Lecture 1: medicalization vs normalization & the community psychology perspective
Contradictory paradigms in the field
- Orthopedagogy: science of the problematic child raising situations
- YES: from pedagogy focused on the ‘clinical’ to a critical, interdisciplinary and
collective/communal approach
o Goal of the course: thinking paradigmatically
Paradigm
Paradigms: theoretical perspectives (lens), a set of coherent ideas or a philosophy that helps us
to understand a phenomenon, or a field and informs professional actions in it
o Paradigms based on a natural science perspective (Kuhn): No linear progression
but also based on consensus, scientific revolutions, new insights by the scientific
community. Paradigms can be incommensurable (but need not always be).
o Consensus: people think in a certain way
o Paradigms based on a social science perspective (Latour): no linear progression
but paradigms are also political: Total objectivity is an illusion.The production of
knowledge cannot be separated from politics (and thus from the notion of multiple
interests and perspectives), but complete relativism should also be avoided.
- Consequences of the political and non-linear nature of the development of scientific
knowledge in social sciences
o Multiple different paradigms operate next to each other
o Paradigms have important consequences for practice
- Paradigms thus are never exclusively based on scientific knowledge or scientific
perspectives, they often are developed in interaction with particular normative positions
in the society.
What could be the relevance of knowing from which paradigm a scientist makes her/his point, or
an intervention, a policy is designed?
- Multiple ways of thinking compare multiple thinks
- Able to shift
- Good to think through what the consequences are
Context: normalization vs medicalization
In the public debate: ‘longer waiting times for youth help’ = not: more children suffer from a bad
condition
- Scientific research: youth well-being and labeling
- Medicalization
o Could be related to overprotection and individualization/professionalization
protect a child from being ill/circumstances: individual child and professional
involved
- Overprotection
- Individualization/professionalization
Medicalization
Medicalization: the process by which previously nonmedical problems become defined and
treated as medical problems, usually as diseases or disorders (E.g. ADHD, alcoholism,
addiction, eating disorders were not medical problems in the past)
- Advantages: people get some rest from stress that causes their problems
- Disadvantage: step out of their old life, label has consequences
, - ‘Medicalized categories are elastic and can expand or contract’ (ADHD, PTSD, hysteria):
(ADHD: formally mostly boys, now also girls, formerly focused on aggression; now
expanses to concentration problems)
- Medical categories change over time (hysteria; associated with women, diagnosis has
disappeared)
- Medicalization exists next to de-medicalization (e.g. homosexuality)
What drives medicalization
- Not always a psychical biological base: describe behavior
- The medical profession: changing diagnosis, drive labeling
- Biotechnology (the pharmaceutical industry, genetics, and forms of medical technology):
invent a new medicine
- Care system: consumers, and managed care (including all kinds of health insurance)
Medicalization: a cultural response of our time?
- Is medicalization part of a/our culture?
- Is being traumatized not a ‘normal reaction to a traumatizing world?
- Why do we declare the person ill, and not the system?: blame the individual without
doing the analyses why this is happening (bigger picture)
- Dirk de Wachter: Dirk de Wachter: Our times are defined by psychiatric diseases and
vice versa. Psychiatry is the mirror of the world we live in. It is based on our cultural
norms on happiness
Medicalization: not only a phenomenon of our times
- Johann Wolfgang von Goethe (1787): Speaking for myself, I too believe that humanity
will win in the long run; I am only afraid that at the same time the world will have turned
into one huge hospital where everyone is everybody else's humane nurse.
o ‘real troubles’ are made into individual diseases
On madness, normality and ‘the norm’
- Paul Verhaeghe: We pathologize behaviours because they go against the norm (we want
to concentrate and sit still; do not accept aggression and concentration problems):
normal is the mirror of abnormal
- Verhaeghe: After Foucault: The discourse of normality (the good child) defines how we
see the deviant/ill child.
o It is a misconception that the diagnostics according to the DSM 5 is based on
scientific evidence, it reflects basically our norms on normality, and the practice
associated with it.
o What is normal is context and time dependent
Opposite paradigm of medicalization
- De-medicalization or normalization
- Community psychology approach: instead of having a problem solved by professionals
you can also make use of the community (stronger community)
De-medicalization: example of the dutch youth law (2015)
- Increase prevention, own responsibility of citizens, normal parenting
- Decrease: specialized care make communities stringer
, A ‘remedy’ to overmedicalization: the educative civil society (de winter chapter 4)
- Increasing demand for youth care/youth welfare despite that prevalence of problems is
stable)
- Re establishing authority to the parent & civil society & parent communities
Community psychology as opposite of medicalization
- Community-ecological approaches
o Human competencies are best viewed/understood/fostered in their social etc
contexts
o Active collaboration between all levels of the community is required
o Empowerment (strength, competencies, resources of the community are
stressed); instead of making individuals stronger, make the individual stronger
o Prevention, not therapy
Take home message & discussion
- No universal self-evident way to look at the care for children. Care is organized according
to different paradigms.
- Medicalization and normalization are opposite tendencies and depend on the norms of a
particular society (none of these are inherently bad)
- Deviant child the normal, the good, successful child: how we see a deviant child has
everything to do with what we think about the good child
- What is the deviant/normal child is time and context specific: norms are strong (not
everything goes) and are the drivers of medicalization
- It is important to study these developments and keep up to date as an academic/
professional.
Lecture 2: securitization and dialogic pedagogies
Securitization of youth
Securitization: The process of presenting an issue in security terms, in other words as an
existential threat (Buzan)
- When youth is ‘mainly seen as a danger to be combatted’ (de winter)
- Different than clinical ‘at risk’ approach securitization frames youth as a source of
threat to the society
Contradictory paradigms in the field
- Orthopedagogy: science of the problematic child raising situations
- YES: from pedagogy focused on the ‘clinical’ to a critical, interdisciplinary and
collective/communal approach
o Goal of the course: thinking paradigmatically
Paradigm
Paradigms: theoretical perspectives (lens), a set of coherent ideas or a philosophy that helps us
to understand a phenomenon, or a field and informs professional actions in it
o Paradigms based on a natural science perspective (Kuhn): No linear progression
but also based on consensus, scientific revolutions, new insights by the scientific
community. Paradigms can be incommensurable (but need not always be).
o Consensus: people think in a certain way
o Paradigms based on a social science perspective (Latour): no linear progression
but paradigms are also political: Total objectivity is an illusion.The production of
knowledge cannot be separated from politics (and thus from the notion of multiple
interests and perspectives), but complete relativism should also be avoided.
- Consequences of the political and non-linear nature of the development of scientific
knowledge in social sciences
o Multiple different paradigms operate next to each other
o Paradigms have important consequences for practice
- Paradigms thus are never exclusively based on scientific knowledge or scientific
perspectives, they often are developed in interaction with particular normative positions
in the society.
What could be the relevance of knowing from which paradigm a scientist makes her/his point, or
an intervention, a policy is designed?
- Multiple ways of thinking compare multiple thinks
- Able to shift
- Good to think through what the consequences are
Context: normalization vs medicalization
In the public debate: ‘longer waiting times for youth help’ = not: more children suffer from a bad
condition
- Scientific research: youth well-being and labeling
- Medicalization
o Could be related to overprotection and individualization/professionalization
protect a child from being ill/circumstances: individual child and professional
involved
- Overprotection
- Individualization/professionalization
Medicalization
Medicalization: the process by which previously nonmedical problems become defined and
treated as medical problems, usually as diseases or disorders (E.g. ADHD, alcoholism,
addiction, eating disorders were not medical problems in the past)
- Advantages: people get some rest from stress that causes their problems
- Disadvantage: step out of their old life, label has consequences
, - ‘Medicalized categories are elastic and can expand or contract’ (ADHD, PTSD, hysteria):
(ADHD: formally mostly boys, now also girls, formerly focused on aggression; now
expanses to concentration problems)
- Medical categories change over time (hysteria; associated with women, diagnosis has
disappeared)
- Medicalization exists next to de-medicalization (e.g. homosexuality)
What drives medicalization
- Not always a psychical biological base: describe behavior
- The medical profession: changing diagnosis, drive labeling
- Biotechnology (the pharmaceutical industry, genetics, and forms of medical technology):
invent a new medicine
- Care system: consumers, and managed care (including all kinds of health insurance)
Medicalization: a cultural response of our time?
- Is medicalization part of a/our culture?
- Is being traumatized not a ‘normal reaction to a traumatizing world?
- Why do we declare the person ill, and not the system?: blame the individual without
doing the analyses why this is happening (bigger picture)
- Dirk de Wachter: Dirk de Wachter: Our times are defined by psychiatric diseases and
vice versa. Psychiatry is the mirror of the world we live in. It is based on our cultural
norms on happiness
Medicalization: not only a phenomenon of our times
- Johann Wolfgang von Goethe (1787): Speaking for myself, I too believe that humanity
will win in the long run; I am only afraid that at the same time the world will have turned
into one huge hospital where everyone is everybody else's humane nurse.
o ‘real troubles’ are made into individual diseases
On madness, normality and ‘the norm’
- Paul Verhaeghe: We pathologize behaviours because they go against the norm (we want
to concentrate and sit still; do not accept aggression and concentration problems):
normal is the mirror of abnormal
- Verhaeghe: After Foucault: The discourse of normality (the good child) defines how we
see the deviant/ill child.
o It is a misconception that the diagnostics according to the DSM 5 is based on
scientific evidence, it reflects basically our norms on normality, and the practice
associated with it.
o What is normal is context and time dependent
Opposite paradigm of medicalization
- De-medicalization or normalization
- Community psychology approach: instead of having a problem solved by professionals
you can also make use of the community (stronger community)
De-medicalization: example of the dutch youth law (2015)
- Increase prevention, own responsibility of citizens, normal parenting
- Decrease: specialized care make communities stringer
, A ‘remedy’ to overmedicalization: the educative civil society (de winter chapter 4)
- Increasing demand for youth care/youth welfare despite that prevalence of problems is
stable)
- Re establishing authority to the parent & civil society & parent communities
Community psychology as opposite of medicalization
- Community-ecological approaches
o Human competencies are best viewed/understood/fostered in their social etc
contexts
o Active collaboration between all levels of the community is required
o Empowerment (strength, competencies, resources of the community are
stressed); instead of making individuals stronger, make the individual stronger
o Prevention, not therapy
Take home message & discussion
- No universal self-evident way to look at the care for children. Care is organized according
to different paradigms.
- Medicalization and normalization are opposite tendencies and depend on the norms of a
particular society (none of these are inherently bad)
- Deviant child the normal, the good, successful child: how we see a deviant child has
everything to do with what we think about the good child
- What is the deviant/normal child is time and context specific: norms are strong (not
everything goes) and are the drivers of medicalization
- It is important to study these developments and keep up to date as an academic/
professional.
Lecture 2: securitization and dialogic pedagogies
Securitization of youth
Securitization: The process of presenting an issue in security terms, in other words as an
existential threat (Buzan)
- When youth is ‘mainly seen as a danger to be combatted’ (de winter)
- Different than clinical ‘at risk’ approach securitization frames youth as a source of
threat to the society
