Not at a deficit, just different

deficit or differenceThere has been a big push in the field of clinical psychology to recognize and celebrate difference, pushing us away from behavioral explanations that might use words such as retarded or deficit. The motive for this is obvious; using these kinds of words with negative connotations can hugely undermine all of the great qualities of the patient in question. I support this kind of thinking, but have the following reservations.

Firstly, I have no problem with the word retarded going into the dustbin of history. That word is no use to anyone.

But I would like to maintain that deficit does have a place. Those in developmental neuroscience are becoming very familiar with neurogenesis (the creation and proliferation of neurons) and brain development. The biochemical environment in the brain tissue during development is crucial for proper neurological maturation and for the brain to function. If the environment in the brain changes, because of high levels of stress hormones or the presence of harmful drugs, the outcome will be a neurological deficit. Depending on where this deficit is will have serious implications on the afflicted’s lifestyle.

You could refer to this hindered development as a difference, not a deficit, but that undermines the fact that given different circumstances (environmental or genetic), there was no reason for the lack of neuronal growth to occur. Academically, it’s critical to recognize the factors that hinder potential growth and the resulting behavioral consequences. To refer to hindered development as just a difference undermines the pursuit of preventing developmental disorders.

Behaviorally, everyone is at a deficit! There are millions of things I will never be able to do, and things that somebody else will always be able to do better than me. But there are nasty diseases that can result in the break down of once healthy systems, and there are nasty diseases that can prevent one from having the healthy system in the first place – such as motor movement and coordination, our propensity for empathy and an intuitive understanding of others, and one’s ability to memorize, intellectualize, and think critically. While these things may not have developed or may have started to deteriorate, as humans we usually learn to compensate for these growing deficits by adopting new skills or techniques that we never used previously. There is nothing wrong with acknowledging the deficits, because that allows us to deal successfully with reality.

This issue of deficits is clearly about respect and a fear that by focusing on deficits we will fail to give people the dignity that they deserve.

Which brings me to my second reservation. There are some disorders that are now synonymous with neurological and behavioral deficits that we would not want to celebrate as just different. The main disorder in question here is a developmental disorder known as psychopathy. Neurologically, we know that those with psychopathy have deficits in their amydalas and in the posterior prefrontal lobe. Behaviorally, psychopaths do not have a conscience, cannot understand emotion, and often engage in very risky behaviors that can seriously harm the wellbeing of others. Here, the term deficit appears perfectly valid, and I think part of the reason is because we despise the behavior of these people and recognize that as their brain failed to develop correctly they are at a deficit, both personally and socially. Psychopathy is not a difference to be celebrated.

I think there is also an element of our willingness to accept a ‘greater good’ mentality over those with neurological deficits to this argument. Autistic individuals are known to have a poor understanding of the feelings and emotions of others. The same is true of psychopaths. Culturally, (for the most part) we accept autism and marvel at the analytical and descriptive talents that are present in some autistic individuals, and those with autism never really go out of their way to harm others. Therefore, we have no problem allowing those with autism to be fully integrated into society, albeit in their fastidious and calculating bubbles; those with autism are just different from us.

But psychopaths? Yes, they have neurological and sociological deficits, but they are harmful to others. So in this case we do need to exercise a ‘greater good’ mentality to keep them out of society and prevent them from continuing to hurt people. This isn’t a difference we can accept. A psychopath’s deficits can make them deadly, and as it is the recognition and comprehension of these deficits that help us to identify these people, talk of deficits is just fine.

Copyright Jack Pemment, 2013

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