Theodore Dalrymple M.D.

Psychiatric Disorder

What's In a Diagnosis?

We increasingly describe conduct as if it were a diagnosis.

Posted Jun 05, 2015

Does demand create supply, or supply demand? The question is not straightforward, though any answer must surely mention publicity as a factor.

A recent article in the Canadian National Post drew attention to a ‘condition’ known as Transability. As yet, few people suffer from it, or at least act upon it, but that could change. The transabled feel that they are in the wrong body and that, really, they ought to have one arm or leg the less, or ought to be blind. They go about procuring their disability for themselves, by cutting off their surplus limb or by blinding themselves. A Canadian academic has interviewed thirty-seven such people around the world, but he is not the first academic to be interested in the subject. Here is what an Italian academic had to say about it a year ago:

   Transabled agendas can be evaluated in terms of antagonism and/or

   conformity to normative discourse. However, a deconstructive

   reading can also expose how transability reveals crucial processes

   regulating the binary opposition between ability and disability. If,

   despite its assimilationist goals, transability remains a desire for

   malfunction, aberration, deformity, this is due not to the nature of

   transabled desire but to the social construction of body standards.

   Normative body standards, if fact, construct sovereign subjects by

   conflating difference with lack and integrity with autonomy.

   Legitimate membership in the class of able bodies is thus revealed as

   a highly policed social determination[1].

It takes years of training to be able to write like this. It is the academic equivalent of the type of speech common to managers (though not to entrepreneurs). As Ms Arfini would no doubt put it, ‘Legitimate membership in the class of academics is thus revealed as a highly policed linguistic determination.’

Now transability is clearly to be distinguished from apotemnophilia, the sexual desire to be an amputee, in so far as there appears to be no sexual component to the desire to be transabled; and it is distinguishable, too, from the mutilation of children by parents or others in order that they might be more efficient or successful beggars, a practice that is said to be rife in India. True, the transabled are likely to demand the economic assistance given as of right to those disabled by disease or accident; but it is themselves whom they mutilate, not others. They are also likely to demand that their hitherto rather peculiar desire be recognised as a genuine illness, for example in the next revision of the Diagnostic and Statistical Manual of the American Psychiatric Association or of the World Health Orgaization’s International Classification of Disease, as well as that it should be regarded as perfectly normal and therefore subsequently removed from those great compendia of pathology. But, as Emerson once said, a foolish consistency is the hobgoblin of little minds.  

Harm prevention means, of course, that surgeons should be willing to disable people under the best medical conditions — cut off their limbs, put out their eyes — because, if they do not, such people as desire it will procure their disability for themselves, thereby causing themselves avoidable pain or complications, and therefore more disability than necessary.

With regard to those who mutilate children with a view to making them more profitable beggars, they too are suffering from a disorder, namely ADSCI, or Adult Disfigurement of Small Children Inclination. The criteria for the diagnosis of this disorder are as follows, the presence of at least three of which are necessary to make the diagnosis:

i) There should be at least twenty years’ age difference between the disfigurer and the disfigured.
ii) The disfigured should be under the age of 15.  
iii) There should be no sexual motive in the disfigurement.
iv) The disfigured child should be set to begging within one month of the disfigurement and not permitted to keep any of the money raised.
v) The disfigurer’s urge to obtain money for himself should be overwhelming and  accompanied by a lack of guilt, regret or remorse, or an awareness that he had done anything wrong.
vi) The condition is chronic and relapsing where more than one child is disfigured, or where the disfigured child is absorbed into an organised band or gang of beggars.
vii) The condition has a tendency to remit as economic conditions improve.

Or, as Ms Arfini would put it, ‘disfigurement of children agendas can be evaluated in terms of antagonism and/or conformity to normative discourse,’ for example that of the proper way to treat children.

On the other hand, perhaps I am only suffering from TCAHCDD, the Tendency to Classify All Human Conduct as Disorder Disorder.    

[1] Alisa A. G. Arfini,

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