Amen. I was diagnosed paranoid schizophrenic in one institution and bipolar in another, and I wasn’t terribly different from the folks held in other rooms in the halls of either bin. It is convenient for believers in the efficacy of the mental health system to say that I was “misdiagnosed”, as if the application of these labels to most others had a different meaning, and the treatment to which they were/are subjected were more appropriate.
I suggest people rethink “mental illness” as “mental condition”. First, a condition is not necessarily bad, and everyone’s mind can be said to in a condition of some sort. Second, it implies a more fluid and ever-changing…uh, condition. The condition that my mind was in in spring of 1980 is a condition that anyone’s mind could be in under the right circumstances. Like “unhappy” or “stressed out”, such conditions become descriptive adjectives, not diagnostic nouns. This is more appropriate because of the failure of the psychiatric profession to develop tight diagnostic definitions and testing mechanisms that result in high inter-rater reliability rates, [as evidenced by my pair of non-matching diagnoses applied to me in different wards by doctors unaware of each other’s findings]-- they are just descriptions of externally observed behaviors as it is!
As to the role of chemistry (balanced or unbalanced), I’m sure it correlates often enough to such conditions. I suspect if I tied you down and inserted pins into your foot, your brain would take on chemical differences similar to those of other people whose feet have been stuck full of pins, but the chemical “imbalances” in your brain are not the reason for your agonies or theirs. Of course, ongoing or congenital differences in blood or brain chemistry, neural tissue structure, or chromosomal composition may cause some people to be more predisposed to lapsing into a certain condition than others are. I have a neighbor who is much more inclined to be a cranky fellow than most folks are, and for all I know it is built into him in some such way. If such people wish to take pills to modulate themselves, I have no objection.
Define character flaw? I think you did that quite well with the long list you provided. My quibbling was with the definition of mental illness being so broad as to include everybody who has anything that sets them apart from the fictional perfectly adjusted person. You want to include examples like those people in your first list then I must argue that that definition includes everyone.
If a person reads nothing but romance novels it indicates mental disturbance? That’s why I wrote the comment about reading SF (and I have read those books BTW, and the juvenile male sexual fantasy world did not escape me.)
My argument is simply that you must have a better definition of dysfunction than one that includes the entire human race or the definition is useless.
I think extreme autism is definitely a disorder, not a deviancy. Severe autistics are helped by specialized instruction and therapy that can help them function vastly better in this world. If you truly have autism, but a mild form that does not harm you, I do not see the problem with identifying it and also acknowledging that it is not severe enough to require treatment. Mental disorders are not a yes/no proposition; the chronic conspiracy theorist is a far cry from the person who wears tinfoil hats so that the government won’t take over his brain and doesn’t ever wash his clothes because they’re trying to kill him by putting poisons in his washer, but they are milder and greater versions of the same problem. If I have trouble reading and am diagnosed with mild dyslexia, this would be a good thing to know; it would mean I don’t have to feel stupid for taking longer to read things, yet you don’t need the same treatment for mild dyslexia (if any at all) that you do for severe versions. I think that identifying the milder version of mental disorders can be useful, and the problem is more with a lack of acknowledgment that mental disorders come on a sliding scale and the milder versions are a far cry from the severe ones than it is with identifying the disorders per se.
As far as I am concerned, if someone’s “not-normalness” does not cause significant problems with their functioning, you should let well enough alone. But I really don’t think you can claim that autistics are simply deviants from a social category and should not be treated as if they have an illness.
I knew a child who had severe autism. His mother and father, his sisters, and every other human being might as well have been fence posts. Despite intense therapy, he never developed language because in the world he inhabited there was no one to talk to. Eventually, although his parents fought it as long as they could, he was institutionalized. It made no difference to him at all.
It confuses me to see terms like “autism” used to define such a broad spectrum of conditions. You and this child are probably as different as two humans could be.
People who truly are mentally ill are ill-served in the broadening of definitions, I think. There are probably street people who live that way because they just honestly want to, and as long as they break no laws they should be left alone. That doesn’t mean that there are not others who suffer from exposure and hunger and neglect because they are incapable of helping themselves, and it’s not right for there to be no legal way for the rest of us to help them.
Let’s clarify - as the last poster observed, there are autists and there are autists. What people traditionally think of as autism - a child who is completely disconnected and cannot communicate - is called Kanner’s syndrome autism or low-functioning autism. I was diagnosed as Asperger’s-syndrome autistic, which is meant to be a disorder in the ‘social gaze’.
Gaudere, there’s a difference between what I went through and what a person with a mild reading disability goes through. I would argue that the child who’s doing poorly in school through no fault of his/her own falls under my rubric ‘pain’. As for me? Hah! I made up my mind back in Chelsea, when I go — wait, sorry, wrong musical.
I thought I was just eccentric, and I wished other people could have looked at me like that. I did not need to have my being different labeled as a disease; having my pleasure in reading and distaste for social contact labeled a malignancy when it wasn’t. Whether or not it required treatment is, thank Goddess, not the issue. How do you think I felt when my parents came to me at age 16 and told me that they had always thought my personality was a disease? It made me feel like they had never given thanks for the child that they had; they regarded my personality as just a cross for me or them to bear.
It made me feel like shit.
And you know what? I’ve probably had more hours of therapy to deal with the effects of being diagnosed with a mental illness than to deal with the ‘illness’ itself.
I don’t mean to be hounding you, but I brought up quite a while ago the example of a person who is perfectly happy riding escalators 24 hours a day and doing nothing else. I asked if you would consider this a “disease”, since your definition of disease said that in order to be classed as a “disease” it had to cause pain. I am not trying to crucify you for a simple insufficient definition, but I think your definition of “disease” is flawed and does not accurately reflect what we should properly consider a disease. Please either amend your defintion, or state that someone who does nothing but ride an escalator 24 hours a day in not diseased in your estimation.
I think that if you are able to function normally, “disease” is a bit strong of a term. Perhaps we should call it a “psychological ailment”, like in the OP, but even that has pejorative implications. But what is wrong with being identified as having a variant of autism, if you are not regarded as being hideously flawed? If you discount the pain of being labeled “different”, and you did previously (“Something’s a disease if it causes pain. And I don’t mean the pain of being rejected because you’re different.”), why can you not discount the pain of being labeled autistic? It depends on the situation, but I would think people would be more sympathetic and understanding towards a person who acts a bit odd because of a minor mental disorder than someone who’s just considered “weird”.
It seems to me that the problem was not that you were identified as being Asperger’s-syndrome autistic, but that your parents and others thought that that made you somehow horribly flawed. Personally, I don’t care what minor mental disorder you may/may not have; you seem to be well adjusted and the knowledge that you may have an apparently very mild version of autism is simply an interesting quirk. Now, if your parents had treated it that way–something to be aware of, so that they could perhaps use established techniques to help you if it ever did cause you problems, but something that you appear to be able to function perfectly well with–would the diagnosis have caused you such unhappiness? If so, isn’t the problem not in the diagnosis, but in other people’s attitude towards it?
I can appreciate that you would have preferred to simply be labeled “eccentric”, but it seems to me that Asperger’s syndrome autism is a sort of mental disorder much along the lines of ADD. Now, I don’t think it would always a good thing to simply call Asperger’s-syndrome autism “eccentric” any more than I would think ADD should be simply labeled “inattentive”. The point of diagnosing these things is so that you can help the child, and understand that they may simply have trouble with social interaction or trouble with paying attention, and they’re not simply “rude” or “bad” or “weirdo”.
FWIW, and for any lurkers, I did look up the symptoms of Asperger’s-syndrome autism so I would have half a clue what I was talking about. Asperger Syndrome
It depends what you mean by this example. Is he riding escalators as his only source of amusement? No problem. I know people who stare at coins as their only source of amusement. Is he riding escalators so compulsively that he doesn’t eat or sleep for extended periods of time? Then he’s injuring himself and is moving into the realms of compulsion.
You are not understanding. I don’t discount the pain of being labeled as autistic as pain; heaven knows, I went through enough of it. I discount it as the sign of a disease because it is circular.
“He’s got a disease! Look, that hurts him. He’s in pain. He must really have a disease.”
Or better yet:
“He’s autistic! Look, that hurts him. He’s beginning to mistrust the people who’re treating him differently. He’s becoming shy and withdrawn. I knew it - he’s autistic!”
I wish we didn’t feel the need to treat people who act benignly weird differently at all, and calling me mentally ill doesn’t help that cause.
OK, which of the following statements from Dr. Corcoran would have made my parents treat me better?
what she said (paraphrased): “Matt has a mild mental condition called Asperger’s syndrome, a form of autism. The eccentricities you complained of are simply a result of this condition. It shouldn’t impair him too much, but he will need some extra help in making friends and relating to people normally. I suggest you monitor his social life and make sure he meets and socializes with people and engages in a wider variety of activities.”
what she might have said if the label she gave me didn’t exist: “Matt simply doesn’t relate to people in the same way you or I do. It’s not a disease and it’s nothing to worry about, it’s just a different way of being. I suggest you let Matt choose a form of social life that suits him; don’t try to force him to behave socially in a normal way. If he wants to be more social, let him decide that on his own. He’ll ask for help if he wants it. The most important thing is that you trust him that he’s doing what’s right for him socially.”
The problem is that the diagnosis seemed to lead ineluctibly to the change in relating, at least among my parents, who until they told me were the only ones who knew about it. And they did use established techniques to help me whether or not it caused me problems.
This is the crux. I was perfectly happy not being normal and my problems didn’t start until they tried to help me be normal, because they assumed that my abnormality must be making me suffer. And Goddess knows that I tried to tell them in a hundred different ways, your blundering attempts to manage my social life and make it normal are causing me pain!
But - Matt’s mentally ill. We have to treat his illness.
I didn’t want to be labeled “rude” or “bad” or “weirdo”, to quote you. But I didn’t want to trade those for the label “diseased”, either. Wouldn’t things have been better if Dr. Corcoran had just said, “different”?
Well, he is perfectly happy doing so, and doesn’t care that he doesn’t get enough food or sleep. You, looking from the outside, say he is injuring himself despite the fact that he is happy. Similarly, your parents believed you were injuring yourself by restricting your social contact, even though you were perfectly happy. Someone with ADD may be happy in school, but the parents and teachers think he is injuring himself because he can’t pay attention. I just want to point out that the fact that a person is happy and content the way they are does not mean we can never classify them as “mentally ill”. Once a “quirk” starts to significantly interfere with a person’s functioning in society, we do indeed see it as an issue, even if that person is happy the way they are. I (and you) would not have said that your avoidence of social contact was significantly interfering with your functioning, but unfortunately this is a subjective judgment and your parents thought differently.
I think your definition of “pain” as being required for a disease is faulty. You allow a lack of taking care of physical needs, like food and sleep, to be considered “injury”, but I think I could make a good case that “social interaction” is a physical need as well. Also, I doubt that you would argue that someone who is so severely ADD that they cannot pay attention at all in school, yet is perfectly happy to be so, is not suffering from a mental illness, yet this person would be in no pain and would not be lacking in any physical needs.
We treat people differently when they act differently, and “mentally ill” at least tries to get across that it’s not their fault. I agree that there should be more acceptance of those who differ from the ideal, but ignoring the various psychological ailments doesn’t seem to be the way to go about this.
You seem to think that is it weren’t for your diagnosis, everything would have been better. Just ask the shy daughter of a homecoming queen, or the bookish son of a star quarterback, or the jock son of a brilliant scientist to see that that’s not true; parents regularly push their kids to be something they’re not and make them miserable because of it. Hell, I can’t guarantee that if a son of mine hated reading that I wouldn’t try to shove books down his throat at first, I just hope that I’d be aware enough to realize that if I’m making the kid unhappy I should just let him be who he is. It’s not the label of autism that made your parents concerned about you; they were concerned in the first place and thought you needed help. The fact that you were autistic and don’t relate to people in the same way they do could have made them more sympathetic. I wouldn’t expect a dyslexic to be a speedreader and I wouldn’t expect you to be a social butterfly.
The problem seems to be that there is little understanding and sympathy towards certain sorts of mental illness. There’s no pejorative sense attached to dyslexia, or ADD, but other forms of mental disorders are often perceived as making that person “broken” and they must be fixed. If it is not causing you problems, and you are happy the way you are, I see no need to “fix” anything. But you seem to be accepting the fact that it is inevitable that being labeled autistic means you are “broken”, and you think not being called autistic at all would solve this. If someone is ADD, does it benefit them to ignore the fact that this is a well-established syndrome that can benefit from treatment if it becomes a problem? Should we allow the fact that some people assign negative implications to certain forms of mental illness prevent us from identifying them as such? It seems to me that you’re buying into the belief that being autistic means that you need to be fixed, and rather than educate people that there is a version of autism that is very mild and very rarely causes problems and simply means that your perceive the world in a different way, you want to avoid the issue and just call yourself “eccentric”.
I agree with you that we should be more accepting of “not-normalness”. But I also think we need to be more accepting of mental illnesses, and understand that they come in a wide range, and that if they aren’t significantly impairing that person’s functioning and that person is happy as they are, nothing needs to be “fixed”. A person with ADD may never be able to sit through an entire opera, and a person with Asperger’s syndrome autism may never be the most popular kid in school, and that’s OK.
Well, even people who have a disease don’t really want to be called diseased. I’ve never heard of a person with leukiemia saying “I’m diseased”. Personally, I think “diseased” is a weird word for mental illness anyhow. We need a better one. I don’t even like “mental illness” when you’re referring to someone who is functioning fine, so I’ll generally try to use the exact name of the syndrome if at all possible.
Should we just call people with ADD or dyslexia “different”? It is often genuinely helpful to be able to categorize something, and use information gathered from research to help the person if it becomes a problem. I think mild autism should be treated like mild dyslexia or mild ADD; something that it might be good to be aware of to understand what could otherwise be interpreted as rudeness or coldness or stupidity, and so that if it ever does become a problem you know what to do.
So far I have agreed with the majority of what you have written, but I have problems with this statement. It seems to me that this definition is wholly dependent on time and place. For instance, homosexuality was considered a mental illness until the latter half of this century, but isn’t now. Still, a gay person living in a very conservative, rural area may be perfectly happy with himself, yet his homosexuality could definitiely interfere with his functioning in society. So is he “normal” in San Francisco but not normal in Podunk?
In general, I understand what you are saying, but it hardly seems like a workable definition in practice. Then again, this starts to get into why psychology is better described as a discipline than a science.
Of course I think this! What am I supposed to think? Diseases ought to be treated! How on earth are you supposed to tell someone, “You have a mental illness, but don’t worry, it doesn’t mean you’re sick”? If I’m not sick, I don’t have a disease!
Hey kids, it’s Matt McLauchlin with another game of “Noam Chomsky’s Paired Examples!”
“Someone with homosexuality may be happy in his sex life, but his parents and friends think he is injuring himself because he can’t have sex with women.”
“You allow a lack of taking care of physical needs, like food or sleep, to be considered ‘injury’, but I think I could make a good case that ‘reproduction’ is a physical need as well. Also, I doubt that you would argue that someone who is so severely homosexual that they cannot pay attention at all to the opposite sex, yet is perfectly happy to be so, is not suffering from a mental illness, yet this person would be in no pain and would not be lacking in any physical needs.”
“We treat people differently when they act differently, and ‘suffering from homosexuality’ at least tries to get across that it’s not their fault.”
OK. Now look. I have two psychological characteristics - autism and homosexuality - which have the following in common:
they place me in a statistical minority;
they affect a great deal of what I choose to do and whom I choose to associate with;
they change the way people associate with me;
often, the way people react to my possessing these characteristics causes me pain;
they cause me to avoid something that most people pursue;
they are not what my parents expected.
I’d appreciate if you’d show me what makes my autism a mental illness and what makes my homosexuality not a mental illness. I would guess that the only thing is the fact that one of them is listed in the DSM and the other one isn’t. That’s not medicine, that’s definition.
So a person who has a 5-second attention span yet is happy has no mental disorder at all? I am sorry if I am asking you to make a judgment call as to the difference between reasonable “non-normality” and a degree of non-normality that is significantly imparing functioning in society. If we simply use your definition of a disease having to cause pain, then a happy pedophile or necrophiliac is not even a tiny bit mentally ill. I really do think we can say “this is an acceptable degree of variation” and “this is out of line”, and drawing up black and white terms tends to end up with everybody being sane, or everybody being insane. Yes, we do make judgment calls, and we do our best to determine whether someone is truly harming themselves or unable to function well in society, or whether they are simply not doing what other people think they should.
People are not unaffected by the the society they are in, and most people born to it can adapt themselves to any human society sufficiently well enough to get by. There’s quite a few behaviors that are acceptable in one society, but regarded as loony in ours. If a woman tried to jump onto her husband’s pyre to kill herself, in the US we’d take her for psychiatric treatment; in India it is still fairly accepted. The difference is such a thing is so grossly unacceptable in the US that it bespeaks a very poor adaption to society if you do so, while it is common enough in India that social pressure can actually push her into it. In one, the person is going along with society so her behavior seems acceptable; in the other, the person is so far outside society’s acceptable range that it bespeaks a very poor adaptation. I think, in the end, “sanity” is only a measure of one’s ability to adapt. A severe schitzophernic or manic-depressive cannot adapt properly to any society; someone who is ADD will have problems paying attention in any society as well.
If it significantly impairs their ability to survive and prosper (within reason) in any and all societies, it should be considered a problem. A homosexual living in Podunk would not have a problem socially interacting because he grossly lacks social skills, the problem would be the people’s perceptions in that one small fraction of society. If their perception of homosexuality were different, he would not have a problem. Similarly, I see a difference between inability to aquire social skills and other people avoiding you because your hair is blonde. I do think there is a difference between inherent inability and other people being assholes; one is a problem no matter what society you are in, the other is only a problem when you’re surrounded by jerks.
Well, let’s see:
Asperger Syndrome
"Persons with AS show marked deficiencies in social skills, have difficulties with transitions or changes and prefer sameness. They often have obsessive routines and may be preoccupied with a particular subject of interest. They have a great deal of difficulty reading nonverbal cues (body language) and very often the individual with AS has difficulty determining proper body space. Often overly sensitive to sounds, tastes, smells, and sights, the person with AS may prefer soft clothing, certain foods, and be bothered by sounds or lights no one else seems to hear or see. It’s important to remember that the person with AS perceives the world very differently. Therefore, many behaviors that seem odd or unusual are due to those neurological differences and not the result of intentional rudeness or bad behavior, and most certainly not the result of “improper parenting”. […] The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning "
Homosexuality:
“Prefers sex with the same sex rather than opposite sex.”
By the way, I have no problem with the idea of psychiatry being socially-based, except that in that case, it is a humanity, not a science, and it defines deviancy, not disease. Unfortunately, it doesn’t seem to want to make this admission.
One significantly impairs ability to function in society based on the syndrome itself, not other people’s reaction to it. Homosexuality in only a hindrance in social situations if other people make it that way. I certainly have not noticed that homosexuals are inherently poor at social situations, or that their homosexuality in and of itself invariably causes them problems interacting, or they hear things that aren’t there, or they make obsessive repetitive motions (Get your mind out of the gutter! That’s not what I meant. ). Whatever problems your autism gave you that were not the result of autism itself and were simply becuase kids can be jerks to anyone different should not be a factor in classifying it. They may have made it worse; but if your diagnosis was correct, the lack of social skills was a symptom, not a result. Dyslexia make a kid shy because he can’t read, but that is a result, not what you use to classify dyslexia.
Explain to me why the specific social situations which Asperger’s syndrome hinders are so all-fired important to every human being in every situation in every culture, and I will believe you that it is a scientific classification. Until then, it is a social prejudice.
“Explain to me why the specific situations which dyslexia hinders are so all-fired important to every human being in every situation in every culture, and I will believe you that it is a scientific classification. Until then, it is a social prejudice.”
I never said “every human being in every situation in every culture”; a person living alone on a desert island can have terrible social skills without impairing his functioning. A person in a culture that does not read will probably never be classified as being dyslexic. A person in a culture where illiteracy is the norm won’t be impaired by dyslexia. Does that mean that dyslexia is simply a social prejudice?
Impairment in social skills can be much like impairment in ability to learn. It is a judgment call, yes, but simply because of that can we discount it? Should we help the children who have trouble learning their ABC’s but not those who have trouble learning how to make friends? If the children have severe problems learning, should we call them “learning disabled” and try to help them, but children who have severe problems in social situations should just be left alone? If you, personally, say that you would have been better off left alone, it certainly sounds that way. However, some people can be helped by therapy; and some parents would simply accept the autism as an explanation for minor quirks, and not try to force someone who can function perfectly well into being someone they’re not.
I want you to respond to this one now, which I’ll repeat in case you missed it: “By the way, I have no problem with the idea of psychiatry being socially-based, except that in that case, it is a humanity, not a science, and it defines deviancy, not disease. Unfortunately, it doesn’t seem to want to make this admission.”
I want you to respond to this one now, which I’ll repeat in case you missed it: “By the way, I have no problem with the idea of psychiatry being socially-based, except that in that case, it is a humanity, not a science, and it defines deviancy, not disease. Unfortunately, it doesn’t seem to want to make this admission.”
