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Dealing with Difference:
Diagnostic Labels, the Hunter-Farmer Metaphor, and
Self-Referential Terms of Identity and Affiliationby Margi Nowak
As the mother of a now-grown and successful son who once had several diagnostic labels attached to him, I have mixed opinions about this way of identifying and marking "biopsychological differences." On the one hand, I see these powerful verbal symbols as being similar to chess pieces, necessary to know by name and function in order to plan the most advantageous strategies of advocacy and support. On the other hand, while we may all nod in agreement that "the label is not the person," it is still too easy for this confusion to take place anyway when the label happens to be part of a world constructed by the highly educated, multiply credentialed experts who refer with authority to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). For this reason I am always interested when critics of diagnostic labeling (especially parents) attempt to challenge the hold such medical labels have over us by trying to create alternative nomenclature for the conditions which the terms purportedly describe. In the community of people affected by Attention Deficit Disorder, for example, Thom Hartmann's "hunter-farmer" metaphor for ADD, (to be discussed in more detail below), represents just such an example of this kind of challenge. As someone who is also a cultural anthropologist, however, I view this particular metaphor through multiple lenses.
First, as a fellow parent who has also hated the negative power of those terms and labels we know only too well - ranging from cruel kid-generated epithets like "weirdo" and worse to socio-politically prompted DSM-IV diagnostic labels (with the recent example of "oppositional defiant disorder" being, in my opinion, a term constructed to express extreme frustration with unfathomably problematic behavior rather than any isolatable biopsychological condition) - I applaud Hartmann's intent to challenge the overwhelmingly negative connotations of these labels by trying to find a substitute term not based on the assumption that "difference" necessarily equals "deficiency."
On the other hand, as an anthropologist with more than a casual interest in human prehistory and the accurate depiction of past and present foraging and food-producing societies, I shudder when a well-intentioned attempt to defend a stigmatized population is based on a very simplistic, overly romanticized reading of human sociopolitical development. Despite what I believe to be Hartmann's good intentions, the naïve depictions of human prehistory presented in his "hunter-farmer" scenario (especially when the word "theory" is used instead of "metaphor") invite such strong overall criticism that the genuinely worthwhile message that inspired this metaphor ("different" brains can indeed make superior contributions to our world) is likely to missed by all those who notice only the anthropological inaccuracies. Furthermore, as a researcher in the field of disability studies, I react with extreme caution to contemporary claims that "things were better back then" for people with biopsychological differences (either because, eons ago, those differences were presumably valued rather than stigmatized, or because earlier societies are assumed to have been more tolerant than those of today). In some ways, for some types of "different" individuals, in some settings, at some particular times, such claims might indeed prove to be accurate, but blanket statements contrasting "then" and "now" will hardly stand up to serious scrutiny.
Finally, as a person deeply concerned about our global society's difficulty in accepting, let alone encouraging, any kinds of "challenging" differences, I would like to suggest that we listen to and learn from the discourse of adults with disabilities who are proceeding - quite independent of the medical establishment, and in many cases, online - to develop their own terminology and meanings for their self-chosen labels of identity. While it will never be the case that all people with negatively-perceived "differences" will agree on such terminology (any more than all people who have experienced prejudice based on race or gender will agree on terminology relevant to those dimensions of human experience), the discourse of these articulate pioneers is here before us, online and in recent print publications, for us all to read and consider.
The Limitations and Perils of Diagnostic LabelsLet us begin these considerations by reviewing what Hartmann himself identifies as the impetus for his adoption of the hunter-farmer metaphor: his concern for the negative self-fulfilling prophecies that typically follow when a child is given a diagnostic label for a condition which society regards as problematic. In an online interview with Janie Bowman (http://www.brightword.com/thom-hartmann.html), he explains that when his then-13 year old son was told by a psychologist that he had a "brain disorder", he (Hartmann the father) thought that this was "a pretty wretched label for any child to have to bear", so he sought a better metaphor to replace the negative connotations of the words "deficit" and "disorder". The phrase he came up with - which Hartmann calls "the hunter-farmer paradigm" - was thus intended to create, for his son and others similarly diagnosed, a less destructive way for them to see themselves, the world, and their place in it.
Leaving aside for now the adequacy of Hartmann's assumptions about the evolution of human subsistence patterns, it is important to point out that the challenge he has here posed to "received knowledge" (in this case, the "knowledge" held by doctors, psychologists, and other "credentialed experts" that a child's inability to focus attention "normally" is equivalent to a pathological condition) - hardly represents the first, let alone best, instance of critical examination of the way diagnostic labels work. In my anthropologically-oriented university course on Disability, for example, I have my students read Medicine, Rationality, and Experience: An Anthropological Perspective, a thought-provoking book by a medical anthropologist (Byron J. Good, a professor of medical anthropology at Harvard University, whose professional biography is nicely summarized as part of one of the projects of the Pain and Suffering Interdisciplinary Research Network at the University of British Columbia- http://www.english.ubc.ca/projects/pain/bgood.htm). In this work, Good argues that the language of medicine (and by extension, the language of any other specialized field of knowledge where "experts" dispense diagnostic labels) is hardly a simple mirror of some "real", dropped-down-from-the-sky-intact empirical world, but rather, such language is a rich cultural language, linked to a highly specialized version of reality and system of social relations.
What this means for the individuals affected by such labels - both medical professionals and the people they hope to heal - is not easy to summarize briefly (Good discusses ramifications that are not only medical in nature, but also moral, aesthetic, and philosophical). For our purposes, it may be most helpful to confine our observations to a subsection of Chapter Three, "How Medicine Constructs Its Objects", from his aforementioned book, wherein he describes certain components of the eight-week course that begins medical education at the Harvard Medical School. This entry into the world of medicine, according to Good, requires that medical students learn certain fundamental practices which will enable them to engage and define reality in a specifically "medical" way, involving specialized ways of "seeing", "writing", and "speaking".
From his penetrating description of the "other reality" of the anatomy lab, where students must learn how to "see and think anatomically", to his comments on medical students' mandatory learning of a huge and foreign vocabulary, which will enable them to construct a world altogether different from the commonsense world, to his analysis of the way in which "doing patient write-ups" confers authority on those students who learn to do this in a way that gains them approval from their superiors and evaluators, Good gives detailed anthropological attention to the multiple ways by which medical education authorizes certain clinical practices while it at the same time reproduces, generation after generation, the power relations in which they are embedded.
To bring the discussion back to diagnostic labels in general, and Hartmann's hunter-farmer metaphor in particular, it should now be clear that the phrase "attention deficit disorder" is indeed expressive of a particular way of seeing, defining, and speaking about "reality" (and it should certainly be pointed out that neither Good nor I intend to castigate as worthless the entire enterprise of the biomedical model he has just described). On the other hand, it should also be evident that this particular "medically sanctioned" way of seeing and talking about people who have difficulty prioritizing attention is not compatible with alternative ways of perceiving and representing such people. Words like "deficit" and "disorder" imply pathology; pathology, for medical practitioners, implies some sort of challenge or obstacle to treat and cure; and nowhere in this mix of words, assumptions, and authorizing institutions is there likely to be much if any support for seeing, defining, or talking about these people as being "gifted" or "perfect the way they are".
While Thom Hartmann may have come very close to the opposite extreme of the "deficit/pathology" model - which would involve romanticizing biopsychological differences as if there were all "gifts", or as if they existed in a social vacuum, as "simply differences" and nothing more - it is still true that he is correct in his judgment that the diagnostic label "brain disorder" is "a pretty wretched label for any child to have to bear". Such labels - bestowed on people "in need" by people in relatively powerful social positions whose professional training mandates that, as professionals, they exclude alternative ways of thinking - are indeed fraught with limitations, for they take for granted a worldview where the word "abnormal" is not a neutral statistical term but rather a condemnatory judgment. In addition, such labels can engender perilous self-doubts in the people to whom they are applied.
What's Wrong with the Hunter-Farmer Metaphor?If Hartmann is thus correct in his assessment of the potential negative impact of certain diagnostic labels on self-esteem and positive self-identify, why should anthropological inaccuracies matter that much when what he is talking about, after all, is (merely) a metaphor? And, what are these inaccuracies anyway?
To begin with the second question, Thom Hartmann himself, in a 1997 interview with Dr. Peter Jaksa, President of the National Attention Deficit Disorder Association (reprinted online at http://www.add.org/content/interview/thom.htm), has stated the following:
When agriculture started around 8,000 years ago, the agriculturists (farmers) began to systematically wipe out the hunter/gatherers. It went from 100% Hunters to today where it's about 2% of the world's population. The Farmers took over. And they instituted social structures and ways of working which suited their particular adaptive ("defective?" <G>) neurology. So the modern office/factory/school world is just a fine place, thank you very much, for the Attention Surplus Disorder people, but can be a cruel place for a Hunter. Those "assets" become liabilities very quickly, and the strengths which the Farmers value are often unavailable to Hunters.
He amplifies this argument - expressed in far more detail in his book ADD; A Different Perception - in chart form on his own website (http://www.mythical.net/hunterfarmer.shtml), where he contrasts a column of "traits" (similar to DSM-IV diagnostic criteria for ADD such as "acts without considering consequences"), first, with a column of corresponding interpretations of how the same trait could be seen positively in a society of "hunters" (such as "willing and able to take risks and face danger") and finally, with a column of opposite "farmer" traits (such as "careful, "looking before you leap").
In both cases, however, the effort to give social approval to people stigmatized with a disorder depends heavily on wildly out-of-context generalizations about modes of subsistence, "types" of behavior patterns, and how these interrelate and are judged in two supposedly opposed types of societies, and the entire argument itself is based on a very faulty assumption, namely, that "farmers systematically wiped out" or "took over" the "hunters". Anthropological observation might indeed support bits and pieces of Hartmann's overall argument about the "non-fit" of stimulus-seeking people in a corporate culture that rewards the ability to focus even when bored, but his support for this argument involves numerous factual and interpretative errors that beg to be corrected.
First, the very term "hunters" as a label for pre-agricultural societies is not entirely accurate, for the first human groups provided themselves and their dependents with food by means of the more general activity of foraging (gathering wild edible plants, scavenging the kills of other animals, as well as engaging in deliberately planned hunting and fishing expeditions, with the last-mentioned activity probably contributing the least dependable supply of daily caloric intake for the vast majority of human societies situated in sub-Arctic regions). Furthermore, the foragers' success or failure in all of these activities would depend directly on individuals' intimate, detailed knowledge of their environment, and this carefully acquired learning would then be transmitted to the young generation by those more experienced and proficient ("pay attention, kids, while I tell you how to work together to stampede this herd over the cliff!"), and while the ability to act quickly and resolutely would certainly be rewarded in some circumstances, so too would the ability to walk long distances without complaining or lie still and wait quietly at the waterhole for hours. In other words, every one of the "ADD traits" that Hartmann would like to make an asset in a "hunter's" world could easily be reinterpreted as a social liability among foraging people, depending, of course, on the particular context. (Furthermore, anthropologists who study contemporary urban work situations can easily provide counterexamples of how the so-called "farmer" traits that Hartmann identifies as assets in today's world - such as "not easily distracted from the task at hand" and "team player" - could actually be dysfunctional in certain circumstances for the individual so endowed.)
As for the underlying assumption of how "the modern world came to be" in this scenario, even though Hartmann does not blame the "farmers" for deliberately or maliciously "killing off" the "hunters", he does more than hint that they "engineered" things so that "the farmers'' (or, presumably, their latter-day office-manager descendants) would henceforth make the rules. But at what cost to truth? The origin myth Hartmann suggests for modern conformist society simplistically telescopes millennia of socio-political-economic developments without recognizing all the complex forks in the road where individuals and groups could, and did, backtrack, change course, and otherwise bring their technology, knowledge, and sociopolitical organization to bear on their natural and social environment in multitudinous ways. From the invention of agriculture (which made it advantageous for people to construct and live in permanent dwellings, waiting for the now much more predictable harvest to ripen), to the invention of storage facilities for surpluses (making possible a more permanent, ultimately heritable differentiation between "haves" and "have nots"), to the creation of cities (giving rise to a specialized and differentiated labor force), through the developments of feudalism, mercantilism, capitalism . . . up to the present-day global multinational corporate environment that is home to Dilbert and company - it is hardly the case that "the farmers" pulled off a one-sided evolutionary triumph over the "hunters"!
Furthermore, looking at the other side of Hartmann's equation - the hunters-losers - here too his grasp of sociopolitical evolution is woefully inadequate. For one hundred years, anthropologists have been documenting the tragic destruction of indigenous societies, many of which did indeed depend on hunting for their members' subsistence needs. And yes, it is also true that today's global population of indigenous peoples has been reduced to an alarmingly low percentage of the total world population (exact figures are impossible to acquire, since there is no one standard definition of who or which groups are included under the rubric "indigenous people"). But all evidence for the causes of this genocide (deliberate physical extinction) and ethnocide (forced suppression of a traditional culture) points, not to "farmers" as the source of indigenous peoples' tragic fate, but rather to the much more impersonal forces of colonialism, post-colonial multinational profit-making, (which prioritizes short-term economic gain over long-term socio-environmental consequences), and an intolerance for any diversity that might challenge the power relations of the status quo.
Accepting and Encouraging Diversity in an Intolerant World
Is there any way that Hartmann's worthy intent - providing a more positive self-understanding for children and adults diagnosed with conditions such as ADD - could inspire a more historically accurate and intellectually honest way of challenging the medicalized labels related to learning disabilities? Can we perhaps learn from the struggles of other groups in society who have also had to contend with terms of reference loaded with negative self-fulfilling prophecies, stereotypes, and prejudice?
To begin with the second question, consider the well-intentioned but horribly truth-distorting attempts made by some black activist groups three decades ago to give African-American children a positive self-image and history: "You are all descended from kings and queens! (And then your African ancestors were overtaken by jealous Europeans)." Creating simplistically false "origin myths" to explain why a particular group suffers more than society's "normal" types does no service to the individuals in such a group. In fact, encouraging such people to believe romanticized pseudo-histories not only promotes a cruel form of self-deception, but it can also threaten to invalidate these individuals' deeply personal thoughts, insights, and feelings ("quick-witted hunter or not, it is much more difficult for me to make and keep friends, and I really don't see how this is the farmers' fault").
An alternative to this invention of some ancient conspiracy against one's ancestors by the ancestors of today's group-in-power can be seen in the ongoing discourse of the articulate, independent-minded adults with disabilities who are now writing their own collective social histories - with narrative passion, respect for historical and social ambiguity (the "good guys" and the "bad guys" are not always easy to keep separate), and often, wry humor as well. Online periodicals and websites such as Ragged Edge Magazine (http://www.ragged-edge-mag.com/), Disability Social History Project (http://www.disabilityhistory.org/dshp.html), the New Paradigm of Disability Bibliography (http://www.aboutdisability.com/bib.html), and, the "multi-tentacled" Disability Studies Web Ring Home Page (http://www.escape.ca/~ccds/webring.html) together point to hundreds of "insider-authored" resources that do indeed challenge disability prejudice without resorting to the use of false origin myths to bolster self-esteem.
Some of these works and writings are purely personal, others, intended as academic treatises, are supported by impeccable scholarship, and many, such as the cartoons of John Callahan and Leeder O. Men, are designed by their creators to give a deliberate shock to those who would pity or patronize the "brave disabled". As should be expected, there is no uniform agreement among these sources as to what the "best" or most politically correct, or least harmful terminology is, or ought to be. As a matter of fact, many activist-writers deliberately employ the same device which some gay and African-American activists have used to "reclaim" referential labels once used against them with disparaging and scornful intent. Thus, persons from outside the disability community may well be scandalized to hear people with motor impairments calling themselves "gimps" or "crips", just as non-homophobic straight people were initially shocked to hear gay people proudly proclaim "We're queer and we're here."
If employing this type of discourse (seizing upon relevant negative labels and deliberately using them with defiant pride) is deemed, by parents of young children with learning disabilities, too raw, gritty, and liable to misinterpretation for these children to use themselves, there are certainly other, less "in-your-face" examples of alternative (i.e. non-DSM-IV) terms of self-reference to consider. A woman who has Asperger Syndrome has written an online article - "Thoughts on Finding Myself Differently Brained" (http://www.inlv.demon.nl/subm-brain.jane.eng.html) which appears on a website designed by and for adults with this and other autistic-spectrum conditions. In it, Jane Meyerding writes, "I'd like to write a book about a world where being Asperger is the norm. How odd others would seem. The 'others' are sublimely unaware of their own oddities, as seen by AS eyes, but quick to detect the odd in us." Her phrase - "differently brained" ("differently wired" also occurs in this type of "insider-generated" discourse) - offers an alternative label for scores of conditions described in the DSM-IV without dragging along the whole baggage of pathology and deficiency, and her article also raises thought-provoking questions about who defines and enforces the definition of "normalcy".
But appropriating the tactics of self-definition and disability activism used by people who proudly "own" their disabilities may give rise to some personally disturbing questions involving the relationship between the socially "marked" disability community and those who can sometimes "pass"' as non-disabled. For most people who themselves (or whose children) appear physically "normal", whose disabilities are invisible, and who may even be able to be seen as "superior" in certain contexts, "claiming" or "proudly owning" their disability is a far different matter than would be the case for someone who is obviously physically "different". Furthermore, would a superbly coordinated, gifted athlete who has ADD or dyslexia even be accepted as "disabled" by a militant group of disability activists whose passionate concern is to fight tooth and nail against the involuntary placement in nursing homes of bright, capable, but motor-impaired people who happen to need personal assistants to live, work, and pay taxes independently? Or, are the differences between these two types of disabilities too great, the competition for scarce resources (such as appropriate education and services) too intense, for any sense of fellowship to develop here? Can either group - the "obviously" as well as the "invisibly" disabled and their respective constituencies - find any commonality, solidarity, and reason to fight prejudice together with the other?
There are no easy answers for these questions. On the other hand, there are indeed principles of social justice and respect that should prompt us to look ever deeper at our first, gut-level responses to such challenges to our comfort zone of affiliation.
For every one of us who has ever cringed, or seethed, or cried, or agonized over the cruel treatment of a child with a disability, invisible or not, the experience was probably followed up by a wish, or curse, or prayer: "Why can't the world be more tolerant of differences?!" (Ironically, the very same sentiment is still, to this very day, on the lips of indigenous people who see their fragile cultures clinging to life like some endangered rainforest species of plant or animal.) The larger issue in both cases, however is that legally mandated, grudgingly granted "tolerance" (i.e. having "those" children in my child's class; allowing "those" people to continue to speak their non-national language in my country) is not at all the same thing as a genuinely enthusiastic encouragement of diversity. This, alas, is a lesson the world refuses to learn. But while you and I cannot change "the world", we can indeed make some headway with some of the people close to us.
Let us begin by teaching our children to see and find genuine commonality and solidarity with others, especially those who are highly unlikely to be regarded by corporate culture or the media as "smart", "beautiful", and "successful". Let us do this without expecting to be congratulated or even necessarily welcomed at first by groups that have faced even more prejudice than we (and our beloved children) have. And let us do this without inventing origin myths that sacrifice anthropological and historical accuracy in an ultimately self-deceptive attempt to romanticize rather than deal squarely with not just the advantages, but also the pain, of being different.
Margi Nowak is a cultural anthropologist and author of several works on "liminal" types of people in society (e.g. refugees and persons with disabilities). These include Tibetan Refugees: Youth and the New Generation of Meaning, published by Rutgers University Press, and "Powered by Modem: New Challenges to Old Hierarchies in Special Education", published in the Review of Education/Pedagogy/Cultural Studies, Vol. 20, No 1. Dr. Nowak also served as the founding editor of Connections, the newsletter of the Washington State Tourette Syndrome Association. You can contact Margi Nowak at mnowak@harbornet.com.
Other articles by Margi Nowak on our website:
Pain, Waste, and the Hope for a Better Future... "Invisible Disabilities" in the Educational System
This information is provided by OSPI and New Horizons for Learning,
funded by a development grant from the Discuren Charitable Foundation.Office of State Superintendent of Public Instruction
Special Education
P O Box 47200
Olympia, WA 98504-7200
(360) 753-6733
E-mail: dgill@ospi.wednet.edu
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