Diagnostics – multiple functions
As we know, diagnoses have several functions – some of them intended, others unintended. Their primary function is to provide guidelines for treatment. However, there is power associated with defining a health problem; it concerns the right to create certain images of reality and decide which problems belong to the areas of responsibility of medicine and health care. The notion of diagnoses as objective and indisputable categories and diagnostics as a neutral mapping has a solid foothold in many quarters – inside as well as outside the health services.
Similarly, there is a widespread tendency to let medical viewpoints overrule all other notions of «reality». With reference to, for example, the use of ADHD, the sociologist Andrew Abbott writes that it is based on the idea that subjective opinions have been replaced by objective definitions, as though these are not encompassed by subjective assessments (6). Thereby, suffering is relocated «from the social to the clinical arena» (7).
In retrospect, it appears as though the medical nomenclature, the very diagnostic act, in both cases served as affective attention deflectors. Since certain observable behaviours and verbally communicated experiences and afflictions had been given the status of symptoms, the children were categorised as «ill», i.e. as characterised by certain pathological conditions, and not as «injured» by something that had been inflicted on them by others. It is worth noting – and reflecting on – how the diagnoses and the basis on which they had been made were not referred to in the trials. In both of these children, behaviours and health afflictions were «read» into a medical interpretive framework and awarded meaning as symptoms. Thus, the diagnoses were given a kind of explanatory value that steered the attention of those concerned. Since it was assumed that the children suffered from a disorder, the fact that they had sustained injuries from violence and abuse was overlooked.
The diagnoses ADHD and Asperger’s syndrome are formed on the basis of symptoms and behaviour that may have been caused by a variety of conditions (8). The danger inherent in all diagnoses is to use them to explain various – occasionally all – aspects of a person’s behaviour or way of life (5). The high status of medical science, coupled with its claim to ultimate truth, may steer the attention of those concerned in certain directions and cause both professionals and laypeople to disregard their own experiences, observations and assessments. Moreover, the way in which afflictions are conceptualised will inform the patients’ self-conception.
A consequence of this could be that the patients themselves as well as those who encounter them are reluctant to trust their own experiences and assessments if these go against medical «truth». In a sense, the diagnoses seduce everybody, so that they see through what can be termed medical spectacles. or with what Michel Foucault, historian of ideas, has identified and described as «the medical gaze» (9).