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One of the interesting problems with the medical model that emerged during our regular contact with it when our first kid was born is that medicine is intensely

One of the interesting problems with the medical model that emerged during our regular contact with it when our first kid was born is that medicine is intensely normative - that is, it assumes a median condition and looks for outliers that require correction. From a statistical and biological perspective this does not make sense. There is no underlying biological norm - variation is real (as in, our fundamental biology differs), and any normal behavior is merely the result of the central limit theorem, etc. Defining this real variation as disordered seems a fundamental problem. This becomes particularly problematic when those norms are measured using a non-representative sample (e.g. white Americans) and applied to everyone else.

dkarl 8y ago
Defining this real variation as disordered seems a fundamental problem. This has been recognized in medicine and mental health for so long that I don't know if you could find someone still practicing who wasn't taught it in school. If you go to a mental health care provider and tell them that your family thinks you have a disorder because you prefer not to socialize and get everything you need delivered so you don't need to leave the house again after work, they're going to ask you if you're unhappy about it or if you feel your life is diminished in some way by an inability to leave the house when you want to. If your kid has six fingers, a doctor's concern will be whether all the fingers are developing in a healthy way or one needs to be removed because it isn't functional and will be a source of pain and injury. The principle hasn't been a panacea for prejudice, of course, notably in the case of homosexuality, but difference itself is not automatically treated as pathology in the absence of social prejudice. Doctors aren't treating people for having red hair or 20/10 vision or thinking stamp collecting is fascinating.
0xcde4c3db 8y ago
> Defining this real variation as disordered seems a fundamental problem. It's a problem that's been recognized in medicine for a very long time. That's why formal definitions of terms like disease and disorder usually aren't based solely on variation, and include a requirement that something actually interferes with a person's ability to function.
SketchySeaBeast 8y ago
> that is, it assumes a median condition and looks for outliers that require correction I think that's all evidence based medicine can really do. It's just a series of "well, people with high blood pressure tend to die early" and "people with high cholesterol have heart attacks". I don't know how they would approach it differently - if it was assumed that everyone was different with entirely different baselines, I don't know how it would be possible to make any sort of predictive assumptions. Really, the best solution would be to increase the granularity of the samples, but that's all they can do, develop more diverse pools of generalizations.
- astazangasta 8y ago
  Increasing the pool of generalizations would certainly help. So would keeping this fundamental problem in front of mind. My kid was an outlier because my genetics tend to being tall and thin. If he was being measured against a set of healthy people with similar genetics he would not be considered an outlier - but this calculus is not considered when he is measured and judged aberrant. Our doctor being Indian was able to see from her experience that he was "normal" - for a kid with an Indian parent. Another doctor (like all the ones I grew up with) might not have the same insight and conclude there is a problem.
  - SketchySeaBeast 8y ago
    Could I ask what concerns they had with your child being tall and thin for his age? I was a 99%'er growing up but I don't remember there being health concerns.

dkarl 8y ago

Defining this real variation as disordered seems a fundamental problem. This has been recognized in medicine and mental health for so long that I don't know if you could find someone still practicing who wasn't taught it in school. If you go to a mental health care provider and tell them that your family thinks you have a disorder because you prefer not to socialize and get everything you need delivered so you don't need to leave the house again after work, they're going to ask you if you're unhappy about it or if you feel your life is diminished in some way by an inability to leave the house when you want to. If your kid has six fingers, a doctor's concern will be whether all the fingers are developing in a healthy way or one needs to be removed because it isn't functional and will be a source of pain and injury. The principle hasn't been a panacea for prejudice, of course, notably in the case of homosexuality, but difference itself is not automatically treated as pathology in the absence of social prejudice. Doctors aren't treating people for having red hair or 20/10 vision or thinking stamp collecting is fascinating.

0xcde4c3db 8y ago

> Defining this real variation as disordered seems a fundamental problem. It's a problem that's been recognized in medicine for a very long time. That's why formal definitions of terms like disease and disorder usually aren't based solely on variation, and include a requirement that something actually interferes with a person's ability to function.

SketchySeaBeast 8y ago

> that is, it assumes a median condition and looks for outliers that require correction I think that's all evidence based medicine can really do. It's just a series of "well, people with high blood pressure tend to die early" and "people with high cholesterol have heart attacks". I don't know how they would approach it differently - if it was assumed that everyone was different with entirely different baselines, I don't know how it would be possible to make any sort of predictive assumptions. Really, the best solution would be to increase the granularity of the samples, but that's all they can do, develop more diverse pools of generalizations.

astazangasta 8y ago
Increasing the pool of generalizations would certainly help. So would keeping this fundamental problem in front of mind. My kid was an outlier because my genetics tend to being tall and thin. If he was being measured against a set of healthy people with similar genetics he would not be considered an outlier - but this calculus is not considered when he is measured and judged aberrant. Our doctor being Indian was able to see from her experience that he was "normal" - for a kid with an Indian parent. Another doctor (like all the ones I grew up with) might not have the same insight and conclude there is a problem.
- SketchySeaBeast 8y ago
  Could I ask what concerns they had with your child being tall and thin for his age? I was a 99%'er growing up but I don't remember there being health concerns.