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Web Topic 6.1: The Meaning of “Normal”

[Referenced on textbook p. 153]

Even the use of relatively neutral labels such as “typical” and “atypical” to denote developmental pathways may create the impression that we are identifying a single developmental history as being the normal or desirable one for each sex and any other histories as being unhealthy, abnormal, or undesirable. In reality, however, we don’t claim the right or the wisdom to make such judgments.

There has been considerable debate over the years as to what doctors and scientists mean when they use terms such as “normal” and “abnormal,” or “health” and “disease.” Sometimes these judgments are based simply on frequency of occurrence. If the values of a trait are distributed according to the bell-shaped probability curve (the “normal distribution”), doctors often use a simple rule of thumb: the approximately 95% of individuals who fall within two standard deviations of the mean value are “normal,” while the 5% who lie beyond those limits are “abnormal” and have a medical condition. Such rules of thumb have been used for defining conditions such as precocious or delayed puberty. The trouble with such simple probabilistic definitions, though, is that they don’t necessarily say anything about what effect the condition has on a person or on society. You can probably think of several undesirable or harmful conditions that are very common, as well as some rare ones that are beneficial or highly valued.

An alternative approach has been to call a condition abnormal (or a disease or defect) if it negates the self-evident function of some body part or process (Boorse, 1981). Thus, we may say that the function of the ear is to hear, and that a person whose ears don’t allow them to hear has the disease or defect of “deafness.” Similarly, we may say that the function of the penis is to void urine and semen, so that a penis in which the urethra does not open at the tip has the developmental defect of “hypospadias” (see Box 6.6). Or, we may say that the function of sex is reproduction, so that a proclivity for masturbation or for gay or lesbian sex is a psychological disturbance.

Teleological (purpose-oriented) thinking of this kind is convenient, and perhaps indispensable, in the day-to-day practice of biology and medicine, but it lacks a sound logical foundation because there is no scientific evidence that purpose or conscious design has played any role in the evolution of our species. One can reframe this kind of thinking in a nonteleological way—by saying, for example, that ears evolved because individuals who could hear survived and reproduced better; therefore, functioning ears were adaptive. But to say that something was adaptive during our evolutionary history doesn’t necessarily mean that it’s a good thing today. In fact, on our overcrowded planet, one can ask whether physical or mental traits that increase people's reproductive success are in fact desirable traits at all.

The dominant view today is that words such as “health,” “disease,” “normal,” and “abnormal” are assigned not purely on the basis of intrinsic properties of the states they describe, but by reference to standards or values held by the user of the words. According to this normative view, a state becomes a disease or defect when it is undesired by the person who has the condition, or by the doctor who treats that person, or by society in general (Merskey, 1986). Thus, one person’s disease or defect may be another person’s glowing good health. In the case of deafness, for example, congenitally deaf persons may be judged to have a defect by hearing people, but not by the deaf individuals themselves. In the sexual realm, states that may (or may not) affect reproduction, such as intersexuality, homosexuality, and transexuality, may be judged unhealthy by people for whom reproduction is an important personal goal, but not by intersexual, homosexual, or transexual people themselves. In the normative view, there are no empirical means to resolve such disagreements.

There are complications, however. For one thing, society is often able to influence a person’s judgment about the worth of their particular state. Thus, a man with a 7-centimeter penis may be made to feel defective, and in fact made defective, by the opinion of others, when otherwise he might have been capable of perfectly satisfying sexual interactions. College textbooks are one channel by which society “inscribes” people with identities such as “homosexual” and loads those identities with values, negative or otherwise (Foucault, 1978). However lightly textbook authors attempt to tread, it is inevitable that their writings will transmit some part of their own values—values that are not necessarily better than anyone else’s.

Another problem is that no one’s sexual life exists in isolation. Parents may have to make decisions on behalf of their children—as to whether or not an intersexed child should undergo genital surgery, for example, and if so, which sex it should be made into (see Chapter 14). Sexual behaviors such as rape and child molestation affect others in the most extreme way. But even simply being an out-of-the-closet lesbian has social repercussions. Thus it may not always be enough just to say “Let people make their own judgments of what is normal and I’ll go along with it.” It may seem appropriate to criticize and restrict, or conversely, to praise and encourage, other people’s actions in the sphere of sex.

As you read this and the following chapters, we urge you to keep an open mind about what is healthy or unhealthy, permissible or impermissible. You may find yourself changing your mind about some things as you learn more. But we also urge you to consider the core values you cherish, to use those values in forming your opinions, and to express those opinions by your actions and by your participation in the marketplace of ideas.

References

Boorse, C. (1981). On the distinction between disease and illness. In A. L. Caplan, H. T. Engelhardt, and J. J. McCartney (Eds.), Concepts of Health and Disease: Interdisciplinary Perspectives, Addison-Wesley.

Foucault, M. (1978). The History of Sexuality, Volume I. Pantheon.

Merskey, H. (1986). Variable meanings for the definitions of disease. Journal of Medicine and Philosophy 11: 215–232.

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