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paradigms and global perspectives
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Hoorcolleges YES01 paradigms & global perspectivesHoorcollege 1: on medicalisation versus normalisation, risk taking and community perspective
In this lecture we outline what perhaps is one of the most prominent paradigms in the area of youth welfare:
the ‘at risk’, or medical-clinical paradigm. In this paradigm individual children are seen as the problem, or the
element that is ‘deviant’ when there is some kind of problem. ‘What goes wrong’ is primarily defined in
medical-psychological-individual terms. In the lecture, we analyze the roots of this kind of thinking, while also
asking what its attractiveness is. At the same time, the lecture points at the limitations and association of this
kind of thinking, and considers alternative points of view, especially those perspectives that have been
associated with strengthening and empowering communities, ecological models or system approaches to child
welfare and wellbeing, that stand out against ‘therapeutic’ ones and can be seen as belonging to the domain of
prevention. The lecture also analyses the difficulties of such community approaches, including those related to
social justice, inequality, and the need for social transformation. Ultimately, the goal of the lecture is that
students recognize the two perspectives or paradigms, but also learn to think ‘paradigmatic’, that is, you
understand that in the field of YES, as in any other social field, policies, programs are designed with particular
visions and assumptions, related to, for instance, the nature of childhood, upbringing, but also with respect to
how to analyze issues of upbringing and parenting, and the solutions these imply.
Introduction:
- A bit of history: Pedagogy in Utrecht/the Netherlands and paradigmatic change
- YES/MOV: from pedagogy focused on the ‘clinical’ to a critical, interdisciplinary, and
collective/communal approach
- To the goal of the course: thinking paradigmatically
Content of the lecture
2. What is a paradigm? And why do I need to know about it?
3. The case of Alicia
4. The medicalization paradigm versus normalization and the community psychology paradigm
o Similar paradigms:
Overprotection & ‘hyper parenting’
Individualization & professionalization
5. Take home message and discussion
2. Why do I need to know about it?
Question for you:
‘What could be the relevance of knowing from which paradigm a scientist makes her/his point, or an
intervention, a policy is designed?’
NB paradigms thus are never exclusively based on scientific knowledge or scientific perspectives, they often are
developed in interaction with particular normative positions in the society
What kind of vision is behind the policy?
What is a paradigm?
Paradigms are defined as theoretical perspectives, a set of coherent ideas or a philosophy that helps
us to understand the field and informs our professional actions in it
Paradigms based on a natural science perspective (Kuhn):
No linear progression but also based on consensus, scientific revolutions, new insights by the scientific
community. Paradigms can be incommensurable
Paradigms according to a social science perspective (Latour):
Total objectivity is an illusion. The production of knowledge cannot be separated from politics (and
thus from the notion of multiple interest and perspectives), but complete relativism should be avoided
3. The case of Alicia
,Scene in which Alicia claims to her caretakers who want to find her a foster home that is special: ‘I am a normal
child!’
‘Longer waiting times for youth help’ = not
More children suffer from a bad condition
- Medicalization
- Overprotection
- Individualization/professionalization
4. Normalization versus medicalization
Medicalization: the process by which previously non-medical problems become defined and treated as medical
problems, usually as diseases or disorder
E.g., ADHD, alcoholism, addiction, mental illness, eating disorders
4. On defining medicalization
‘Medicalized categories are elastic and can expand or contract’ (ADHD, PTSD, hysteria)
Medical categories change overtime
Medicalizations exist next to de-medicalization (e.g., homosexuality)
4. On medicalization
- What drives medicalization?
- The medical profession
- Biotechnology (the pharmaceutical industry, genetics, and forms of medical technology), to…
- Consumers, and managed care (including all kinds of health insurance)
4. Medicalization: not only a phenomenon of our times
Speaking for myself, I too believe that humanity will win in the long run; I am only afraid that at the
same time the world will have turned into one huge hospital where everyone is everybody else’s
humane nurse. Johan Wolfgang van Goethe, Italian Journey, Napels, May 27, 1787
‘Real troubles’ are made into individual diseases
4. medicalization as a cultural response?
- Is medicalization part of a/our culture?
- Is being traumatized not a ‘normal’ reaction to a traumatizing world?
Dirk de Wachter: the end of normality, our times are defined by psychiatric diseases and vice versa
4. on madness, normality and ‘the norm’
Paul Verhaeghe (2020) about normality and other deviances, Prometheus, Amsterdam
Verhaeghe (2020):
After Foucault: the discourse of normality (the good child) defines how we see the deviant/ill child
It is a misconception that the diagnostics according to the DSM5 is based on scientific evidence, it reflects
basically our norms on normality, and the practice associated with it.
Discourse of normality is context and time dependent
A discourse is the totality of words and images that forms a more or less coherent societal vision based on a set
of norms and values (p. 17)
4. and what about Alicia?
And what can we say about Alicia from the perspective of medicalization vs normalization?
What is the opposite paradigm of medicalization?
- De-medicalization
- Normalization
, De-medicalization: the example of the dutch youth law (2015)
Increase prevention, own responsibility of citizens, normal parenting
Decrease: specialized care
A remedy to medicalization: the educative civil society
- Chapter 4 of the winter (2012)
- Increasing demand for youth care/youth welfare despite that prevalence of problems is stable
- Reestablishing authority to the parent & civil society, & parent communities
- Further reading:
o Educative civil society
o Immigrant parents learning communities
Risk taking versus overprotection
‘Helicopter parents’ & ‘cotton wool kids’
The study of ‘parenting’ in the 21st century
- Hyper intensive parenting (hyper-version of the modernization of childhood) as part of the risk society
(Beck) ‘the risk society. Towards a new modernity’ Ulrich Beck (1992)
- What is typical for 21th century in European middle-class families? (Furedi, 2002, 2008; de Winter,
2012)
o Parenting determinism
o Professionalization
o Parenting as a separate social domain
o Individualization
o High expectations
o Anxious parents
Sharon Hays (1996) ‘the cultural contra dictions of motherhood’
Frank Furedi (2001, 2008) ‘paranoid parenting’
What is the opposite paradigm of overprotection?
Example of the opposite paradigm of overprotection: trustful parenting
(How) can we learn from practices in under schooled societies/communities?
‘Trustful parenting in our modern world’
Individualization & professionalization of child rearing (de winter (2012) chapter 4)
Professionalization as
Medicalization/psychologizing in tandem with individualization (compare hyper parenting)
Positive care: control/surveiilance (donzelot & castel)
Proto professionalization (De Swaan)
What is the opposite paradigm of individualization & professionalization?
- Community/ecological approaches
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