Diagnosis Distributed: A Sociocultural Analysis

Year: 2016

Author: Davies, Kim, Renshaw, Peter

Type of paper: Abstract refereed

‘Diagnosis’ is commonly understood as a personal experience, sought for and by individuals and conducted and conferred by individual expert practitioners, like clinicians. From a sociocultural perspective however, ‘diagnosis’ can be considered both as a sociocultural practice and a cultural tool (Vygotsky, 1934; Wertsch, 1998), one that helps maintain the seemingly ‘natural’ boundaries between particular individuals as well as maintaining the flow of socially constructed if ‘naturalised’ categories of difference across and from public to private spaces. In our paper we take up a sociocultural perspective - tweaked critically - to challenge the prevailing common sense view by positing ‘diagnosis’ as an inextricably socio-personal practice, distributed through sociocultural spaces and across sociocultural actors in a phenomenon that we call distributed diagnosis (Davies, 2016). Using a range of cultural artefacts including the transcript of a clinical interview involving a psychologist, parents, a child and the diagnosis of ‘Asperger’s Syndrome’, we analyse ‘diagnosis’ by applying Bakhtin’s (1984) concept of chronotope in new ways to explicate the historicised sociocultural conditions and shared personal-in/and/as-social practices that have elevated diagnosis to such contemporary prominence - as an individualised experienced of simultaneous identity-fication and social placement. Our chronotopic reading of diagnosis as socioculturally distributed enables an alternative framing of the current prevalence of diagnosis in schooling, especially in what is represented as ‘inclusion’, understood here as the systemic commitment to meeting the learning needs of all students in regular schools and mainstream classrooms (Salamanca, 1994). We conclude our paper with considerations of the role of schooling and teaching in the continuing distribution of diagnosis and through it, the individualised medicalisation and pathologisation of those students deemed to be ‘at risk’ of having ‘special needs’. Being ‘at risk’ is risky for students, especially since this categorisation is often preliminary to outright exclusion from or a precursor to conditional participation in mainstream schooling, carrying, as effects, inequitable legacies in social outcomes and personal wellbeing. Our analysis highlights the complex challenge of working inclusively with students in ways that don’t sear the historicised sociocultural context from frame through a blinding spotlight on the biological, psychological and increasingly neurological make-up of particular individualised students.