Saturday, 19 March 2016

More and more diagnoses… finally!

 140 characters don't really contain more complex ideas. Neither does 280 characters.
There is this prevalent idea that the rise in mental health and neurodiversity diagnoses is … about coddling kids, about replacing parenting or teaching with pill popping, …
And the more I think about these arguments, the more they anger me.

Media: where arguments enter the memosphere

One of the great classics in this genre is Why French Kids Don't Have ADHD in Psychology Today:
French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children's focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child's brain but in the child's social context.
This is taken as supporting evidence that instead of being a neurological difference, ADHD is a manifestation of the environment somehow being off, and thus the US medical culture is medicating where they should counsel. Only … it's not actually true. Also in Psychology Today, the psychiatrist Dr Elias Sarkis is interviewed, pointing out that
[The french model] is "at the price of the child experiencing increased anxiety and internalizing problems". For those children who are not able to receive excellent parenting and high structure, ADHD behaviors can be extremely impairing.
In France it is difficult for parents to get an evaluation and treatment for their ADHD child.  It takes 8 months for a child to get an appointment with a specialist, and it can take another 8 months before a child is prescribed medication (Getin, 2011). 
Or, take The Atlantic arguing that ADHD is in fact “normal narcissistic personality traits”.

Facebook: people pick it up and run with it

From a Facebook thread discussing the article from The Atlantic:

Or here, from a Facebook thread discussing ADHD in French kids:

A big theme out there is how Back In The Day, the things now getting diagnosed were just boys being boys; just a fact of life; and the hardy and good ol' people were just sucking it up — just like these spoiled kids should.

And it makes me furious.

So, the diagnosis didn't exist…

…but that does not mean that the diagnosis is wrong.
That does not mean we shouldn't do anything about it.

If anything it means it is a tragedy we haven't picked up on it earlier.

One red thread running through my own journey, through my contacts with mental health professionals, is how the fundamental criterion is Does this cause suffering? The one thing that keeps returning is whether it degrades my quality of life.

If it does, it is worth trying to alleviate.
If it doesn't, there isn't really a problem.

And this is pretty much an invariant. Even if you fit cleanly into diagnostic criteria in the psychiatric diagnostic manuals, it all stands or falls with this fundamental question: is it a problem?
If it is a problem, you should get help — even if you are not easy to diagnose.
If it is not a problem, there's nothing to fix — even if you are a good diagnosis fit.

The fact that it didn't use to be a problem is in no way an argument against help now.
It might be an illustration of how suffering might have been both widespread and repressed in the past, but it is not an argument against doing anything about the problem now.

But… but… overdiagnosis! overprescription!

Sure, these things might be overdiagnosed.
Treatment through medication and medication only might be way too common.

It still doesn't mean diagnosis and treatment are bad ideas.
We need more funding, better health care, so that even more labor intensive treatments are an option.
We need more research, so we can get better at recognizing and distinguishing possible issues.

What we really, really, really, don't need is shaming and repression of the problems that do exist. That leads pretty straight to more suffering.

Besides, “more diagnoses” is far from the same thing as “over-diagnosed”.
Why do we see more ADHD and autism diagnoses? More depression and anxiety diagnoses? How about:

  1. Better diagnostic criteria, research advances, so we can tell what's going on better than we used to.
  2. (Slowly) decreasing stigma, so more people even try to seek help instead of just sucking it up and suffering on their own.
  3. More diagnosed adults of hereditary issues that have been viewed as childhood issues, like ADHD, leading parents to consider it as a possibility for their children, and allowing them to be diagnosed.
By all means, it might have been that people weren't diagnosed depressed, ADHD, autistic, bipolar, anxious, phobic, … when you were a kid.
It is a tragedy that they weren't. And it is not a reason not to diagnose and help today.

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