November 4, 2009

"No, no, no. I can talk. I have a friend. What a ridiculous suggestion!"

Persons with an Asperger's diagnosis don't want to lose it, but it looks like they will.
If [the experts revising the psychiatric diagnostic manual] have their way, Asperger’s syndrome and another mild form of autism, pervasive developmental disorder not otherwise specified (P.D.D.-N.O.S. for short), will be folded into a single broad diagnosis, autism spectrum disorder — a category that encompasses autism’s entire range, or spectrum, from high-functioning to profoundly disabling....

The proposed changes to the autism category are part of a bigger overhaul that will largely replace the old “you have it or you don’t” model of mental illness with a more modern view — that psychiatric disorders should be seen as a continuum, with many degrees of severity....
That makes intuitive sense. Does it not also suggest that mental illnesses are not real illness? That is, aren't we all on a continuum, and isn't the question, really, at what point on the continuum do we think you ought to be offered/subjected to treatments — especially, treatments that will be covered by health insurance?

70 comments:

Southbound Blues said...

In other news:

http://www.youtube.com/watch?v=WnNjRaBj3zs

Obama satire?

Salamandyr said...

Aspberger's has become a bit of the "cool thing" in certain circles. It excuses all sorts of anti-social behavior, and the stereotype is that sufferer's from it tend to be highly intelligent.

It will be a lot less hip to say you have "Autism spectrum disorder"; nobody associates autism with genius.

Not saying that real cases of Aspberger's do not exist, merely that it's one of the few diseases people seem to brag about having.

Oligonicella said...

"Does it not also suggest that mental illnesses are not real illness?"

As an illness is an "unhealthy condition" re Webster's, I'd say severe cases of any number of mental conditions that cause you to neglect yourself until you die would still be illnesses.

Paul Snively said...

Salamandyr: It will be a lot less hip to say you have "Autism spectrum disorder"; nobody associates autism with genius.

Really? That's funny. Lots of people I know associate autism with genius.

Not saying that real cases of Aspberger's do not exist, merely that it's one of the few diseases people seem to brag about having.

Being somewhere on the high-functioning end of the autism spectrum really does seem to be of significant advantage in highly technical fields. Tyler Cowen has written on the subject. See also this and this article from Wired.

My own thesis, based partially on the 20-year study done in Silicon Valley, is that all successful computer programmers are indeed not neurotypical. That is, we may be so high-functioning that we'd never be diagnosed with any of the identified points on the autism spectrum, but that nevertheless we are more than one standard deviation out from neurological normalcy, in ways that make it possible to engage in the internal symbolic manipulation necessary in order to be a successful programmer. Think "A Beautiful Mind," thankfully without the paranoid schizophrenia.

Graham Powell said...

I have a bum knee, but it doesn't trouble me enough to have it operated on. So am I really injured?

Ignorance is Bliss said...

Does it not also suggest that mental illnesses are not real illness?

In what way is that different from non-mental illnesses? Certainly you can have the flu and have it be fatal, or it could be mild. At the far end of that range, you can get the flu and have your immune system fight it off so successfully that you never even have a symptom.

Coronary artery disease can likewise range from fatal to symptom-free.

Sloanasaurus said...

I agree with Althouse on her implication that we are all on a continuim, which is why at some point every mental difference will be changable with drugs.

Highly intelligent people have some sort of mental defect. Their brains don't function properly.

How about pro atheletes, they also have mental defects. I once saw an interview with a pro-hockey player who stated that he could almost see in slow motion. One scientist speculated that pro-atheletes are able to process twice as much visual information in the same time as normal people. This accounts for their natural ability. However, the downside is they they get tired much faster and have to sleep more

Tibore said...

"That makes intuitive sense. Does it not also suggest that mental illnesses are not real illness? "

Function and dysfunction of anything, be it a mechanical system or human behavior, can also have its scope of possibilities arranged on a spectrum, but none of that means that there's anything fake at all about having elements of dysfunction present that need addressing. As a mechanical example, a car may run with a defect or broken element - say, worn piston rings in the engine, leading to smoking and oil burning - but while the engine is still functional, it clearly has an issue that needs addressing.

I'm not well enough versed in the psychological/psychiatric sciences to create a similar analogy there, but I think everyone can see where I'm going with this.

"... and isn't the question, really, at what point on the continuum do we think you ought to be offered/subjected to treatments — especially, treatments that will be covered by health insurance?"

Personally I believe it's more about whether the details of the issue justify the intervention at that given point on the spectrum. But yes, the professor has identified a very central sticking point here. Take Aspergers, for example. There's a spectrum from "high functioning to profoundly disabling", as the article reads. Well, what criteria exist that defines when the behavior is "profoundly disabling"? And what levels of severity exist between high functioning and profoundly disabling. Once that's determined - no easy task, BTW; in fact, as the Professor implies, it's probably an example of a type of sticky point that'll exist in determining cost:benefit ratio in all treatments - which level of severity is the one where functioning in society becomes compromised? And is that the level where the cost of treatment does indeed justify intervention vs. not treating the patient?

None of these will be easy questions, true, and all of it will be complicated by the messiness of the lack of firm boundaries between function and dysfunction. It's even more complicated than just arraying it on a spectrum; each point in and of itself probably has it's own specturm to analyze. As another automotive example of this: Most will agree that rust is usually a cosmetic issue. But if it compromises a vital component - say, for example, dangerously affects a suspension component, which if it fails can cause a car wreck - it's no longer a cosmetic issue, it's a functional one. But how do you deal with the idea of fixing "rust"? When do you intervene? I can't imagine that similar questions aren't already being asked in the psychological fields; on the contrary, they have to be.

The professor is absolutely correct: The question is most definitely what the cost:benefit ratios are on any given point on a given issue's spectrum. And they will not be easy issues to resolve.

Roger J. said...

Its pretty hard to dispute the gaussian distribution when it comes to the human condition. The difficulty is rolling the entire range of conditions into something like the DSM (what number are we on now? Rather than dealing with the second or third deviation, we are consolidating conditions, and we will ultimately be enshrining the entire area under the gaussian curve for disability, medicare payments, and god knows what with Obamacare.

c3 said...

At what point is "odd" not a diagnosis but just a description?

raf said...

When will inability to understand the obvious rightness of the government's viewpoint become conclusive evidence of a disfunctional mind?

wv: duvile. Duplicitious plus servile?

TRO said...

My youngest son has been diagnosed with OCD and, now, a very, very mild "case" of Aspergers (somewhat socially inept but extraordinarily bright). I've done a ton of research into this whole continuum nonsense and we - me, my wife, and my son - don't like it at all. People like to know what is wrong with them. When my son got his diagnoses of OCD he was so relieved that he wasn't just "crazy" but had a real medical condition that the diagnoses alone made a positive difference in his life.

Mental illness is an illness, it's just not as socially acceptable as a diabetes for example.

Seneca the Younger said...

Not saying that real cases of Aspberger's do not exist, merely that it's one of the few diseases people seem to brag about having.

Does this mean I have to go back to saying "cranky old nerd"?

Shanna said...

They keep mucking around with the autism diagnosis, adding the "spectrum" and all that. I don't like it. I think there will at the end be less understanding and sympathy for true autism.

I get irritated when they have these tv commercials talking about how autism dx is rising...well no kidding when you muck around with the definitions! Gah.

Bad Penny said...

I'm an aspie, and am far enough down the spectrum that I have some of the autism tics like "stimming". Thankfully I grew out of hand flapping.

I would never brag about being an aspie. I taught myself social skills. I can function socially. I can go to a party and schmooz, it's just that I don't want to.

I am a software worker, or at least I was before the economy took it's current nose dive. Now I work in a hospital and I have to pretend every day that I am normal. It's exhausting. I liked it better in a software company where I could go to my office and not have to interact with anyone if I didn't want to. Every one else did the same thing.

I am not sick. I am functional. But if I had not grown out of the hand flapping and if I didn't live in an age when there is work for people like me, I wonder what society would do to me.

Using a different ID today.

traditionalguy said...

The statement that someone has an illness is a slander per se. The "Mental" illness slander is much harder to disprove since we are all think differently anyway. IMO the battleground is being reset to allow an easy accusation whenever needed. Many very skilled people are unintelligible in the first 30 minutes upon awaking from sleep. Is that a bug or a feature? The target group is angry white men, and all men need to defensively learn only to show a pleasant countenance and smooth speech today...unlike Clint Eastwood's GranTourino traditionalist character.

former law student said...

Does it not also suggest that mental illnesses are not real illness? That is, aren't we all on a continuum

Colors are on a spectrum, too, yet we are still able to distinguish yellow from red -- although defining where orange begins and ends can be difficult.

Consider that “Nobody has been able to show consistent differences between what clinicians diagnose as Asperger’s syndrome and what they diagnose as mild autistic disorder,” Nobody to my knowledge is making similar statements about paranoid schizophrenia. Nobody is saying that they can't tell the difference between ordinary tidiness and OCD.

Bissage said...

"One ribbon to bring them all and in the darkness bind them."

TMink said...

What a great line of discussion. I just got off the phone with a mom who is bringing in a kid with mild Aperger's. I thought I could come into this thread and straighten out some misunderstandings and generally share some knowledge.

There is no needor opportunity. This is a great thread and you are all to be commended, as is our hostess. The only thing I have to add is that you guys rock.

Carry on please.

Trey

Andrea said...

"One ribbon to bring them all and in the darkness bind them."

Bissage FTW!

Seriously, we're turning into a nation of hypochondriacs. Once we're too busy worrying about what sicknesses we have to do anything else, we'll be that much easier to control.

Fred4Pres said...

Autism is very real and I know families suffering and dealing with it. But including Asperger's into the spectrum is not necessarily a smart move. Aspergers is a real condition, and has its own challenges, but a very different condition from other forms of autism.

Part of the reason autism is growing is because it is encompassing more and more conditions that were formally classified as something else.

Bruce Hayden said...

I am not sure if there really is a continuum, or some of those diagnosed as Aspies are really high functioning Autistics. There seems to be a difference to me, but I am not a psychologist/ psychiatrist/ neurologist, or anything close. But probably my best friend these days is a woman who is mid range Asperger's.

When she was in elementary school, she was diagnosed as Autistic because she wouldn't talk to anyone at school (not couldn't, but wouldn't, which is key). But that got her put in special ed, and her IQ was twice that of most everyone else so she started talking just enough to get out, and graduated from HS at 16.

On the other hand, when I met her a decade ago, everyone just thought that she was extreme OCD. Not really, though for her, it is a good front. I have a lot of OCD in my family, and even have one brother more OCD than she, but there is a subtle difference here, and it takes a lot of time to really see it.

But it also seems different from Autism. She worked for awhile with children with Autism, and it drove her crazy. She could almost get through to them, but then wanted to take them home with her. It just drained her much too much.

Simon Baron-Cohen theorized that people with Autism were missing a governor on their brains. Or something like that. That is not true of my Aspie friend. Her mind is extraordinarily fast, but not infinitely so. I can still get her with jokes (and she gets me back).

One thing that amazed me about her was her ability to see color. That is her skill, just like Bad Penny's is apparently software. This friend was scary good with interior design. We were driving through trees this fall in Montana, and she talked about the thousands of colors, shades, and hues of green she could see. I saw dozens.

Bruce Hayden said...

Let me also point out that another distinction between OCD and Asperger's is that people with OCD can be social. My mother sure was, with some 200 of her closest friends showing up for my parents' 50th, and overflowing the Sanctuary at her funeral.

But, not everyone who is great at software is anywhere close to having Asperger's. I have taken multiple tests, and don't have it. Again, the big distinction is social. I like people, but am also quite happy to spend eight hours mostly alone working on something, whether it be software or law. And, yes, I have spent 16 hours straight sitting in the same chair working on a software problem, without saying more than a couple of words to anyone else during that time. And, yes, I solved the problem, and became the 2nd person in the (very large) computer company to understand the piece of software.

This doesn't detract from Bad Penny and her software expertise. I have no doubt that she is extraordinarily good there, and that it is likely a result of her Asperger's.

Fred4Pres said...

Talking about Ring analogies, here's an oldie but goodie:

Recently one of my friends, a computer wizard, paid me a visit. As we were talking I mentioned that I had recently installed Windows XP on my PC. I told him how happy I was with this operating system and showed him the Windows XP CD. To my surprise he threw it into my microwave oven and turned it on. Instantly I got very upset, because the CD had become precious to me, but he said: 'Do not worry, it is unharmed.' After a few minutes he took the CD out, gave it to me and said: 'Take a close look at it.' To my surprise the CD was quite cold to hold and it seemed to be heavier than before. At first I could not see anything, but on the inner edge of the central hole I saw an inscription, an inscription finer than anything I had ever seen before. The inscription shone piercingly bright, and yet remote, as if out of a great depth:

12413AEB2ED4FA5E6F7D78E78BEDE820945092OF923A40EElOE5 I OCC98D444AA08EI


'I cannot understand the fiery letters,' I said in a timid voice.
'No but I can,' he said. 'The letters are Hex, of an ancient mode, but the language is that of Microsoft, which I shall not utter here. But in common English this is what it says:


One OS to rule them all, One OS to find them,
One OS to bring them all and in the darkness bind them


It is only two lines from a verse long known in System-lore:


"Three OS's from corporate-kings in their towers of glass,
Seven from valley-lords where orchards used to grow,
Nine from dotcoms doomed to die,
One from the Dark Lord Gates on his dark throne
In the Land of Redmond where the Shadows lie.
One OS to rule them all, One OS to find them,
One OS to bring them all and in the darkness bind them,
In the Land of Redmond where the Shadows lie."'

Bruce Hayden said...

Seriously, we're turning into a nation of hypochondriacs. Once we're too busy worrying about what sicknesses we have to do anything else, we'll be that much easier to control.

I will respectfully disagree, at least here, as to Asperger's (and Autism). It took a number of years before I really was able to see the difference between someone with Asperger's and someone without (who was just severely OCD). It is not a difference in quantity, but rather, in kind. Things that are instinctual with most of us are very difficult for those with those problems (e.g. Bad Penny's having to pretend to be normal).

It is somewhat hard to put your finger on, but on the one hand, you have ultra-sensitivity, and on the other hand, an inability to really understand inter-personal cues that the rest of us understand instinctively.

Take my friend. She was in her mid forties before we figured out that the reason that guys always thought that she was coming on to them was that she would not maintain a proper separation with guys, but would end up at a more "intimate" distance, and then would concentrate exclusively on what the guy was saying. Another good friend mentioned it to me the first time he met her, and I watched her, and he was right. She just didn't understand inter-personal distances and their meanings. This from an extremely bright 45 year old.

Or, another time we were in a club with a lot of loud music. She went almost catatonic for a bit there, and I just held her. The bouncers wanted to throw her out as drunk, even though she had had a single drink. She was in sensory overload. Luckily I was an attorney, and was able to intimidate them into letting us alone until she got it together (I mentioned the ADA, reasonable accommodations, and owning the club if they did throw her out - maybe the later was an exaggeration, but they brought their management over, and we worked it out).

I am sure that there are kids with OCD who are diagnosed with Asperger's just to get the private schooling that some school districts provide in such cases.

But Asperger's is real. And it really does make life a lot harder for those who really do have it.

Finally, why is the diagnosis skyrocketing? My best guess, besides much better diagnostic techniques, is called assortive mating. Two engineers or programmers who are borderline marry, and some of their kids cross the line. This didn't happen in the past near as often, since marriage was more likely based on geographical proximity and familial involvement than working together.

FormerTucsonan said...

But it also seems different from Autism.

You say that because you're seeing it in someone who's had a long time to develop coping mechanisms and strategies to integrate into the mainstream.

I've got a 15 year old step son with Aspergers. I've seen him sit on the sofa and rock back and forth, or pace like a tiger in a cage, when he's watching his favorite TV show.

He bangs his head on the matress before he goes to sleep at night. Don't know why, but he's done it all his life.

I've also seen him react rather violently when he can't express what he's thinking.

Yes, he's a smart kid (all Honors classes this year), but don't kid youself that Aspergers = Socially Inept Brainiac. There's a lot more to it than you know.

Bad Penny said...

Why is there more autism? It's evolution. Analytic skills are rewarded. Maybe the urge to socialize is no longer as needed for survival. In fact, we live in such crowding that maybe it is an advantage to be able to withdraw?

Neurotypicals seem emotionally needy to me. Like dogs wagging their tales, seeking affection and approval. Aspies are more like cats. Dogs probably enjoy life more, but if you have to be a cat, then be a cat.

Dust Bunny Queen said...

I believe that it is a sliding scale.

I am mildly aspergers and do my best to be more sociable/normal and pay attention in social situations so I don't annoy or confuse people. My brother, a computer systems analyst, is pretty much further on the scale and has a wonderful wife who basically guides him through life. My father probably also has a mild version of the syndrome, given his absent minded professor persona.

The questions are, I think: When does the sliding scale from mild to severe become something that is problematic and needs intervention or attention? And...who is going to set those markers? Is the definition going to continue to be a moving target?

Colors are on a spectrum, too, yet we are still able to distinguish yellow from red -- although defining where orange begins and ends can be difficult.

This is interesting too. My mother(now deceased) and brother are both colour blind and as such are unable to distinguish red/green green/brown yellow/orange and pastels just don't exist in their world. In order to describe things to my mother and brother, we learned that it is useless to use colour as a descriptor. Dimension and other details are a more important way to communicate. Blue bowl means nothing to them. Large bowl with flowers and leaves engraved on the upper rim and that has a slight hairline crack in the base: that means something.

In addition how do you know what colours I see and how they look compared to how you perceive them?

Is the green that I see when I look at the trees the same one you see? Just exactly what tone of yellow is that daffodil to you compared to how it looks to me?

Can you tell?

Joe said...

My youngest son has always been odd. Early in elementary school, a teacher wondered if he had Aspberger's. My wife and I started doing research. The two stunning things I found were that the Asperger's and Autism groups were at odds with each other with the latter trying to subsume the former. Even more disturbing was the trend toward making the definition of both Asperger's and Autism larger and larger to the point where I thought they'd lost all relevancy.

Fast forward several years. At the suggestion of a Jr. High counselor we decided to have the school district psychologist evaluate him. I worried that he'd just make a pronouncement. I was so wrong. The doctor spent an huge amount of time with my son and wrote a fascination and very perceptive report. His conclusion; however odd he is (and he is odd) he doesn't have Asperger's.

Yes Asperger's is real. Yet most people who claim to have it don't. Same with ADD (and if you ever meet someone who really does have ADD the difference is quite stark.)

As Salamandyr said, Asperger's has become cool; it's the new ADD. A catch all. It's all too often a way to excuse anti-social or just weird behavior. On the other hand, it's also used by introverts to get extroverts to stop bugging them--a kind of "fine, I'm mentally ill, now fuck off."

As a side note, the diagnosis of Autism has also gotten absurd. What's fascinating, though, is that there is an almost exact inverse relationship between diagnosing Autism and diagnosing retardation. (I have a distant relative who is "autistic". But he it's VERY obvious that he's very mentally retarded, but autism is the lie the family wants, so it's the lie the doctors tell.)

Oh, and follow the money. When it comes to the disease of the day, including the flu, just follow the money.

Bad Penny said...
This comment has been removed by the author.
Richard Dolan said...

TRO: "People like to know what is wrong with them." Yes, of course.

I think the difficulty lies in the abiding problem of relating mental states to biological or chemical causes. Talking about the mind as a machine that can be fixed by a little grease here, a little lubricant there, is to start off with a picture that's out of focus. There are certainly diseases of the brain that can be analyzed and dissected in those terms. But the brain and the mind are different; mixing them up is a sure way to get confused. With mental phenomena, there are correlations, necessary-but-not-sufficient relationships and the like between brain chemistry and personality/behaviour problems. But attempts to reduce personality disorders to biochemical phenomena, to equate mental states with brain states, is (I think) a step backwards from understanding and thus from any solution.

You see that problem manifesting itself here, in the behavioural continuum vs. physical disease models of mental illness. Ann asks: "Does it not also suggest that mental illnesses are not real illness?" Yes, but mostly by calling into question what we mean by "real illness." One size doesn't fit all. And "real" doesn't necessarily mean biochemical in origin, even if biochemistry may provide a way to deal with symptoms.

former law student said...

I blame higher education. Since the GI Bill, nerds and geeks have gone to college, where they meet and marry other nerds and geeks, instead of the girls/boys next door. (Nerds and geeks being intelligent and able to focus on their studies/work instead of wasting time socializing.) Graduate school is even worse, in that any female student who wants can find a mate there.

Freeman Hunt said...

This is interesting. If they apply a spectrum to every mental illness, where on these spectrums will they start pushing medication? I think medication is hugely overprescribed right now (ADD meds and antidepressants, for example), so I think it would be good if they addressed that.

Lynne said...

I sort of hesitate to weigh in on this, but I've read a few things that struck me:

"One thing that amazed me about her was her ability to see color. That is her skill, just like Bad Penny's is apparently software. This friend was scary good with interior design. We were driving through trees this fall in Montana, and she talked about the thousands of colors, shades, and hues of green she could see. I saw dozens."

I'm a mild synasthaete. For me, life is all about the colors. Sounds have color and shape, (sometimes they're blinding), strong tastes have a color, strong smells have a color. If I hear loud bump in the night when I'm asleep, I 'see' a flash of light. If I stub my toe, I get a flash of red or orange. I once hid a shirt my husband bought because it was the color of body odor and I couldn't stand for him to wear it.

I didn't realize there was anything 'different' about me until I happened to read something about synaesthesia. It never occured to me that everybody doesn't experience color this way. I quizzed my husband and wound up feeling a bit sorry for him- his description of his sensory experiences sounded like color-blindness to me.
Then I found out that synaesthesia is part of the autism spectrum.

So reading about this color stuff in the comments is intriguing to me.

Andrea said...

Well Bruce Hayden, I'm glad you have so sunny an outlook on everyone and their strange-acting dog now being considered to have some sort of mental illness instead of maybe, just maybe, being what former sturdier societies called "eccentric" or "following the beat of a different drummer."

It's all part of the endless war against introverted people who just want to be left alone. When you're a kid it's known as "she's a little bit shy," and there's always a grown-up's hand at your back shoving you at some group of kids you don't know who will take one look at you and know they've got their chum (as in, food for the sharks) for the day. When you're older it's "We just want to bring you out of your shell!" and "Don't you want to date boys? When I was your age I was always on a date!" and "Get your nose out of that book!" You think when you finally reach adulthood you'll be left alone, and then the horrible truth dawns: you'll never be considered to be fully adult, because while you were reading, and avoiding the others who were frantically socializing with everyone because they couldn't bear to look into the dark void within their own souls, they retired the concept of "adulthood" and replaced it with "I've got such and such syndrome, I go to therapy. Want to hear about my symptoms?"

Then again, maybe the person who said "it's also used by introverts to get extroverts to stop bugging them" is right. Maybe that's what I have to do to get some frickin' respect (and alone time!) in this world. But it all seems so shaming and clinical.

Paul Zrimsek said...

The problem with the "disease" model isn't so much the existence of a spectrum as the implied assumption that the spectrum must have a "normal" and "diseased" end. This is all very well when you're talking about knee joints, but when you're talking about minds, it's properly the stuff of value judgments rather than medical diagnoses. (See, for example, the ex-disease of homosexuality.)

FormerTucsonan said...

As Salamandyr said, Asperger's has become cool; it's the new ADD. A catch all. It's all too often a way to excuse anti-social or just weird behavior. On the other hand, it's also used by introverts to get extroverts to stop bugging them--a kind of "fine, I'm mentally ill, now fuck off."

There also seems to be a bit of a bandwagon effect. If Junior's got it then I must have it. I recently heard the music critic from a well known magazine (the name escapes me, but I think it was the Atlantic) on NPR, bragging about being diagnosed with it at the same time his son was diagnosed. He claimed that it's what gave him such special insight into music.

WV - ledliz - reptile heavy metal band.

former law student said...

While we're on that subject: Reading about Phillies reliever Scott Eyre I learn he has Adult ADD. What happened to being easily distracted, or finding it difficult to concentrate?

Dust Bunny Queen said...

Then I found out that synaesthesia is part of the autism spectrum.

So reading about this color stuff in the comments is intriguing to me.


Yes, to me as well. It is interesting that my brother who is mildly autistic is colour blind. He does have perfect pitch, was a self taught professional musician for some time and is very much into music, especially jazz. Music was one of the few social activities that he could participate, especially during his school days. Everyone expects musicians to be odd balls.

So...I guess there are many variations on the theme just as it seems that the syndrome, or whatever it is, is on a rather large sliding scale.

I really don't see the lower end of the spectrum as being illness. However, I have known people with children that had autism. One poor child was so non-functioning that all he would do was balance bits of paper on the end of his fingers and scream if you tried to get his attention away from that activity. This was before there was even any type of therapy or understanding about autism. Very sad.

peter hoh said...

Aren't we all on a continuum, from birth to death?

Who is to say at what point on the continuum one ought to be getting treatments -- especially treatments that will be covered by health insurance?

Paul said...

Ann opined:

Does it not also suggest that mental illnesses are not real illness? That is, aren't we all on a continuum...?

Not necessarily, no. Because one could say the same of the things you recognize as "diseases"--i.e., colonization by a bacterium, virus or parasite, or the proliferation of tumor cells. Medical science is coming to find that cancer, for example, is actually far more common than was once believed: it's just that most upsurges of cancerous cells are euthanized by the immune system before any symptoms show.

Ditto infectious diseases: we swim in a sea of bacteria, molds, viruses and protists, billions of which are seeking entry into our bodies at any given moment. Most of the time when one succeeds in gaining access, via a break in the skin or through one of the orifices, it is quickly and efficiently demolished by antibodies and killer T cells.

Only when the immune system fails in its mission do we recognize that we are ill. But at any given moment we are all "on the spectrum", at least in a probabilistic sense.

FormerTucsonan said...

I'm a mild synasthaete. For me, life is all about the colors. Sounds have color and shape

From what I have read; Jimi Hendrix used colors to express musical ideas. So, depending on your musical tastes, you may be in good company.

WV - rhearita - Rhea Perlman's contribution to the cocktail hour.

tim maguire said...

Diagnoses are done for insurance purposes and don't necessarily tell you much about a person's course of treatment, just how payment is justified.

The "spectrum" idea may make more sense in that sharp lines are usually drawn in arbitrary places, but lumping together so many variable symptoms under a single umbrella conveys much less information and so is probably a bad idea.

Penny said...

"At what point is "odd" not a diagnosis but just a description?"

When you learn to embrace your own "oddness".

For those who don't, there are more than enough psychiatrists and psychologists to help you find your perfect place along this spectrum or that.

John Lynch said...

When I was growing up Asperger's did not exist. Autism was banging your head against the wall in a padded room. I was just weird. Not having a label didn't make it any easier.

Asperger's isn't cool, nor will anyone think more of you for having it. Maybe in the abstract, listening to people talk about it on NPR, or reading about it in a book. But in reality, in person, no one finds it interesting or attractive.

It's about being socially awkward with limited empathy, with a big intimidating vocabulary. With a bad temper. And odd habits. With no athletic ability. In short, unlikeable. Simply putting a label on it changes nothing.

Asperger's doesn't make you smarter except in some pretty limited and not very useful ways. It can leave you with an amazing ability to use big words but confounded when a car battery needs to be changed (took me 3 hours). Having a 30 point spread between verbal and nonverbal IQ isn't something most people understand. Yes, that's right, it can give you levels of nonverbal IQ that are in the retarded range. For some visual tasks I am far below average. It's really not that great.

As for whether it exists, oh yes it does. It's a DISORDER, which means it sucks. Whatever people want to call it, there's a part of the brain that I don't have. It's part of my identity, no way around that, but it isn't something most people would want to be.

Life with Asperger's or on the autism continuum or whatever is about overcoming problems that are not even problems to anyone else. It's about people thinking you are smart, but knowing that you really aren't, just specialized. Easy things are hard. Some hard things are easy. It's a very different life than what most people lead. A lot of it is finding a situation that maximizes your strong points while minimizing the many problems. That's not so different from everyone else, but it is more extreme.

Synova said...

I think we have a cultural issue with anything seen as abnormal... and that is that it *obviously* needs to be cured.

So we can't say that homosexuality is abnormal because that suggests that it needs to be cured. Yet, pretty obviously and by definition it *is* abnormal to be attracted to the same sex. That doesn't mean it's a *problem* that needs to be solved.

An albino person is abnormal, too. Despite precautions to prevent sun burn, though, it's really not something that needs to be (or could be) cured. It just means you're different. So what?

My husband was diagnosed (?) with "minor brain damage" when he was a kid... that was what they called ADHD back then. In any other culture in History, where children were not required to sit in a classroom and be quiet... would this be a problem? Not, hardly. It makes some things more difficult than others, even if you don't get the H part of it. But they don't medicate those, like me, who just have ADD.

Amateur diagnosis here, for sure, but I believe my oldest daughter has ADD with a slight H and my youngest daughter has some slight degree of Asberger's. Compared to my other two, I can tell. But how much of a problem it is? Everyone has problems. Everyone. Both of them can function as well as most people, just differently. Different challenges and different difficulties.

I think it's helpful to recognize what those *are*, particularly when dealing with schools.

I'm not at all convinced that it would be an issue for either of them at all in other situations.

I wouldn't consider them *illnesses*, mental or otherwise... not like depression or bi-polar disorders or various things that are caused by a chemical imbalance. Downs Syndrome isn't an illness either, no matter that it's a severe disability.

If there is a continuum between very mild aspergers and severe Autism they become a disability when they *are* a disability.

former law student said...

they become a disability when they *are* a disability.

Excellent point. Define disability by the results and not the disease process that causes them.

Pogo said...

Without more discrete psychiatric categories, how the hell are we supposed to make fun of people?

People still freak out when I tell them my brother is retarded.
You mean he's mentally challenged.
No, I tell them, Joe Biden is mentally challenged. My brother's just retarded.

Pogo said...

Psychiatry is like the educational system. it likes to change things around just so they don't get bored.

It don't mean much.

Darcy said...

Fascinating comments. Really enjoyed reading about this.

John Lynch said...

Pogo-

Dead on about boredom.

Bruce Hayden said...

I am mildly aspergers and do my best to be more sociable/normal and pay attention in social situations so I don't annoy or confuse people. My brother, a computer systems analyst, is pretty much further on the scale and has a wonderful wife who basically guides him through life. My father probably also has a mild version of the syndrome, given his absent minded professor persona.

Hey, I don't pay attention in social situations, and do routinely confuse and annoy people (esp. at work). And I don't have Asperger's.

The confusion and annoyance is primarily that I don't answer the question asked, or, answer the question that was actually asked, and not the one that was meant to be asked.

My boss is one of the only people who can truly control me. He attributes it to having done a lot of hostile depositions. I still annoy him, but he gets what he needs out of me.

Someone above talked about introversion. Aspies are mostly introvered, but most of those who are introverted are not Aspies. I think that part of being introverted is being shy, and part is being self contained in one's head. I was shy when young, and have always been somewhat introverted - but shyness can wear off (mine did), and I really like people.

I think that one reason that many more men are diagnosed as having Asperger's is that women can hide it much better, by, as suggested above, working very hard at seeing social cues, which guys are less inclined to do. (Also, Baron-Cohen suggested in his "The Essential Difference" that Asperger's and Autism may be the result of extreme male systemizing tendencies in the brain).

I think that it is that difficulty in recognizing and understanding social cues and norms that is one of the more noticeable indicia of at least Aspberger's. It is something that most of us do automatically, and Aspies have a very hard time doing.

Bruce Hayden said...

Psychiatry is like the educational system. it likes to change things around just so they don't get bored.

I have never quite figured out Pogo's practice area, but somehow I don't think that it is psychiatry.

Bruce Hayden said...



Life with Asperger's or on the autism continuum or whatever is about overcoming problems that are not even problems to anyone else. It's about people thinking you are smart, but knowing that you really aren't, just specialized. Easy things are hard. Some hard things are easy. It's a very different life than what most people lead. A lot of it is finding a situation that maximizes your strong points while minimizing the many problems. That's not so different from everyone else, but it is more extreme
.

And, I would suggest, harder.

The problem for the rest of us is that we mostly cannot see what is inside someone's head. So, we see someone who makes something look easy, and maybe envy them. What we don't take into account with Aspies and high functioning Autistics is that doing what the rest of us find easy is often very difficult for them.

But this does bring up the question of what is meant by someone being "smart".

My Aspie friend had a photographic memory until maybe a year ago (another story, some other time), and with her blindingly fast mind, she came across as extremely smart. She also never got a B (or lower) once she got herself out of special ed, because she would just roll the film, and every test was an open book test.

Yet, she cannot analyze most data nearly as well as I can. My mind is fairly fast, but nowhere near as fast as hers. I frankly don't know which of us is smarter. I am sure that I can beat her on some tests, and she can beat me on others.

Mark V Wilson said...

Calling something a spectrum disorder makes it easier to enlarge the population as to whom drugs may be prescribed.

Allison said...

--Life with Asperger's or on the autism continuum or whatever is about overcoming problems that are not even problems to anyone else. It's about people thinking you are smart, but knowing that you really aren't, just specialized.

This is a terrible working definition for Asperger's or ASD.

It's the experience of anyone who ever went to MIT/Caltech/grad school in math/physics/biochemistry and who isn't a genius level Nobel Prize winner. All but the truly exceptional folks "know that we really aren't that smart". And we've all got impostor syndrome, where we are all terrified of being found out for merely being a bit bright, but not usefully so. Yet as soon as they say the words "I went to MIT" the people respond with "oh, you're so smart".

I'm having a lot of trouble with the discussion here, because it's not clarifying how Asperger's isn't "socially awkward brainaic." It's clear to me that it isn't, but I've not gotten enough concrete reasons why to recognize the differential diagnosis.

Based on the descriptions here, half of the MIT student body would be called Asperger's cases. It's just not true--they are mostly functioning just fine, with foibles just like other folks. They may not be neurotypical in the first place, but that doesn't make them Asperger's or ASD.

What I've read here largely boils down to "these people are annoying." And that may be the problem: the working understanding of Asperger's and ASD and even much more severe autism is that these people ARE annoying, largely because other people don't exist to them the same way they do to the rest of us. But common wisdom seems to have inverted the inference direction, and decided anyone annoying is an Aspie.

Think Max from Rushmore. Most people can't stand him, and having a catchall basket to put the people you can't stand in, and a medical tag for it is rather convenient.

WV:silikers: GeeWhillikers, that's silly.

Allison said...

The problem with most of the descriptions listed here of Asperger's folks or "socially awkward" folks is that it's indistinguishable from the social behaviors of others who have some issue but not AD/Asperger's.

I had profound social phobia throughout my childhood, adolescence and into my 20s. I was orders of magnitude passed "shy". I was petrified by nearly every social interaction as a child. By the time I reached adolescence, I had made some friends, and knew how to work certain social settings, but others were a nightmare, and the fears worsened.

Fear prevents cognition. It stops both recall of and formation of memories, as well as interferes with analytic processing (your amygdala is the only thing operating, and your cortex can't override it.)

So I wasn't learning anything about how to read people. I wasn't learning about social cues like how close to stand to someone to be friendly, or how to make eye contact to be polite by not coy. I wasn't learning because a) I was looking at my shoes, and b) because I wasn't processing even when I was looking. I too did "stimming" as I had learned tricks to control the terror.

Definitions for illnesses that cite specific process failures or impairments of function would be more useful, I suspect.

To the bigger "what's an illness" question: the severest mental illnesses are understood as having anatomical and neurobiological bases. Schizophrenia can be positively disagnosed by brain scan. Bipolar 1 can be diagnosed with bloodwork.

That depression, anxiety, ADD, Asperger's and a host of other mentall illnesses can't means we don't understand much at all about them. That they can be treated equally by talk therapy and medication should be sending up more red flags. Of course these sets of experiences are true, and as my anxiety was, can be truly debilitating. But it'd be better if we could understand these adaptations of our moods and cognitive processes not as illnesses but as something else that can be modified. Seeing oneself as having an illness can be devastating. Seeing that one has deficiencies that can be worked on, as one improves one's coordination, is empowring.

former law student said...

Now I'm wondering if a person I met as a child was autistic. She was a daughter of friends of my grandparents, a grown woman who lived with them on their farm. As a child I wasn't super-observant, but she seemed to be pleasantly living in her own dream world, until someone asked if she would like to play the piano. She sat down and proficiently played a number of standards.

lucid said...

Ann---

That is really quite a spectacular non-sequitor, that something on a continuum is not a real disease or disorder or does not require treatment.

Heart disease, pulmonary disease, cancer, senility, blood diseases, etc, etc, etc, all exist on a continuum.

The requirement for treatment has more to do with the degree of impairment that is present and the degree of improvement that is possible.

I would venture to say that something about psychological treatment makes you uneasy for non-rational reasons.

Allison said...

No, the analogy of the continuum for heart disease or cancer does not match the continuum for the ASD.

A diagnosis on the austism spectrum doesn't worsen without treatment. Wherever you are, you are, it seems, with perhaps some ability to improve. Treatment isn't about changing your location on the spectrum; treatment is about improving your ability to function in this modern world.

A person doesn't have "a little bit of cancer". They have an EARLY stage of cancer, which will, as far as we know, almost always get worse without treatment. Treatment of cancer is about stopping, killing off, or retarding the growth of cancer.

The continuum is about how the sickness is attacking you, and progressing in that attack. Autism isn't like that. It's not even clear the same process is happening with the "volume" turned higher on the spectrum. A mother of two autistics told me that "Autistics never play makebelieve". Well, that's a discrete difference than an Aspie, certainly.

When we look at an illness like rheumatoid arthritis, there's a continuum: the pain may be a continuum, the damage is a continuum, but the process going wrong isn't different.

I think the real issue is why mental illnesses are now being called spectrum disorders in general. Look at the new diagnosis of bipolar II. The desire to diagnose seems to be tied to the desire not to pay for one's own treatment.

Penny said...

"The desire to diagnose seems to be tied to the desire not to pay for one's own treatment."

Precisely, Allison. "Autism", now Autism Spectrum Disorders, has become big business in my state. Not only is there a law requiring an annual dollar amount for research, but insurance companies are required to pay for diagnosis, treatment and even applied behavior analysis, which is really training that has no scientific basis. This doesn't speak to the numbers of additional state workers, non-profit employees, health care professionals who will be employed because of this expanding interest in autism spectrum disorders.

My heart goes out to the parents of children who have what autism or aspergers was once thought to be. Those children will never function properly or grow up to be self sufficient, but 1 in every 150 kids do not have that kind of severe disability. That number is currently 1 in 90 in my state, and will most likely increase as the legislation supports it.

Pogo said...

Oh, lighten up, people.
And worry not, for soon the State will have all of your medical treatment records and IRS information together, and you will all be categorized, and appropriately treated.

Conservatives have Fascist Disorder, Libertarians have Authoritarian Insufficiency Syndrome, and Liberals with Approved Social Skills are just fine, thank you.

Remember, A gramme is better than a damn.

lucid said...

Allison--

Actually, you are wrong on almost al of your points.

Aspberger's and other pervasive developmental disorders (let alon things like anxiety and depression) do worsen without treatment and amelioration. Almost every physical disorder does exist on a continuum (and mental disrders always have a physiological substrate--the mind exists in the body). And some of them do not worsen without treatment (but do cause damage, as do mental disorders), e.g. hyperlipidemia, hypertension, osteoporosis, coronary artery disease, etc, etc, etc.

Paul Zrimsek said...

and mental disrders always have a physiological substrate--the mind exists in the body

A classic case of an argument that proves too much. Since the mind exists in the body, mental everything has a physiological substrate; therefore, identifying a physical substrate for a particular way of thinking or acting brings you no closer to being able to call it a disease.

lucid said...

Paul,

the point about the physical subtrate attacks the false distinction between mental andphysical diseases. that everything mental is physical does not touch the question of whether a particular mental state is a disease state--only that the distinction between physical health and mental healt--whether one is addressing healthy states or disease states--is a false dichotomy.

Zimri said...
This comment has been removed by the author.
Zimri said...

My thought is that the non-Asperger's people ought to be the ones who are classed as disabled.

There are people who live their whole lives not questioning the world around them, and not extending their professed beliefs to their logical conclusion. I've seen right-wing commenters refuse to accept the evidence for evolution or biblical text-criticism, usually bringing in some form of Pascal's Wager as their rationale for not bothering ("we'll all find out when we die", etc). I've seen left-wing commenters pretend that the brain ceased to be subject to evolutionary pressures circa 200,000 BCE.

It's a horror to me that willful ignorance exists. All these poor people should be treated for not being autistic enough.

ken in sc said...

When I was in high school, in the 60s, I dated a girl who smoked, she said, because her doctor said it would help her with her concentration. I thought she was lying just to justify doing something she knew was bad for her. Recently I read that nicotine actually can be helpful in controlling ADHD. Supposedly it also helps prevent Parkinson’s. Of course I have no idea if the tradeoff is worth it.

Paul Zrimsek said...

I still think abolishing "artificial" distinctions between physical and mental illnesses at the cost of abolishing the mind is proving too much. Different of course if having a physical substrate is not the same thing as being physical.

michael a. livingston said...

My son has Asperger's, and although it may well be a continuum rather than a traditionally defined illness, the fact remains that the diagnosis helped him get the help that he needed and may have saved his life. What's bad about that?