Showing posts with label DSM. Show all posts
Showing posts with label DSM. Show all posts

January 4, 2009

If you were blind, would you want a Seeing Eye dog...

... or a Seeing Eye miniature horse — a black and white one named Panda?

"[M]iniature horses are mild-mannered, trainable and less threatening than large dogs. They’re naturally cautious and have exceptional vision, with eyes set far apart for nearly 360-degree range. Plus, they’re herd animals, so they instinctively synchronize their movements with others. But the biggest reason is age: miniature horses can live and work for more than 30 years."

And they seem pretty cool. So cool that maybe you're thinking you want one even though you are not blind. Service animals, they're not just for blind people.

I was thinking I'd like a nice big protective dog to walk with me everywhere, down to campus, into the buildings, into the classroom. What problem/disability would I need to get that privilege? Anxiety?
[A] growing number of people believe the world of service animals has gotten out of control: first it was guide dogs for the blind; now it’s monkeys for quadriplegia and agoraphobia, guide miniature horses, a goat for muscular dystrophy, a parrot for psychosis and any number of animals for anxiety, including cats, ferrets, pigs, at least one iguana and a duck.
Oh, yeah! Anxiety!
They’re all showing up in stores and in restaurants, which is perfectly legal because the Americans With Disabilities Act (A.D.A.) requires that service animals be allowed wherever their owners want to go.
Come on, psychiatrists! Just put Sense of Entitlement Syndrome in the DSM and help us all out.

I don't want to make this post too long. I'm into Twittery terseness today. But the article is long. I'll just flag 2 things:

1. Jim Eggers, a man whose parrot purportedly keeps him from "snapping": "'I have bipolar disorder with psychotic tendencies,' he told me as he sucked down a green-apple smoothie. 'Homicidal feelings too.'" Now, I'm officially afraid of people who drink green-apple smoothies. I'm afraid of green apples. Hell, I'm afraid of people who use straws. Can I have a parrot in a restaurant now?

2. "Business owners and their employees often couldn’t distinguish the genuine from the bogus. To protect the disabled from intrusive questions about their medical histories, the A.D.A. makes it illegal to ask what disorder an animal helps with. You also can’t ask for proof that a person is disabled or a demonstration of an animal’s 'tasks.' There is no certification process for service animals (though there are Web sites where anyone can buy an official-looking card that says they have a certified service animal, no documentation required). The only questions businesses can ask are 'Is that a trained service animal?' and 'What task is it trained to do?'" Apparently, soothe me is the wrong answer.

This is a tough issue. Too many conflicting interests. You have the people who obviously need service animals with trained service animals like Seeing Eye dogs, people who are just completely abusively bringing animals everywhere, and everything in between. And you have business owners who want to be compassionate and who accept that they must follow the law, but who don't want to be played and who are afraid of losing customers and of being sued. And you have all the people who are annoyed, allergic, and afraid of all the animals other people are imposing on them.

I have no answer of my own for this, but gee, wasn't that little horsey cute? I can see why the NYT Magazine led off its article with the blind woman and her Panda!

December 20, 2004

The Autistic Liberation Front.

Some autism activists don't think in terms of curing a disease but celebrating difference.
A neurological condition that can render standard forms of communication like tone of voice, facial expression and even spoken language unnatural and difficult to master, autism has traditionally been seen as a shell from which a normal child might one day emerge. But some advocates contend that autism is an integral part of their identities, much more like a skin than a shell, and not one they care to shed.

The effort to cure autism, they say, is not like curing cancer, but like the efforts of a previous age to cure left-handedness...

On e-mail lists frequented by autistics, some parents are derided as "curebies" and portrayed as slaves to conformity, so anxious for their children to appear normal that they cannot respect their way of communicating.

I note that the cost of treating autism is high, and that ought to create a lot of momentum for people who argue that treatment is not desirable. But there is a big difference in interest between "high-functioning" autistics and other autistics. If the high-functioning autistics win support for the idea that they should be appreciated for their distinctive differences and that treatment is oppressive and abusive, won't that tend to undermine the availability of treatment for those who are not high-functioning? You can see why those who care about non-high-functioning autistics are afraid of the acceptance movement.

Reading to the end of the article after drafting that last paragraph, I realize that, although I tried to present both sides of the extremely complex problem, I leaned towared the liberationists by writing "autistics" and not "persons with autism." Those who want the condition treated see it as separate from the person, something they hope to remove. Those who do not say things like "describe me as 'an autistic' or 'an autistic person,' versus the 'person with...' ... Just like you would feel odd if people said you were a 'person with femaleness.' "

UPDATE: An emailer provides some very helpful insight:
Thanks for pointing out the article. Unfortunately I am rather familiar with Asperger's, as three of my children have it.

I think they are using misleading language when they speak of disease and cure. Aspergers people are essentially emotion-blind. This makes interacting with others fraught with misunderstandings, and is a substantial handicap in dealing with other people. Imagine trying to get the day's work directives from your boss when the small-talk and the assignment seem of equal importance. As far as I know there is no "cure" to give them the neurotypical understanding of body language or voice tone. But we've found that the didactic approach seems to help them figure out "what to do next."

Teaching a child protocols sometimes helps: if the other person does X, you can say Y or Z. Some people have had success teaching children how to recognize facial expressions. I'm trying to drum up interest in experimenting with using acting coaches to teach about body language.

None of these are "cures" and none deal with the various quirks that come with the Aspergers package. Quirks don't matter so much, provided you can communicate without misunderstanding. We can easily make a place in our lives for someone with an intense fascination with doorknobs; which I suppose is what they mean by acceptance. But I very much want my own children to be able to figure out when you can joke with a policeman and when you cannot.

Unfortunately the intensive training you need is exceedingly expensive, and some things work with one kid and not with another.


ANOTHER UPDATE: The day after running the above-linked article, the NYT runs a long article about the difficulties of getting insurance companies to pay for the very expensive treatment:
Insurers have long raised objections about the very nature of autism treatment. Edward Jones, a senior official of PacifiCare Behavioral Health and chairman of the American Managed Behavioral Health Association, an insurance industry group, asked, "Is this really an educational service or a therapeutic service?"

A diagnosis for autism is included in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Treatment of some kind for most disorders in the manual is covered by health plans.

According to Mr. Jones, though, "most people feel it is a biological, neurological disorder, but that cannot be proven." He added that "we don't seem to have any biological treatment for autism."