ABSTRACT
Various studies in the social sciences have shown an expansion of abnormality, or rather of the commonly held idea of medical abnormality in wealthy countries. Examples illustrating this abound: the definition of autism has widened leading to a rise in actual and related cases, ‘normal’ cholesterol levels are increasingly exacting, and childhood lead poisoning has gone from being rare to having the status of an epidemic in France, due to a decrease in the level of lead considered acceptable in the blood stream (Vailly 2008). Without seeking to provide an exhaustive account, it is possible to identify several of the modi operandi through which this expansion occurs. One of these is population screening, which now includes more people presenting a wider range of physical characteristics to the medical gaze (Armstrong 1995). Another is the evolution of the mental health field: Robert Castel (1991) has shown the expansion of medical practices in this area, from psychiatry to psychology, including psychoanalysis and behavioural therapies. The increasing precision of biomedical techniques constitutes yet another mechanism through which this trend operates. Among many other examples, pregnancy ultrasounds can be cited, where the detection of small anatomical abnormalities associated with an increased risk of chromosomal anomaly can lead to dilemmas for both parents and professionals regarding how to proceed, as well as to the loss of foetuses due to further, more intrusive, tests (Getz and Kirkengen 2003). Economic pressures can also play an important role when abnormality becomes a source of profit for pharmaceutical companies or a criterion for exclusion from various forms of social protection. In Belgium, in particular, Ine Van Hoyeghen and colleagues (2006) have shown how in the case of bank insurance, normality is not defined by the absence of illness but by the absence of risk, and a substantial number of people do not fall within the category of normality due to financial and banking reasons. It should, however, be noted that this expansion is partly countered by profound social and economic inequalities which can, on the contrary, lead to the people in question having a restricted conception of medical abnormality. This is the case, for example, concerning the absence of early detection of tumours in immigrant women in Australia (Markovic, Manderson and Quinn 2004). Because these women normalize abnormal signs or because their experience of bodily abnormality is not in line with medical explanations, diagnosis of gynaecological cancers is delayed or impaired for them. Furthermore, the study of social inequalities in access to Down’s syndrome screening in France has revealed that there is a higher level of prenatal diagnosis in women of higher socio-economic status, which means that foetuses considered to be abnormal by these woman could be considered normal for women more
distanced from the medical field (Khoshnood et al. 2006). Despite these important qualifications, generally speaking Western biomedicine appears to have more and more means at its disposal to produce medical abnormality. In this context, one of the issues at stake for the social sciences is to try to understand how this expansion is linked to societal values. In this respect, bringing down levels of detection and tolerance for illnesses is part of a larger movement rejecting bodily impairment, which is increasingly considered to be intolerable (Fassin and Bourdelais 2005). The example of newborn screening can afford us an understanding of one of the ways in which this takes place.
