Saturday, November 11, 2006

Diagnosing Kids: No Standards--UPDATE

UPDATE: I'm going to keep this post at the top for a while, because the topic is important and deserves some discussion. Please read the comments. There are some interesting thoughts.

The problem with psychiatry and psychology, well one of them, is the inability to agree on what exactly is the problem. For all the jokes about economists disagreeing on how to diagnose the state of financial affairs, the mental-health profession is notoriously unscientific and unstandardized and divided about mental affairs. This from the New York Times' writer Benedict Carry:

“Psychiatry has made great strides in helping kids manage mental illness, particularly moderate conditions, but the system of diagnosis is still 200 to 300 years behind other branches of medicine,” said Dr. E. Jane Costello, a professor of psychiatry and behavioral sciences at Duke University. “On an individual level, for many parents and families, the experience can be a disaster; we must say that.”
Part of the reason these "disasters" happen, of course, is that every person is an individual and variable and unique. Even more important, every psychologist and psychiatrist is individual and unique and bristles at the notion of imposed criteria even though the DSM receives as much reverence as the Bible.

So, adults, but even more concerning, children, receive various and sundry diagnoses and treatments depending on who they see and that health care professional's beliefs and biases. Children who aren't really mentally unbalanced receive diagnoses when the answer might be diet, discipline, parenting skills, getting a moral education (i.e. church) or changes in academic environments (to name a few changes.) Everyone today, has a mental problem. And children are being diagnosed, "treated" and medicated younger and younger. And that leads to the state were in today:
At least six million American children have difficulties that are diagnosed as serious mental disorders, according to government surveys — a number that has tripled since the early 1990s. But there is little convincing evidence that the rates of illness have increased in the past few decades. Rather, many experts say it is the frequency of diagnosis that is going up, in part because doctors are more willing to attribute behavior problems to mental illness, and in part because the public is more aware of childhood mental disorders.
There is no such thing as Jame's Dobson's "Strong-Willed Child". There are only children, heck, there are only adults, who have "disorders" or "issues" that must be medicated and treated.
Beginning in the 1990s some researchers began to argue that bipolar disorder was underdiagnosed in adults. Soon, several child psychiatrists were arguing that the illness was more common than previously thought in children too.

Some experts who made those arguments had ties to manufacturers of antipsychotic drugs, financial interests disclosed in professional journals. But the message struck a chord, particularly with doctors and parents trying to manage difficult children.

Parents whose children have been given the label tend to adopt the psychiatric jargon, using terms like “cycling” and “mania” to describe their children’s behavior. Dozens of them have published books, CDs, or manuals on how to cope with children who have bipolar disorder.
Is this healthy? Is there any scientific basis for these sweeping cultural and health care changes? No and no.

Too many adults absolve themselves of responsibility and the mental health profession encourages this--more patients equals a better economic future. Too many adults lack coping skills and pass this deficit along to their children.

Even children with diagnoses like Autism, must eventually decide (if they are able) how to navigate the world and usually this decision hinges on the parent's own decision about how to interpret Autism. "Oh it's terrible, debilitating, a life-long scourge". Or, "This is what you're capable of, I know you can do it, and how can we make this happen?"

The mental health profession, by removing responsibility, removes the patient's ability to change his or her lot in life. This is terribly unhelpful in the long-run. Rather than building resilience and coping mechanisms, people are sympathized with and coddled. What kind of future does this fragile person possess? And, worse, how are the supposed helpers harming those who need the most support?

Our children will pay a very stiff price for these interventions not just neurobiologically. Their minds and bodies are being monkeyed with and there is almost no scientific support for any of what passes for treatment. More importantly, children are being taught that the solution to their problems is outside of them, beyond their ability to handle and hopeless. These are not people who will grow into healthy, tough-minded adults. Rather, they will be a whole other class of victims waiting for society to "make it better."


mcewen said...

The latest figures [unverified] are that as many as 1 in every 166 children are diagnosed with autism.
Best wishes

Anonymous said...

This is a very important post because this problem is truly huge. The point that you are making, kids growing into healthy, tough-minded adults, is a challenge all the way around, much less for children who already have challenges to overcome.

Psychiatry and psychology are such subjective fields that it is often very difficult to discern the value in it. This post said it very well,
"on an individual level, for many parents and families, the experience can be a disaster."

I find this very sad because folks that seek out this profession are at a place in their lives where they truly need some real help. What is the answer to this problem?

Anonymous said...

You all might be interested to know that the mental health field has already begun to tackle this problem. They are not blind to it.

The newest movement in the field is just exactly what you suggest in your post when you say, "Even children with diagnoses like Autism, must eventually decide (if they are able) how to navigate the world and usually this decision hinges on the parent's own decision about how to interpret Autism. 'Oh it's terrible, debilitating, a life-long scourge'. Or, 'This is what you're capable of, I know you can do it, and how can we make this happen?'"

It's called: positive psychology.

Anonymous said...

I'll check this out. Thanks!

Dr. Melissa said...

I'm glad the mental health field is indeed looking at "positive psychology", but please forgive me for not being overly confident about this development.

A few examples: Abraham Maslow was writing and talking about positive psychology--studying what makes a healthy and whole person fifty years ago. He was a giant. And it netted nothing--except maybe in the field of Business.

Martin Seligman wrote best-selling books fifteen years ago about Learned Optimism. He has excellent, well-researched ideas, meanwhile medication use has sky-rocketed.

The problem with Positive Psychology is that it is more labor intensive for both the client and helper. Plus, the Mental Health Professional must be smarter. It is easy to throw around medication and see what sticks. It is easy to sit like a lump "u-huh, u-huh" for an hour. It is not easy to challenge beliefs, and unhelpful behaviors.

Our society as turned from stubborn self-reliance to externalizing blame--everyone is a victim. How dare you question my pain? The harm done by the politically correct mentality and special interest groups has been done. Undoing it is equivalent to the government taking entitlements away and we all know how popular that is.

Anonymous said...

I've actually heard a therapist once say, "who is listening" when asked how she can listen all day long to so many problems that people face. The patient paid $95.00 out of pocket. Needless to say, that statement terminated their relationship for good.

So much of "therapy" is the patient simply "talking it out". Well, excuse me please for saying this, but you can set your teddy bear on the couch and do that with.
As you very well said, "it's not easy to challenge believes and unhelpful behaviour". Everyone wants to be so nice, not step on anyones toes, and no one will dare to stretch themselves to "really" help someone competently. Is it niceness, is it incompetence, is it ignorance, playing guessing games, or is it a little of all of those?

This field needs some major breakthroughs to really start helping people in a concrete way. More people are now on some kind of medication for mental health then ever before. And it is only those who understand "side affects" that refuse to go on medications. These people have to do the best they can on their own. This whole thing is alarming!!! I wonder if the suicide rate has gone up as well. Somehow it would not suprise me!

Anonymous said...

Often it is this very mental and emotional anguish though, that is an opening to a deeper spiritual pathway. If it only could be discened that way! Some things only God can heal!!!

Anonymous said...

Oprah had a special on her show today on depression. It was very good and very important because it addressed
some of the more deeper issues about depression. Children often suffer very deep depression as well but who can really recognize that?