3.1.1 Treatment or management?
In the preceding paragraph you will notice that we talked generally about the treatment of conditions, but referred to ‘managing’ dyslexia. Why did we do this? It relates to the following important general issues:
Is treatment (i.e. intervention) warranted ? We mentioned this issue when we were discussing sociocultural or personal distress based definitions of abnormality. Intervention is not always desirable or sought by the individual, who may feel that what other people perceive as ‘abnormal’ is little more than an individual difference that simply requires increased awareness on the part of other people. For example, some people with hearing impairment do not use hearing aids, which they find unnecessary or distracting. A hearing aid may make life easier for hearing individuals speaking to someone with a hearing impairment because it means that they do not have to adjust their own behaviour to accommodate the other person's difficulties. But it may not make life easier for the hearing impaired person. From this perspective, such an intervention is just as unnecessary as it would be if all hearing people were required to communicate in sign language. Alexander Faludy's case study provides a good illustration of someone who has found a way of managing his difficulties, most of which are only perceived as ‘difficulties’ because of the constraints and expectations that he is expected to work within.
Are all conditions ‘curable’ ? In many cases it is simply not possible to treat the condition in the sense of ‘curing’ it, and so the individual often has no choice other than to find a way of managing his or her symptoms. As already noted, few psychological conditions have a single cause that would respond to appropriate treatment and disappear, because of the complex interaction of different factors and the difficulty in altering some types of biological difference. Moreover, it is worth considering what might be lost as well as gained if some types of psychological functioning were ‘corrected’. Dyslexia is often associated with compensatory strengths (as described in the Case Study in Section 1.3). If all children could be inoculated against developing dyslexia, then these strengths may also fail to develop. A crucial point to consider is whether the gains of any intervention might outweigh the potential losses.
What caused it ? Choice of intervention is often influenced by what is believed to cause the condition. For example, if the primary difficulty is believed to be cognitive then the strategy for intervention may also centre on addressing cognitive rather than biological or social aspects of the situation. As we shall see, dyslexia is a good example of a condition where intervention strategies have been largely cognitive in nature, but increased understanding of its biological basis is leading to new possibilities. In contrast, children with ADHD are already offered drug-based treatments simply because these appear to calm their disruptive behaviour, despite the lack of any clear evidence for corresponding biological theories of what causes this ‘syndrome’. However, the idea of prescribing such drugs to young children has proved controversial in the UK and raises issues to do with the appropriateness of some treatments. Do the ends really justify the means? As we have seen, most ‘problem’ behaviours are usually sustained by many influences operating at different levels. This means that in some circumstances any intervention that helps to break what is sometimes a vicious cycle may be beneficial. Although it is helpful if a clear ‘primary cause’ can be identified and tackled, this is not always necessary for treatment or management strategies to be effective.