Encyclopedia of Global Bioethics

Living Edition
| Editors: Henk ten Have

Abnormality

  • Gregor WolbringEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-05544-2_1-1

Abstract

Abnormality as a concept has been used in many cultures for a long time. Many synonyms and antonyms of abnormality exist. Abnormality is used to judge abilities and morphologies of the human body and other biological entities such as animals and nonliving objects. Behaviors of biological entities from humans to nature are judged as abnormal, as are how people relate to each other and to animals and to nature. The use of abnormality as a judgment raises numerous ethical issues. Who decides what is abnormal? What is a variation, what a deviation? What is an ethical reaction toward abnormality? Who decides what is ethical? What about judgment conflicts on what is abnormal on the local and global level? This entry concludes that there are still unresolved issues of how to use and react to the label of abnormality, unresolved ethical, social, cultural, economic, legal, and other issues that apply to existing and emerging discourses and meanings of abnormality.

Keywords

Abnormality Disabled people People with disabilities Impaired people Genetics Screening Human enhancement Women Heteronormativity 

Introduction

Over 100 synonyms exist for abnormality; some synonyms are classified as synonyms of abnormality in the sense of describing being different from standards or norms such as aberration, anomaly, deformity, deviance, eccentricity, and unnaturalness. Some words are classified as describing congenital abnormality such as congenital defect, congenital malformation, deformity, disability, and mutation. Some synonyms of abnormality are classified under the meaning of backwardness, meaning underdevelopment, such as idiocy, mental deficiency, and mental retardation. Many are clustered under the meaning variation as in different; some are clustered under peculiarity (Roget’s 21st Century Thesaurus 2009). Some antonyms for abnormality are conformity, normality, normalness, regularity, sameness, standard, uniformity, and usualness (Roget’s 21st Century Thesaurus 2009).

Abnormalities can be clustered into two main categories, one being how we judge the human body and its abilities. The second category is linked to the code of behaviors written down in religious, legal, and other documents to give guidance as to which behaviors are normal and expected and which are not.

After a brief history covering both categories of abnormality, this entry will focus on body-linked abnormality. It will then introduce emerging forms of abnormalities followed by engaging with two ethics issues related to abnormality, one being the issue of who decides what is “abnormal” and the second being what to do with the “abnormal.”

History of Abnormality

That so many words are linked to the meaning of abnormality and normality indicates the importance of normal behavior throughout human history. Human history is abundant with examples of certain groups making certain behaviors the norm. Menes (pharaoh of Egypt) establishing codes of conduct for the Egyptian civilization in 3040 B.C., the Mesopotamian Codes of Hammurabi (1754 B.C.), the action of Cyrus the Great (539 B.C.) in Babylon that freed slaves and set the norm of racial equality, and the Universal Declaration of Human Rights (1948) are just some examples of humans as individuals or as a collective setting certain behavior norms. The concept of “natural law” is linked to the reality that people often follow certain unwritten laws. Roman law was based on rational ideas derived from the nature of things. As to the norm of individual rights, there is the Magna Carta from the UK (1215), the French Declaration of the Rights of Man and of the Citizen (1789), and the US Bill of Rights (1791).

However, as to the actual use of the term “abnormal,” the term “abnormal” appeared first in Western Culture in the nineteenth century to denounce humans who behave in certain ways as medically abnormal. The idea of the normal people displaced the enlightenment ideal of human nature during the nineteenth century. The field of abnormal psychology was formed in the nineteenth century with the German physicians Griesinger and Kraepelin linking abnormal behaviors to biological abnormalities and to psychopathology. The medical journal The Lancet that published its first issue in 1823 mentioned the term “abnormality” for the first time in 1847 reporting on the meeting of the Pathology Society of London, UK (Lancet 1847). Since then, the term “abnormality” has been used over 26,333 times in The Lancet. In 1897, the book Sexual Inversion was published in the UK, which describes homosexuality as an inborn abnormality. The first issue of the Journal of Abnormal Psychology appeared in 1906, with the journal still publishing today. The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1952. The history of the DSM is one example of how criteria of what is called an abnormality change constantly and how “new” abnormalities are constantly generated.

Emerging Abnormalities

Medicalization of the Species-Typical Healthy: The New Abnormal

Medicalization refers to the process by which up to then “nonmedical” problems become dealt with as “medical” problems. Medicalization of the “healthy” is a dynamic where perfectly healthy persons are made to feel bad about their appearances or functioning. It sells to healthy people the idea that they are sick. “Disease-mongering” is a term employed in the critique of the medicalization of the species-typical healthy (see “Disease Mongering”). The reality of medicalization is acknowledged by many. A recent issue of the Seattle Times mentions that 75 % of the adult U.S. population is labeled as diseased (Kelleher and Wilson 2005). Given that the term “abnormality” is often used for medical conditions for not being healthy, one could say that 75 % of the adult U.S. population is abnormal.

Medicalization and the Enhancement Model of Health

Increasingly scientific and technological advancements are emerging and envisioned such as genetic manipulations through somatic and germ-line genetic interventions and synthetic biology (the design of genomes from the bottom up) and body implant technologies that have the potential to allow humans to have abilities that are not exhibited by humans as of now. For example, a brain machine interface allows humans to thought-control devices linked to a computer. Recently, two humans were connected through a brain-to-brain interface device which allowed one person to control actions of the other person (Trimper et al. 2014). Genetic manipulation of the human genome would allow adding all kinds of abilities to the human body. Some genetic manipulations could lead to enhancements of existing abilities such as being strong. Other genetic manipulations could add totally new abilities to the body; for example, it is proposed to add abilities to the body so it can deal with side effects of climate change (Liao et al. 2012). These emerging developments are accompanied by an emerging social dynamic that expects new abilities from the human body. Indeed, the social movement of transhumanism is based on the idea of evolving human abilities beyond the species-typical (Humanity Plus formerly World Transhumanist Association 2005). Julian Huxley, First Director-General of UNESCO, used the term “transhumanism” with the meaning of constant improvement of human abilities already in 1957 indicating that transhumanism would lead to a new kind of existence of humans fulfilling the destiny of humans (Huxley 1957). This development raises the question of who of the in-the-moment species-typical people will be reclassified as abnormal, or “not normal,” because they do not have the beyond-species-typical body and abilities? Given the existing dynamic of pathologization, the reclassification of many so far species-typical as abnormal will be accompanied if not driven by a change in the meaning of healthy, fitting with the established dynamic of medicalization. The enhancement model of health sees a nonenhanced human body as defective and in need of improvement beyond the species-typical boundaries; every nonenhanced human being is seen as impaired. Every human, no matter how “medically healthy,” in the species-typical sense is defined as limited, defective, impaired, and in need of constant improvement made possible by new technologies (a little like the constant software upgrades we do on our computers). “Medically healthy,” in this model, means having obtained maximum (at any given time) human enhancement (improvement) of one’s abilities, functions, and body structure beyond species-typical boundaries (Wolbring 2005, 2010). The enhancement model of health moves the dynamic of medicalization toward perceiving the species-typical body in need of an improvement period. If species-typical is a diseased state, one can justify the field of enhancement medicine where one employs genetic (somatic enhancement, germline enhancement, synthetic biology) and nongenetic (cyborgization) interventions as therapies.

The dynamic of labeling something or someone as abnormal comes with various ethical issues. Two main ones are covered below, namely, (a) who decides what and who is abnormal and who has the power to influence the labeling of something as abnormal process and (b) what to do with the abnormal labeled; for example, many abnormal-labeled people such as disabled people feel they are discriminated because their set of abilities is seen as abnormal.

The Ethics Issue of Who Decides

The very concept of abnormal implies that there is a majority or a powerful group that decides what is seen as normal. Having power allows one also to influence what abilities are seen as essential and how to treat and label people who do not have the “essential” abilities. A lively ethics debate exists around the issue of enhancement beyond the normal, for example, with some denouncing the process but others stating that it should be an obligation (Wolbring 2012) (see also entry “Designer Babies”). Once the process of enhancement is accepted, the question is how one deals with the nonenhanced. This power to influence what abilities are seen as essential is often used to disable the less powerful. Various groups were and still are affected by being labeled as abnormal. In general, the question is who should be allowed to label? Should anyone be allowed to label? Should everyone have the right to identity self-determination? Is identity self-determination a part of autonomy? Should self-identity security, meaning that one can perceive oneself as one wishes and that one is not forced to accept labels put on oneself by others, be a part of human security? In the same way that labeling someone or something as abnormal has a long history, so has the rejection of the label by the ones labeled.

Rejecting One’s Label: The Case of Women

Women have been labeled for some time. Hysteria was linked up to the nineteenth century to the abnormal movement of the uterus making hysteria a female biological abnormality. This label has been denounced by women for a long time. Men set up the expectation that one has to have the ability of being rational, of being able to act rational. Males decided at the same time that women were not rational. Women have been fighting against being pathologized and seen as inferior to men due to “abnormal” sets of abilities for a long time (see, e.g., Suffragette’s fight for women’s right to vote in the nineteenth and beginning of the twentieth century in many Western countries (Buechler 1990)). A gendered discussion around ability stereotypes, around which abilities are normal, exists (Appel et al. 2011; Kelso and Brody 2014; Martinot et al. 2012). In Western countries up to recently, many men have felt that it would be abnormal for women to have certain abilities one can obtain through educational means. The idea that it is abnormal for girls getting an education beyond certain levels is still an issue in various places around the world.

Rejecting Ones Label: The Case of Disabled People

Disabled people are another group that has been and still is experiencing being labeled as abnormal. Indeed, the very term used to define them as a social group depends on the dynamic of having a norm and labeling not fitting the norm as an abnormality. Given the linkage of abnormality to the concept of pathologization, people seen as abnormal also obtain labels linked to not being healthy such as patient, impaired, disabled, and diseased and are dealt predominantly within a medical narrative. The medical narrative roots the problem, the “disability,” the person encounters in the deviance of the person. Management of the problem of the disabled person or person-to-be (embryo, fetus) is aimed at cure, prevention, or adaptation of the person (e.g., assistive devices) to eliminate or compensate for the abnormality. Medical care and rehabilitation are viewed as the primary issues, and at the political level, the principal response is that of modifying or reforming health care policy.

The disabled people’s rights movements in the USA and Britain coined the term “ableism” in the 1970s to question and highlight the normative expectations toward species-typical body abilities and the disablement (prejudice and negative treatments) people experience when their body-linked abilities are labeled as “impaired” (as deficient).

To give three concrete examples of discourses rejecting the pathologization, the cultural concept of neurodiversity has been discussed since the 1990s questioning the medical deficiency discourse people with certain labels such as autism, Asperger syndrome, attention deficit hyperactivity disorder, bipolar disorder, developmental dyspraxia, dyslexia, epilepsy, and Tourette syndrome are exposed to. Even longer does the discussion exist whether not hearing is a deficiency or a different way of being as people who adhere to the concept of Deaf culture state. Finally, Down syndrome is often used as an example of an undesirable, underperforming characteristic. Alternative narratives exist that state that Down syndrome is not an illness or a genetic defect.

“Down syndrome is a naturally occurring chromosomal arrangement that has always been a part of the human condition. Down syndrome is not a disease, disorder, defect or medical condition. Down syndrome itself does not require either treatment or prevention” (Canadian Down Syndrome Society 2007).

However, in all three cases, the nonmedical, nonabnormal alternative narrative is not accepted as the mainstream narrative.

Rejecting One’s Label: The Case of Heteronormativity

In 1886, Krafft-Ebing defined homosexuality as a hereditary degeneration. In 1897, Havelock Ellis and John Addington Symonds published Sexual Inversion, claiming that homosexuality is an inborn abnormality. In 1924, the Society for Human Rights in Chicago became the earliest known gay rights organization in the USA. The first lesbian rights organization in the USA, the Daughters of Bilitis, was established in San Francisco in 1955. The American Psychiatric Association removed homosexuality from its official list of mental disorders in 1973; with other words homosexuality was labeled in the USA until 1973 as a disorder. In China, homosexuality ceased to be classified as a mental disorder in 2001. However, homosexuality is still labeled an abnormal behavior in over 80 countries (blog 2015) (80 countries are listed at http://76crimes.com/76-countries-where-homosexuality-is-illegal/). In 2014, the Uganda Anti-Homosexuality Act was signed into law, for example. Furthermore, even if a country does not define homosexuality as a mental disorder or as an abnormal behavior, that does not mean that groups within a country do not adhere to the abnormality label, and it does not mean that LGBTI people are not treated badly. A controversy was evident around the treatment of LGBTI in Russia in the wake of the 2014 Winter Olympic Games in Sochi (Russia).

The Ethics Issue of What to Do with the Abnormal

Once someone or something is labeled as abnormal, the question is what to do about it.

The Issue of Social Discrimination of the Abnormal-Labeled

Humans have a long history in using the power of labeling something or someone as abnormal to negatively influence that someone or something. “Witches,” “demons,” and other terms were used to label certain people as exhibiting abnormal behaviors in order to treat these people in a negative way (e.g., Christians when the Roman Empire did not accept Christianity; women and men during the Spanish inquisition; the pogroms against Jewish people; people with albinism today in various countries). Disabled people have been for a long time and still are targets of negative treatments, of social discrimination. The UN Convention on the Rights of Persons with Disabilities (United Nations 2007) highlights the many negative social treatments disabled people experience globally.

The Issue of Selecting Out

With the linkage of the concept of abnormality to the medical field, the assumption is that there has to be a way to quantify and identify and possibly eliminate the abnormality. People labeled as impaired due to not fitting the species-typical ability norm were one main target for negative eugenic practices such as their sterilization to prevent them from having offspring that would have the same “abnormality” (see eugenicsarchive.ca). The elimination of the “impaired” fetus after the detection through prenatal testing and the deselection against embryos that were/are identified as “impaired” after preimplantation diagnostic are two other deselection practices (see also “Designer Babies”). The range of genetic and nongenetic characteristics of humans one can test for is constantly increasing. Ultrasound allows us to test for the sex of the potential offspring and other bodily morphologies. We can test for characteristics that manifest themselves right after birth or later on in life. We can test for predispositions meaning that one might be in “danger” of developing certain characteristics down the road in life. We are constantly searching for genetic explanations for human characteristics and behaviors. Many search, for example, for the gay gene or genetic components of violent behavior with the idea to label the finding as genetic abnormalities. The issue of where to draw a line in detecting and eliminating genetic- and nongenetic-based characteristics of humans has gone on for over 40 years. How are lines drawn and justified in what is permissible/acceptable and what is not?

At the moment, the line is drawn at what can be labeled as a disease. The deselection against females is, for example, seen as negative. A variety of laws and law proposals exist which prohibit sex selection for “nonmedical reasons.” Arguments used to justify the prohibition are diverse. Some are (a) sex selection poses significant threats to the well-being of children and siblings, the children’s sense of self-worth, and the attitude of unconditional acceptance of a new child by parents, so psychologically crucial to parenting; (b) sex selection leads to negative consequences for the unwanted sex; (c) sex selection leads to the oppression of the people with the unwanted sex, to social injustice; (d) sex selection is as a form of sex discrimination leading to the enhancement of sex stereotypes, which means that people will have certain expectations toward people with one sex or another; and (e) sex selection leads to designer babies and trivializes the selection procedure leading to the selection of children based on ‘cosmetic reasons’ (Wolbring 2003).

Being gay is labeled as a medical abnormality by many. Some believe that being gay is rooted in the genetic makeup meaning that being gay is a genetic abnormality. As such efforts are going on for some time to identify a gay gene, many do not agree with a test for being gay because they do not see being gay as an abnormality and believe that the search for a gay gene reflects homophobia. The opponents of the search for a gay gene also fear that identification of a gay gene might lead to prenatal genetic tests that might endanger future gay people in certain places. Many of the same arguments used to justify sex selection prohibition are used by people questioning the search for a gay gene.

In both cases, the people demanding sex selection prohibition and prohibition of a search for a gay gene draw the line by saying they are not a disease as an argument. With other words, being seen as a disease as an abnormality is the justification for employing deselection techniques.

In the discourse around the use of genetic tests, an animal farm philosophy (some are more equal than others) is evident (Wolbring 2004). Many arguments used to justify the prohibition of, for example, sex selection can logically be used to justify the prohibition of selection for or against other characteristics such as what people label as impairments. However, if disabled people use the same argument, they are made void by the argument that they do not apply as they only apply to nonmedical characteristics. The article “The Disability Rights Critique of Prenatal Genetic Testing Reflections and Recommendations” (Parens and Asch 1999) outlines the many disagreements between “disabled” and “nondisabled” bioethists on the topic. As such, the issue of medicalization of bodies and ability differences gains more importance because once one is medicalized, one is not part of the same moral and ethical reasoning anymore.

The Issue of Generating New Characteristics

Increasingly, humans can try to influence the genetic composition of humans not only through negative deselection but through genetic modification of body and reproductive cells to (a) fix genetic realities labeled as genetic abnormalities and (b) add new genetic characteristics to humans. In the case of fixing genetic abnormalities, the issue arises again on what is seen as an abnormality and who has the power to decide. Other questions arise around the practice of adding genetic characteristics to humans: How will people without the enhanced characteristics be perceived? Will they be the new abnormal? Given that abnormal is applied to ever-changing targets, this is an area that still has to play itself out (see also entry “Designer Babies”); however, if enhancements give advantages which are seen by the majority or powerful people as useful and if a given enhancement becomes an expectation, it is reasonable, given the history of use of the term “abnormality,” that the ones not having a given enhancement might experience negative treatments and might be labeled as abnormal.

Conclusion

This entrée covered historical and emerging dynamics of labeling someone or something as abnormal and the medical, cultural, social, and some ethical aspects linked to labeling something or someone as abnormal. The entry highlighted that what is abnormal and what to do with the abnormal-labeled plays itself out differently in different countries, social settings, and cultures. The entry indicates that we have not solved the problems evident in the discourses around labeling something or someone as abnormal, that there are still unresolved ethical, social, cultural, economic, legal, and other issues that apply to existing and emerging discourses and meanings of abnormality.

Cross-References

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Further Readings

  1. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Retrieved from http://www.dsm5.org/Pages/Default.aspx. Accessed 15 May 2015.
  2. Eugenics Archives What Sorts of people should there be. Retrieved from http://Eugenicsarchive.ca. Accessed 15 May 2015.

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Department of Community Health Sciences, Community Rehabilitation and Disability Studies, Cumming School of MedicineUniversity of CalgaryCalgaryCanada