So this has been a big story today.
Here's what I'd like to know: why do these people believe they've found a possible way to treat autism instead of coming to the conclusion that autism is over-diagnosed? With only seven cases, and the doctors saying no conclusions should be drawn, why is it such major news? Is it really, truly that necessary to tell parents to pay attention to their children?
They say 1:68 children has some form of autism, am I the only one who sees that as utterly ludicrous? Am I the only one who thinks too many people just want a drug to make the problems go away?
To be COMPLETELY CLEAR - I am not saying I don't believe in autism. I'm sure the severe cases prove the existence of a disorder. What I'm saying is, I hate the concept of autism spectrum disorder blah blah blah because it detracts attention from a real serious issue.
Relevant, non-snarky, serious discussion thoughts?
Disclaimer: I'm 41 and I have ADD (not ADHD), my 14-year-old son has ADD (not ADHD). This is another thing that I have accepted has a name, but do not really agree that it is something that needs to be treated.
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I hate the concept of 'hairline fractures'. I'm not saying I don't believe in compound fractures, I'm sure the severe cases prove the existence of broken bones, but what I'm saying is I think the concept of 'hairline fractures' detracts attention from a real serious issue.
As long as you're starting from the position that the disorder in question don't actually exist, you're not going to get much more than snark, or other like-minded people reinforcing your biases.
All the behavioral training in the world didn't do anything to help my brother out until he found the right medicine that let the behavioral training help.
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Is it a vaccine? Please dear god let it be a vaccine!
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That would be amusing, but sadly no.Is it a vaccine? Please dear god let it be a vaccine!
Oh :( well, I guess I'll go look for ironically appropriate humor in the Ebola wars thread.
So this has been a big story today.
Here's what I'd like to know: why do these people believe they've found a possible way to treat autism instead of coming to the conclusion that autism is over-diagnosed?
Hard to tell. Could be because that didn't make a sensational news headline, or because science writing in news is horribly shoddy and doesn't take nuance into account, or because autism got merged with aspergers which is more of a personality type than a brain disorder (and reaaaly prevalent in the geek community)
They say 1:68 children has some form of autism, am I the only one who sees that as utterly ludicrous? Am I the only one who thinks too many people just want a drug to make the problems go away?
See aspergers above. That part is all about aiming for some non existent normal for people to conform to, because gods forbid we be offended by someone different than us.
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... aspergers which is more of a personality type than a brain disorder ...
As someone who had Asperger's back when it still formally existed, there's more to it then personality. There's some sensory integration issues (my brain in loud and/or light-show style environments is like an old computer running a crowded MMO region or using lots of virtual memory, my sense of smell is incredible, and I can interpret background noises as music sometimes), and even the occasional light touch of aphasia. There's also the whole "can't read humans unless they're in large print" thing, and having a 2007 unspecialized Mac be able to beat me at face recognition.
Anyway, my attitude towards a 'cure' can be best summarized as "just say 'no, get it away from me!'". In PF terms, I'd say it would a cursed item, just like a helm of alignment change or the girdle of opposite gender. Nothing's wrong with being NT, but I'm fairly used to the mind I have.
Also, early intervention to teach kids how to pass is not a cure. It's a treatment.
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As someone who had Asperger's back when it still formally existed,
hardly a unique qualification around here :)
there's more to it then personality. There's some sensory integration issues (my brain in loud and/or light-show style environments is like an old computer running a crowded MMO region or using lots of virtual memory, my sense of smell is incredible, and I can interpret background noises as music sometimes), and even the occasional light touch of aphasia. There's also the whole "can't read humans unless they're in large print" thing, and having a 2007 unspecialized Mac be able to beat me at face recognition.
Right, but my larger point (which you seem to agree with) is that none of that runs into a disease in need of a cure. Your brain (and by extention, you, because you are your brain) are just different, not worse.
Anyway, my attitude towards a 'cure' can be best summarized as "just say 'no, get it away from me!'". In PF terms, I'd say it would a cursed item, just like a helm of alignment change or the girdle of opposite gender. Nothing's wrong with being NT, but I'm fairly used to the mind I have.
I'd say its more like an apparatus of the crab. Its not the usual cloak of resistance and you're not sure what you ARE going to do with it, but its so different from the cloak that they're completely incomparable.
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As someone who had Asperger's back when it still formally existed,hardly a unique qualification around here :)
there's more to it then personality. There's some sensory integration issues (my brain in loud and/or light-show style environments is like an old computer running a crowded MMO region or using lots of virtual memory, my sense of smell is incredible, and I can interpret background noises as music sometimes), and even the occasional light touch of aphasia. There's also the whole "can't read humans unless they're in large print" thing, and having a 2007 unspecialized Mac be able to beat me at face recognition.Right, but my larger point (which you seem to agree with) is that none of that runs into a disease in need of a cure. Your brain (and by extention, you, because you are your brain) are just different, not worse.
Anyway, my attitude towards a 'cure' can be best summarized as "just say 'no, get it away from me!'". In PF terms, I'd say it would a cursed item, just like a helm of alignment change or the girdle of opposite gender. Nothing's wrong with being NT, but I'm fairly used to the mind I have.I'd say its more like an apparatus of the crab. Its not the usual cloak of resistance and you're not sure what you ARE going to do with it, but its so different from the cloak that they're completely incomparable.
Yes, I do agree that I don't need a cure.
I guess I call it a cursed item because I doubt a cure could be deactivated and reactivated at will, whereas you can just choose not to use the apparatus of the crab if you don't want it. Owning one doesn't leave you trapped inside a robot when you'd rather not be.
EVERYONE has something about their brain they don't like. If you're typical you're by definition not as smart as some people for example. There is however no "normal" to turn on and frankly given how most people are the hypothetical normal is a fate to avoid like the plague.
EVERYONE has something about their brain they don't like. If you're typical you're by definition not as smart as some people for example. There is however no "normal" to turn on and frankly given how most people are the hypothetical normal is a fate to avoid like the plague.
This is along the lines of how I think about it too. There are those who just want everyone to fit into one mold, and those who don't need to be "fixed". I don't like it one bit.
Regarding Aspberger's, I'm willing to bet I could find a number of doctors that would diagnose me with it as well. But like NoncompliAut said, I'm happy with who am I (though I wish I could dump the migraines).
What are your qualifications to make that decision, because you are going against hundreds, if not thousands, of doctors, and thousands of hours of research.
My only qualifications are that I'm a thinking person that just doesn't automatically agree with what people tell me. I give it a bit more weight if it's information coming from professionals, but I've had a number of professional doctors misdiagnose problems I've had in the past. I think there are some cases where "experts" get away with things just because they're "experts". You've heard of Stanley Milgram, no?
All the behavioral training in the world didn't do anything to help my brother out until he found the right medicine that let the behavioral training help.
But at least behavioral training was tried first before drugs were added? If drugs are necessary, there is no problem with that. I just don't like that in many cases drugs seem to be the default position.
Again, small study. Needs more research, longer term, more patients, etc. But interesting. And it's not a "give them drugs" approach, so that's good, right?
Agree on all counts. I just wish the media could not jump in and sensationalize a story that really isn't yet. But I'm sure we all know that will never, ever be the case.
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They say 1:68 children has some form of autism, am I the only one who sees that as utterly ludicrous? Am I the only one who thinks too many people just want a drug to make the problems go away?What are your qualifications to make that decision, because you are going against hundreds, if not thousands, of doctors, and thousands of hours of research.
The problem is that its pretty clear what they're doing to reach that number. They're grouping
Autism
and
"Autism spectrum disorder" which can constitute anything from autism to a personality type known as "the geek".
I don't Think it takes any special training to notice that what most people think of as autism isn't nearly that prevalent.
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As someone who has worked as a behavioral analyst for 10 years, there does seem to be a lot of misinformation spread about an "epidemic" of autism. Please understand that it wasn't until the DSM4 came out that Aspergers was classified under the autism spectrum umbrella. That meant millions more people were officially diagnosed with ASD (Autism Spectrum Disorders). In addition to this, we now have a stable method of diagnosing children as early as 24 months (the MCHAT), which is about 4 years earlier than used to happen. Also, now that ASD is more well known, many families (especially from inner cities who may not have found out about their child's needs till they went to school) are seeking treatment earlier. All this leads to a larger population hat are correctly diagnosed with ASD earlier.
Are there doctors who are misdiagnosing children as having an ASD? Undoubtedly. I do believe the main reasons for an explosion of cases is better diagnostics, for the most part.
As to a "cure" for ASD... Well, one of the few things that we absolutely know is that all ASD are neurodevelopmental disorders most likely genetic in nature. There has never, to my knowledge, been a cure for a neurodevelopmental disorder. There are practical, behavioral methods that have been proven to work with many people and some drugs that can help people with ASD to deal with concurrent disorders (like depression and anxiety disorders) that can cause maladaptive behavioral, learning, and sensory integration issues in people with ASD to be even more apparent.
Sorry for the rant, but in have spent many years working with people with ASD and when someone claims to have a cure, it is frustrating as families get sucked in so easily. Then they get hurt.
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They say 1:68 children has some form of autism, am I the only one who sees that as utterly ludicrous? Am I the only one who thinks too many people just want a drug to make the problems go away?What are your qualifications to make that decision, because you are going against hundreds, if not thousands, of doctors, and thousands of hours of research.The problem is that its pretty clear what they're doing to reach that number. They're grouping
Autism
and
"Autism spectrum disorder" which can constitute anything from autism to a personality type known as "the geek".
I don't Think it takes any special training to notice that what most people think of as autism isn't nearly that prevalent.
Actually you are WAY off. All ASD have fairly rigid definitions. Geek doesn't fit the bill. Actually, it is kind of insulting.
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Just read the article... Lol. This is not news. One of the only things we know that helps the majority of people with ASD is early intervention. Really, the only thing new about this is that a news story actually reported about ASD without talking like the world is about to end. There are a number of studies (large scale) that back up the assertion that early intervention helps. If you are interested, check out the JOURNAL OF APPLIED BEHAVIOR ANALYSIS site. They have a good search engine to find relevant articles.
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So this has been a big story today.
Here's what I'd like to know: why do these people believe they've found a possible way to treat autism instead of coming to the conclusion that autism is over-diagnosed?...
As a professional who specializes in the research and treatment of ASD and as a person on the spectrum themselves, I feel it is critical to state that ASD is absolutely NOT over diagnosed in the super-majority of cases since the transition to the DSM-5 diagnostic standards. The frequency of false positives has plummeted and the reliability of diagnoses from geographically distant practitioners has greatly increased (that is the likelihood of two separate diagnosticians returning identical results for the same patient).
1:68 is likely an understatement of the number of actual incidences of ASD as well. Individuals with Level 1 ASD sometimes have an easier time of blending into society given the milder nature of our condition, but that does not change the fact that we are a part of the population.
Actually you are WAY off. All ASD have fairly rigid definitions. Geek doesn't fit the bill. Actually, it is kind of insulting.
Insulting to our hobby or psychiatry?
The first tends to come with a certain amount of self awareness of our own faults and self depreciating humor. The second is too subjective for anything I'd consider rigid definitions.
Could you tell me what you would see for aspergers that you wouldn't see a plethora of at gencon?
The three criteria are significant levels of:
1. Rigid or ritualized behaviors ( for example, rocking or flapping of hands)
2. Social delay
3. Communication delay.
You might see one or two of these issues in an average convention goer, but all three are less likely than you might think.
Yes, different people who have been diagnosed with ASD may show these symptoms more or less, but all three are present.
And psychiatry has little to do with ASD. Only the French actually use psychoanalysis to tear ASD. the gold standard is based in behaviorism.
Treat, not tear...
You might see one or two of these issues in an average convention goer, but all three are less likely than you might think.
Yes, different people who have been diagnosed with ASD may show these symptoms more or less, but all three are present.
Thats narrower than other definitions I've seen. Linky
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
Sorry Wolf if I came on strong. I am just really passionate that appropriate treatment is received as soon as possible, and get nervous when people talk about how Aspergers or other ASDs isn't really any different than a gamer geek... It felt like you were belittling a disorder that can be really debilitating.
Again, sorry. I think I over reacted
You might see one or two of these issues in an average convention goer, but all three are less likely than you might think.
Yes, different people who have been diagnosed with ASD may show these symptoms more or less, but all three are present.Thats narrower than other definitions I've seen. Linky
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
Yes, but now that Aspergers I has been swallowed up by Autism in the DSM5, that broader ASD definition applies.
Just checked your link, and I believe you missed the rest of the diagnosis from the DSM4
Included it as I don't know how to link.
[The following is from Diagnostic and Statistical Manual of Mental Disorders: DSM IV]
(I) Qualitative impairment in social interaction, as manifested by at least two of the following:
(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)
(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia."
And Ovulsion is correct. It was updated in the DSM4tr
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Sorry Wolf if I came on strong.
Please, you haven't even insulted my intelligence once. Its been 3 posts. A new record!
I am just really passionate that appropriate treatment is received as soon as possible, and get nervous when people talk about how Aspergers or other ASDs isn't really any different than a gamer geek...
I think it is different but its a matter of degree rather than kind. I don't know if Autism and aspergers are related at all by anything but a a few of the same behaviors, and that's a tentative way to connect things in something as complicated as the human brain.
It felt like you were belittling a disorder that can be really debilitating. Again, sorry. I think I over reacted
No, just some of the number crunching, lying with statistics, and the subjective nature of psychology. (Not really a fan). Helping people is a noble goal, and I believe that people can be great at it, but I'm skeptical at how much objectivity is claimed by what is ultimately a very subjective practice. I mean nothing actually changed, but someone moved a definition a little bit (like above) and look what happened: autism goes from something rare to something every second or third classroom has to deal with.
I agree that it is an area that would be well served by serious, intelligent and relevant articles, and mostly harmed by sensationalism. This (I couldn't find it from the link) seems to be a good example of the second kind. A study of seven patients is not something you can conclude much of anything from.
Autism and Asperger's syndrome are relatively new entities. While they were described several decades ago (Leo Kanner described classic autism in the 40s), it always takes a good, long while for this understanding to penetrate society, human thought and tradition to a functioning system of diagnosis, research and the beginnings of treatment. Even when that has happened, ways to file off the false positives and negatives are a work in progress. This situation has been the case for most known health conditions. It should surprise nobody that it happens to ASD (and ADHD, another example of a relatively recent discovery). When understanding and diagnosis grows, you WILL see a dramatic rise in the numbers of the diagnosis - of course. This is not a sign of malfeasance, even though many think so.
The next thing you need to understand is that autism/Asperger's syndrome is the term for the point on a scale where the symptoms actually hinder you. See the definition above. There are MANY people with symptoms of it that are not significantly hindered by it. A very large part of the population has what is called autistoid traits - traits shared by ASD patients. These are things like perfect musicality, difficulties in wearing watches because they remain aware of it all the time (most people stop noticing it after a while), increased tolerance to cold, and so on. The common denominator of some of these traits seem to be that the mind processes parts rather than the whole for preference, something also seen clearly in ASD patients. And of course, this does have some advantages.
Being a geek does not mean you have ASD. If you have ASD, it is quite likely you will find much in geek culture to your liking, however.
Are you saying ASD is a fairy tale, BNW? Or something else, hopefully?
Are you saying ASD is a fairy tale, BNW? Or something else, hopefully?
ACK! No.
Ah. =)
First off, thanks to everyone making an effort to keep on topic.
So now I have some questions for the professionals that have shown up. Given that the DSM is created and updated by professionals in psychology/psychiatry, how do the rest of us assure that it doesn't become a totally self-serving document? Given that many of the classified disorders have a genetic component and are very treatable, what are the odds that the ratio of people with a classified disorder becomes 1:1 in the future? Is that even something to be concerned about, or is it just worth a collective shrug? What can be done to fight the "there's a drug for that" mindset? Should anything be done to fight that mindset?
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Good questions. Let me try to answer this.
What existed before the DSM (and the ICD) was no system at all. Depression was one thing in France and another in the UK. Studies diverged hopelessly since the points measured varied so widely. In short, having a standard for psychiatry is a GOOD thing. Now, if someone in South Africa makes a study about depression, everyone will know that the criteria used were at least roughly comparable. I say roughly, because there are certainly other related issues that have not been solved (such as which rating scales are used).
The making of the DSM is not a secret process. Rather, it is open, widely debated, involving many, many people. Certainly, there is factionalism and people trying to profit, but they are far from alone in writing it. Note also that though the diagnoses are detailed in it, there are no recommendations for treatment there. Most significantly, though, psychiatry is much like foreign aid: Unceasing need and demand, always a lack of supply. Trust me when I tell you that nobody has a serious interest in "making patients". Yes, Big Pharma would love that, but every diagnosis is something a doctor needs to put and then treat. Psychiatric patients typically have the resources to pay for long-term care themselves, and so they only get it if someone helps pay for it. At the end of the day, it is the politicians who decide what psychiatric care looks like, which patient groups to prioritize, and so on. Sum total: Don't worry about too much psychiatry.
This becomes even more clear when you look at the ratio you describe. About half of humanity will have a serious depression in their lives. At any given moment, 8% of us suffer from depression. 10% or so will have substance-abuse problems at some point. 1-5% will be bipolar. 1% will have schizophrenia. Everybody has anxiety every so often, but 10-25% have clinical levels of OCD, panic attacks, generalized anxiety disorder, or such. Add in Alzheimers disease, psychiatric problems associated with other disorders (depression after stroke, for example). Suicides are expected to (or have already) overtaken accidents in various measurements of risk of death, after only cardiovascular disorders. All this points to one serious conclusion: Psychiatric disorders are ALREADY a massive problem that leaves noone or very few people untouched. The sad fact here is that we can't deal with what we have today due to a lack of resources. If people did more than give a collective shrug, the effect would be massive.
Drugs are not what most people think they are. Each psychiatric drug, like all other medical drugs, has been tested for more than a decade in very expensive and thoroughly exhaustive studies. The substances are purified and isolated to lower the risk of side effects. VERY few of them are addictive (Morphine derivates, bensodiazepines and central stimulants, generally). The side effects they do have are at least fairly minor. So... if we have a patient who can't have a functioning life without taking medication (schizophrenia, bipolarity, serious depression at least), why is it wrong to test a drug to see if it helps them? If they don't feel better for it, they will stop taking it. It is not uncommon that someone has to switch to another drug that suits them better. I don't see it as a problem.
Finally, it is worth addressing the principle here. As human knowledge grows and we understand the system better, we will naturally come to see certain traits as expressions of disorders that were not previously identified. Why? Because it gives us a handle on helping those people. It is all well and good to say things like "ADHD is just b!##~%*~ designed to sell medicine" if you and yours do not have that particular problem - but should this be the basis for health care in our society? "Cut out cancer care, it's too expensive, and in my family we always die before sixty in heart attacks anyway", "Alzheimer's disease is a lie, and nobody in my family has ever gotten it, so who cares if there are medications that work?"
They say 1:68 children has some form of autism, am I the only one who sees that as utterly ludicrous? Am I the only one who thinks too many people just want a drug to make the problems go away?
Just something to note with regards to this statistic is that all diseases have very mild forms that are hard for casual acquaintances to notice beyond a person generally being strange or off. In the past there were no real treatments and people were just expected to deal with mental illness themselves or with their families. As a result there is a cultural bias against getting chemical help even when it is the real solution. For point of reference about 1 in every 200 people suffers from schizophrenia, and in males this number jumps to nearly 1 in every 100. Most of the time this manifests not a full blown hollywood hallucinations but things like hearing sounds that aren't there, disorganized thinking that makes conversations difficult or impossible to keep up with, and delusions or persecution. Most of these can be ignored or overlooked unless a person actually gets examined by a professional.
Given that the DSM is created and updated by professionals in psychology/psychiatry, how do the rest of us assure that it doesn't become a totally self-serving document? Given that many of the classified disorders have a genetic component and are very treatable, what are the odds that the ratio of people with a classified disorder becomes 1:1 in the future?
Sissyl's answers were excellent, though I might disagree a bit about the interest in "making patients" in some cases, but I would add one additional note to them:
Like most things in life there are at least two sides. Especially when money is involved.
Insurance and managed care companies have their own mental health professionals involved in both the DSM/ICD revision processes. In addition, many plans and policies are managed in a way that require precertification or authorization for services (mostly excepting "standard" outpatient treatments). Effectively there is already one layer of oversight to what is being billed, which translates to what is being treated (though I acknowledge many might argue any layer is too much).
From what I've observed, autism treatment itself is in an interesting phase in the US, as far as legistlation and recognition goes, especially on a state level. In addition, with the introduction of mental health parity laws a few years ago, there are more and better treatment options available in many areas for mental health treatment for autism and other diagnosis.
-TimD
Thanks Sissyl, you make some interesting points. I know I have a few more thoughts and questions, but they'll have to wait until I get home and off my phone.
Also, just for clarification, I'm not dead set against people taking drugs ever. I just believe that non-drug treatments should always be attempted first. I believe that informed people should be allowed to do what's best for them as long as it isn't harming others. My concern is for the uninformed who have a habit of being taken advantage of.
What are the odds that the ratio of people with a classified disorder becomes 1:1 in the future?
What are the odds that the ratio of people with a physical disorder becomes 1:1 in the future?
I'm shocked, -- shocked, I tell you, -- to learn that people have medical histories. If I remember my medical history correctly, I have experienced a broken bone, a dislocated thumb, a case of adult-onset chicken pox, a concussion, and have had several fillings in my teeth. I also wear glasses. Why, this obviously must be the result of rampant overdiagnosis, because there's no way that any one person could have all this go wrong with them over the course of a lifetime.
My general rule of thumb is that everyone has a pathology of some sort -- no one is truly "normal." This applies to the physical as well as the mental. Few pathologies are truly life-threatening; I don't think I'd die if you hid my glasses or if the doctor had set my leg wrong. But both of those are certainly treatable, and I have a much better quality of life wearing my glasses than not.
I'd similarly urge anyone with doubts about their visual acuity to go to an optometrist and get an opinion about the appropriateness of treatment (glasses).
Thanks Sissyl, you make some interesting points. I know I have a few more thoughts and questions, but they'll have to wait until I get home and off my phone.
Also, just for clarification, I'm not dead set against people taking drugs ever. I just believe that non-drug treatments should always be attempted first. I believe that informed people should be allowed to do what's best for them as long as it isn't harming others. My concern is for the uninformed who have a habit of being taken advantage of.
Non-drug treatments are preferable and no one should be forced to undergo a medical procedure they don't want to, but they should always be available and people shouldn't be stigmatized for taking them.
The thing is, in America at least, these medications all require prescriptions which have to be given by a doctor. Doctors don't receive any money for prescribing medication, they receive money from visits and in house administration. Additionally the possibility for corruption and collusion between drug companies and doctors has been considered by the state and is rather tightly investigated in most areas. Since the 80s you have had to report all interactions between clinical offices and drug companies and more recently every single transaction has become a part of the public record. This has actually caused my office to stop even going to any sort of lunch meeting or out of state lecture on new medications, simply because any compensation or assistance they receive is listed as a gift in dollar amount between the pharmaceutical company to the practice. So for instance plane tickets for all the doctors is simply listed as the drug company gifting us several thousand dollars.
Finally, it is worth addressing the principle here. As human knowledge grows and we understand the system better, we will naturally come to see certain traits as expressions of disorders that were not previously identified. Why? Because it gives us a handle on helping those people.
I'd just like to +1 this.
Medical history is littered with things that were considered simply to be part of ordinary human variation or the natural order of things. Now we know better. Malaria isn't caused (as the name suggests) by "bad air," but by mosquito bites. Childbed fever isn't something that "just happens" if the medics take appropriate sanitary precautions. Measles isn't an ordinary part of childhood any more, because we understand vaccines. People don't catch "consumption" from milk any more.
I look forward to the day when Alzheimer's, depression, and disconnected children with bad grades are seen as preventable relics of medical ignorance like measles and rickets are today.
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I'm going to attempt to cover the points that Sissyl did not already address in their rather comprehensive response.
First off, thanks to everyone making an effort to keep on topic.
So now I have some questions for the professionals that have shown up. [1.]Given that the DSM is created and updated by professionals in psychology/psychiatry, how do the rest of us assure that it doesn't become a totally self-serving document? [2.]Given that many of the classified disorders have a genetic component and are very treatable, what are the odds that the ratio of people with a classified disorder becomes 1:1 in the future? [3.]Is that even something to be concerned about, or is it just worth a collective shrug? [4.]What can be done to fight the "there's a drug for that" mindset? [5.]Should anything be done to fight that mindset?
1. The probability of the DSM becoming a self-serving document is so statistically unlikely that it can safely be called impossible in this lifetime. Additionally, since the DSM does not include treatment recommendations, there would be an exceptionally small return for the amount of effort required to influence the DSM to such a degree.
2. Who's to say that it was not 1:1 all along? The only reason I doubt we'll ever see that ratio are that there will always be some fraction of the population unwilling to get a diagnosis.3-5. Sissyl pretty much nailed these.
What are the odds that the ratio of people with a classified disorder becomes 1:1 in the future?What are the odds that the ratio of people with a physical disorder becomes 1:1 in the future?
I'm shocked, -- shocked, I tell you, -- to learn that people have medical histories. If I remember my medical history correctly, I have experienced a broken bone, a dislocated thumb, a case of adult-onset chicken pox, a concussion, and have had several fillings in my teeth. I also wear glasses. Why, this obviously must be the result of rampant overdiagnosis, because there's no way that any one person could have all this go wrong with them over the course of a lifetime.
My general rule of thumb is that everyone has a pathology of some sort -- no one is truly "normal." This applies to the physical as well as the mental. Few pathologies are truly life-threatening; I don't think I'd die if you hid my glasses or if the doctor had set my leg wrong. But both of those are certainly treatable, and I have a much better quality of life wearing my glasses than not.
I'd similarly urge anyone with doubts about their visual acuity to go to an optometrist and get an opinion about the appropriateness of treatment (glasses).
Sorry, I didn't realize broken bones and bad eyesight were classified neurological disorders. I think one of us may have made a mistake.
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Sorry, I didn't realize broken bones and bad eyesight were classified neurological disorders. I think one of us may have made a mistake.What are the odds that the ratio of people with a classified disorder becomes 1:1 in the future?What are the odds that the ratio of people with a physical disorder becomes 1:1 in the future?
Yes. You seem to think there's a quota on "classified neurological disorders" that is obviously nonsensical when applied analogously to physical ones. This is indeed a mistake, and I pointed it out. Perhaps I was too subtle.
It is not as if non-drug treatments have not been studied as to efficacy as well. We know by now pretty well which conditions it helps in a significant way. Generally, the more severe psychiatric disorders are not receptive to such treatment, because when you're in that situation, you can't make sense of the therapy anyway.
Yes, indeed, nobody should be forced into medication - so long as their condition doesn't prevent them from understanding such treatment options. A severely paranoid, delirious, psychotic or severely depressed person can't make those calls, and needs society to step in and force him or her to an effective treatment. These sorts of laws exist in most or all countries in the world. I am deeply thankful for them, to be honest - it would be horrible if people who are that ill couldn't get help.
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Forgive me if this has been stated this way, but diagnosis is also important for qualifying for resources. This is how I've worked with many people with autism and mostly gives a frame of for behavioral treatment, day programs, parenting techniques, talking with teachers and other caretakers, etc. Also there is no "autism drug", and those who need medications get them for diagnoses often comorbid with autism, such as seizure disorders, dyspepsia, rarely some psychotic disorders (those individuals with disabilities are at MUCH greater risk for abuse). Many people are able to manage behavior through behavioral programs.
Typically, autistic patients are helped by anxiolytics and sedatives to handle anxiety and sleep disorders, and since they do have a higher risk of other psychiatric disorders, many other specific treatments can be useful at various points. However, nobody has yet found any sort of drug that specifically and significantly helps them with their ASD problems.