Diagnosis and the problem of how we view knowledge

[Posted on 9 January, 2018 by Magnus Landgren]

The word diagnosis comes from Greek, and originally refers to the ability to distinguish between different things as well as the ability to judge, assess and evaluate. The most accurate distinction and assessment possible is a prerequisite in order to provide the best possible treatment. A correct diagnosis is founded on thorough examination and should first and foremost benefit the patient. Medical diagnoses can be adjusted over time with increased experience and research according to scientific methodology.

A person studying to become a special educator today is taught different educational perspectives to be applied and tried in supportive efforts for children with learning difficulties. The knowledge about these children’s cognitive disorders does not, even now in 2017, appear to have been integrated with an evidence-based pedagogic approach. Student health services should be able to offer comprehensive investigations to the children with learning difficulties and behavioural problems, where medical, neuropsychological and pedagogic experts collaborate, complemented when necessary by counsellors, speech therapists, work therapists and physical therapists.

One fundamental problem, according to the recently published book ”Kunskapssynen och pedagogiken – varför skolan slutat leverera och hur det kan åtgärdas”, i.e. ”Our view of knowledge and the state of pedagogy today – why schools are no longer delivering and how we can fix it” (Inger Enkvist, Magnus Henrekson, Martin Ingvar, Ingrid Wållgren. Dialogos förlag 2017-08-17), is ultimately the prevailing view of knowledge within the school bureaucracy/educational policy complex. Learning and automatising basic skills like reading and writing has been neglected and keeps being neglected in favour of process-oriented thinking, without any clear and explicit teacher-headed progressive knowledge goals. The primary goals of Swedish schools, in what is still a contradictory curriculum (Lgr11), are best interpreted as whatever students and parents themselves want them to be, emphasising collaboration, rather than serving as a time and place for transferring knowledge. Truth is not considered to be a question of correspondence with reality, but rather something that is constructed in a social context and thus essentially subject to a majority ruling. Without objective knowledge, we are at a loss when solving societal problems, building houses, treating illnesses and establishing a common language for discussion and exchanging ideas. The authors argue that school is of paramount importance to the future of our society, and that how we view knowledge is absolutely critical.

Not long ago, I heard about a boy in a major Swedish city who had been in a kind of play therapy since the age of three, but who now, at the age of ten, had been examined and had his symptoms diagnosed as autism and ADHD. He objected heavily to his new therapy sessions, and his therapist, not being very knowledgeable about autism anyway, thought that the boy might as well be allowed to stop undergoing therapy. The relativistic view of knowledge has affected and continues to affect even parts of health care services in their approach to facing children with learning difficulties and behavioural problems. Different non-evidence-based treatments are offered without adequate examinations, and patients are often kept waiting for examination and treatment for years.

In the name of equal health care, processes are emphasised in much the same way as in schools, and just as one might have thought that schools have the unequivocal objective of providing knowledge, one might have believed and assumed that health care services strive towards the ultimate goals of correct diagnosis and treatment. But even in health care services there are sometimes functional care units – just as there are sometimes well-functioning educational units, i.e. schools – that are re-organised to become non-functioning units, all in the name of equal treatment and common processes. All the systems are working like the bureaucracy in Washington, “No one is doing anything wrong, all the systems are delivering exactly according to plan, which is to say nothing at all”. It is not primarily a matter of resources, to quote Martin Ingvar, “One cannot compensate for going in the wrong direction by going faster”.

An interesting article in the scientific paediatric journal Pediatrics (Misdiagnosis and Missed Diagnoses … I J Chasnoff et al 2015;135;26) showed that specialised “funnel clinics”, i.e. ones that focus on one or two specific diagnoses, like e.g. ADHD and autism, tend to not only overlook relevant diagnoses but also hand out incorrect ones. It turned out that real and current knowledge and expertise was important in order to function in accordance with “science and proven experience”. This is just as important as educational methods in schools being determined and implemented by knowledgeable, competent educators with both formal and practical pedagogic merits.

[This is a blog. The purpose of the blog is to provide information and raise awareness concerning important issues. All views and opinions expressed are those of the writer and not necessarily shared by the GNC.]