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Double Retired
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05 Sep 2021, 9:51 am

The Washington Post today included a book review of DSM: A History of Psychiatry’s Bible, by Allan V. Horwitz.

I'm not qualified to critique the DSM or the book, but I'll note that the third paragraph of the review includes:

Quote:
In this history, as in his 2013 book on the concept of anxiety, Horwitz emphasizes the social construction of scientific concepts. This account underscores the economic incentives in play as psychiatrists tried to reach consensus on how to describe specific disorders so that they could treat them — and be paid well to do so. If these clinicians were going to live up to their medical credentials, the thinking went, they should be able to prescribe medications for a specific disease regardless of the particular circumstances of the person who had it. Treat the disease and not the patient. The problem is, says Horwitz, an emeritus professor of sociology at Rutgers University, “almost all psychotropic drugs do not work specifically for particular DSM mental disorders.” But there was money to be made in making it seem like they did.


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magz
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12 Sep 2021, 1:53 pm

 ! magz wrote:
A post of which the author has been identified as spammer-baiter has been removed.


I'm not a fan of DSM - it's too symptom-oriented, without much attempt on identifying underlying mechanisms.


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carlos55
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12 Sep 2021, 2:23 pm

The DSM was always a stopgap for diagnosis for brain disorders science cannot explain.

In the future it will end up in a museum alongside Lobotomy & Asylums replaced by modern biological / genetic treatments

https://b.online.csp.edu/resources/arti ... treatment/


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15 Sep 2021, 12:54 am

they should be able to prescribe medications for a specific disease

Disease - a disorder of structure or function in a human, especially one that produces specific symptoms or that affects a specific location (Brain) and is not simply a direct result of physical injury.



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15 Sep 2021, 3:02 am

cyberdad wrote:
they should be able to prescribe medications for a specific disease

Disease - a disorder of structure or function in a human, especially one that produces specific symptoms or that affects a specific location (Brain) and is not simply a direct result of physical injury.


Where ever you got that quote from seems to fit like a glove many peoples experiences of autism.


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cyberdad
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15 Sep 2021, 5:19 am

carlos55 wrote:
cyberdad wrote:
they should be able to prescribe medications for a specific disease

Disease - a disorder of structure or function in a human, especially one that produces specific symptoms or that affects a specific location (Brain) and is not simply a direct result of physical injury.


Where ever you got that quote from seems to fit like a glove many peoples experiences of autism.


DSM



autisticelders
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20 Sep 2021, 7:10 am

how interesting! Thanks for this post!



Velorum
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20 Sep 2021, 12:39 pm

I am involved in identification (or diagnosis if you must) of autism on a weekly basis.

This involves using assessment tool based on DSM and direct reference to it in the report on identification made.

I view it as crude and based upon bad science and a poor understanding of autism. I have to work around it to help the person involved get to where they need to be.

The challenge in having to function within a clinical system where a fundamental difference is pathologised.

I am hopeful that one day autistic people will be able to self identify and for this to be accepted in the same way that people can self identify as being a number of other things without needing the validation of "experts" with no or little lived experience.


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carlos55
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20 Sep 2021, 1:53 pm

Velorum wrote:
I am involved in identification (or diagnosis if you must) of autism on a weekly basis.

This involves using assessment tool based on DSM and direct reference to it in the report on identification made.

I view it as crude and based upon bad science and a poor understanding of autism. I have to work around it to help the person involved get to where they need to be.

The challenge in having to function within a clinical system where a fundamental difference is pathologised.

I am hopeful that one day autistic people will be able to self identify and for this to be accepted in the same way that people can self identify as being a number of other things without needing the validation of "experts" with no or little lived experience.


Maybe you only diagnose on the most higher functioning end of the scale?

While I agree the DSM is crude, not sure how any professional can claim adults on the severe end with no independent living skills, who self-harm and wear diapers is not a pathology or disability.


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Velorum
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21 Sep 2021, 1:41 am

carlos55 wrote:
Velorum wrote:
I am involved in identification (or diagnosis if you must) of autism on a weekly basis.

This involves using assessment tool based on DSM and direct reference to it in the report on identification made.

I view it as crude and based upon bad science and a poor understanding of autism. I have to work around it to help the person involved get to where they need to be.

The challenge in having to function within a clinical system where a fundamental difference is pathologised.

I am hopeful that one day autistic people will be able to self identify and for this to be accepted in the same way that people can self identify as being a number of other things without needing the validation of "experts" with no or little lived experience.


Maybe you only diagnose on the most higher functioning end of the scale?

While I agree the DSM is crude, not sure how any professional can claim adults on the severe end with no independent living skills, who self-harm and wear diapers is not a pathology or disability.


I dont agree with functioning labels - in my view you are either autistic or your are not, there is no mild or severe.

Most of my identification work is carried out with young people who have an intellectual disability or mental health issue. I am very careful not to conflate the disability or condition issue with their autistic identity if thats how they are.

Just because an individual has a good level of resilience or has developed good coping mechanisms does not mean that their autism is 'mild' or they are 'high functioning' in my opinion.

The most frequent discussion I have with fellow professionals aside from asking them to stop using pathologising language is to help them get their heads round the term 'spectrum' - in that this does not represent some kind of linear presentation ranging from 'mild' to 'severe' but many different ways of experiencing the world and our selves some of which are more pronounced than others - each individual being a unique combination of these. Think of a sound studio mixing desk with the controls sliders set to different values.


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magz
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21 Sep 2021, 2:44 am

Velorum wrote:
Most of my identification work is carried out with young people who have an intellectual disability or mental health issue. I am very careful not to conflate the disability or condition issue with their autistic identity if thats how they are.

I'm not nearly as experienced as you but what you describe relates to my case.
There is autism - the way I experience the world - and there was mental illness - anxiety, C-PTSD and various misadaptations stemming mainly from unhealthy upbringing.

Was my autism mild when I was studying physics without accommodations? Was my autism severe when I was a suffering mismedicated mess?
Autism was the same. Even difficulties were the same. Functioning was very different.

I also saw it in my daughter - she went from a bit awkward and unevenly skilled to full-blown disability and back again - depending on how teachers in her school acted about it.


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Velorum
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21 Sep 2021, 2:58 am

magz wrote:
Velorum wrote:
Most of my identification work is carried out with young people who have an intellectual disability or mental health issue. I am very careful not to conflate the disability or condition issue with their autistic identity if thats how they are.

I'm not nearly as experienced as you but what you describe relates to my case.
There is autism - the way I experience the world - and there was mental illness - anxiety, C-PTSD and various misadaptations stemming mainly from unhealthy upbringing.

Was my autism mild when I was studying physics without accommodations? Was my autism severe when I was a suffering mismedicated mess?
Autism was the same. Even difficulties were the same. Functioning was very different.

I also saw it in my daughter - she went from a bit awkward and unevenly skilled to full-blown disability and back again - depending on how teachers in her school acted about it.


Makes sense.

If we were to regard anxiety and certain other manifestations of distress as forms of mental health issue (the former is of course when it becomes more severe) then it would be fair to say that there is a much higher prevalence of mental health issues within the autistic community in comparison or the predominantly neuro typical one.

I accessed mental health services and was treated for anxiety and depression in my 20's - way before I had an autistic identification. Once I understood how I was different and stopped trying to be something that I am not then most of this melted away. No need for drugs or CBT - just understanding and acceptance. I still experience varying degrees of anxiety of course - but understand that this this is the inevitable consequence of being autistic and having to live in a mainly non-autistic world. At least a high percentage of my family (including my daughters and grandchildren) are autistic so we are own kind of small community!


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magz
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21 Sep 2021, 3:37 am

Velorum wrote:
Once I understood how I was different and stopped trying to be something that I am not then most of this melted away. No need for drugs or CBT - just understanding and acceptance.

I had similar experiences - well, in my case, therapy for C-PTSD and drugs for insomnia were also required - but it all started working after identifying how the healthy me looks.
The healthy me still doesn't get the "obvious" despite seeing myriads of details. The healthy me still has clumsy hands and strange interests. The healthy me still hears everything louder than others and gets overwhelmed by too much happening at once.
The healthy me just navigates it all with way less stress.


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