Rashad Rehman delineates what pathologization means, drawing upon the example of differences and disorders of sexual development.

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The word “pathology” comes from the Greek pathologia (science of diseases), itself comprised of two terms i.e., pathos (disease) and logos (account, reason). As the medical study of diseases, pathologists are engaged in identifying, classifying, and diagnosing complex (patho) physiologies. However, when clinicians speak of a “pathology” in professional environments, such as in healthcare settings, they are socially and morally (and increasingly institutionally) responsible for dissociating a person from any of their pathologies. When a person is identified with or reduced to a pathology, or has any of their benign anatomical characteristics conceptualized or treated medically as a disease, this may be understood as an instance of pathologization

Pathologization should be morally condemned as an instance of harm or disrespect. It reduces a person to their pathologies, or it treats as pathological something that is, in fact, benign. Consequently, pathologization is viewing, unethically, someone or something in terms of disease where this, in turn, carries a negative normative judgment of being disvaluable or dysfunctional.

Photo Credit: Nicolas Raymond/flickr. Image Description: A Caduceus Grunge Symbol.

In order to better understand what pathologization is, and to assess its evaluative content and sketch avenues for depathologization, I will draw on the example of persons with differences or disorders of sexual development and their medical treatment. These differences or disorders are “congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical.”

Persons may be pathologized and as well as bodily attributes. Pathologization of persons inappropriately treats persons as fundamentally diseased and judges them negatively by virtue of the pathologies they have. Pathologization of bodily attributes inappropriately regards a bodily attribute as a “disease” and thus as something inherently bad, when in fact it is not bad and is just a type of normal variation.

After the 2006 Chicago consensus statement on the medical treatment of “disorders of sexual development”, some activists and scholars criticized the use of “disorder” because it was perceived to be pathologizing to persons. The criticism could also be extended to the pathologization of bodily attributes. Some disorders of sexual development involve the medically accurate description of a pathology, such as the genetic mutation that causes 21-hydroxylase deficiency and congenital adrenal hyperplasia. But the consensus statement failed to appreciate the potential for the term “disorder of sexual development” to refer to benign anatomical features. This caused the pathologization of bodily attributes.

Pathologization of bodily attributes comes in two forms. Pathologized characteristics that are inappropriately taken to be “diseased” might be wrongly thought of as characteristics that ought to be repaired. For example, in the 1920s and 30s, many persons with differences of sexual development received masculinizing and feminizing genitoplasty surgery, when the benefits of this surgery were speculative. In most cases, the patients would have been better off without surgery. It was wrong to pathologize their bodily attributes.

The other form of pathologization of bodily attributes holds that pathologized characteristics need not necessarily be repaired. If the treatment options are too risky, or simply unavailable, then one may be better off without its repair. With the right technological advancement to minimize surgical risks and harms, surgical repair of a legitimate pathology might be good for a person. But without this technological advancement, the person would be better off not having received the surgery. Consequently, pathologizing this bodily process would not be justified in that context.      

Depathologization, whether of bodily processes or persons, refers to the theoretical and clinical commitment to explicitly reject any form of pathologization, whether at the systemic, clinical, organizational, or legislative level. Consider a case in which there is a genuine “disorder” of sexual development, such as salt-wasting congenital adrenal hyperplasia with negative functional implications for health. In this case, since it is in fact a “disorder”, depathologization should pertain to depathologizing the individual with the disorder. Depathologizing strategies might include an explicit dissociation between the person and their disorder, such as by using person-first language.

However, for a mere difference of sexual development, rather than a disorder, the worry would be not only about pathologizing the person, but also pathologization of bodily processes. This form of pathologization could perhaps be rectified by individualizing each disorder or difference of sexual development. That is, each disorder or difference should distinguished from the others and categorized in terms of meeting the criteria for being a disorder or being a mere difference. Careful distinctions could prevent mistaken assumptions about pathologized bodily processes, and consequently open further avenues for depathologization. Headed towards depathologization through such distinctions, in the next post, I – with Dr. Darius Bagli – will articulate novel, nuanced criteria that helps us distinguish between mere differences and disorders.

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Rashad Rehman is Assistant Professor of Philosophy at Franciscan University of Steubenville, OH.