differences. I am also well aware of the mobility difficulties experienced by some people in wheelchairs, for example. However, I think it is important to alert parents whose children do not run risks or difficulties of this kind not to encourage their further stigmatization just to avoid annoying queues or waiting times; this continues to impose on them the great privilege of never being equal to the rest of the world.
*The reader may suppose that I, being a veteran of the world of letters, have a hard time applying the famous inclusive language; however, I confess that it begins to shock me deeply – especially when I talk about how delicate it is to put labels – to refer to girls and boys always in the masculine, as in this case, calling them “boys” (which inevitably makes me imagine, even for a moment, a group of pure men). In Spanish, there is no doubt that I am also tempted to use the e of “universal” gender: chiques, niñes, alumnes. How many readers would tolerate it? No doubt the words youths and adolescents are a blessing!
Translation by Daniel Wetta
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This article from Observatory of the Institute for the Future of Education may be shared under the terms of the license CC BY-NC-SA 4.0 
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